The target dose is the dose which gave the most proven benefit in clinical trials. Target dose remains the same whether you take one drug or five. For example, if you already take an ACE inhibitor, the target dose for an added ARB would be the same as if you were not taking the ACE inhibitor too.
If you can tolerate it, all your heart failure meds should be raised to the target dose, because that is the dose proven to give the most benefit to the most patients with your illness. However, the same drug will affect people differently - that's a fact. If you cannot tolerate all your meds at target dose, you and your doctor must decide which drugs will give you the most benefit. Those drugs should then be raised to the target dose while other drugs - which may provide less benefit to you in your specific situation - are kept at lower doses. This is another reason it pays to have a good CHF specialist.
For instance, if you have low blood pressure and cannot tolerate target doses of both Coreg and an ACE inhibitor, your ACE inhibitor dose may be lowered and your Coreg taken to target dose. Why? Because a Coreg target dose has been shown in trials to reduce mortality more than an ACE inhibitor.
If you then tolerate the target dose of Coreg well, perhaps your ACE inhibitor can slowly be raised again to see if you can also tolerate it at target dose.
Of course, patients are in charge of their own treatment in the end. After all, it's our body and our health. I have talked it over with my own CHF doc and at my request we've kept my ACE inhibitor dose high (40mg Monopril daily) and my Coreg dose under target levels (15.5mg BID - I weigh 200 pounds). I want it that way because certain side effects of Coreg at higher dose are not worth the reduction in mortality risk to me. It's my call. My doc disagrees but like I said, it's my body.
Please note: My CHF specialist flatly stated that if I went under 6.25mg Coreg BID, I could find myself another CHF doctor. He also said that I had better seriously consider a minimum dose of 12.5mg BID. He has - as usual - sound reasons for his medical opinions and I take him very seriously. After all, I pay him for his judgment as well as his medical skills. You are in charge of your treatment - but you must pay attention to what your doctor is telling you!
These are not absolutes. Your CHF specialist may choose a different starting dose or a different target dose for you based on your individual health and physical condition. These are pretty good general figures though. This is not intended to be a comprehensive list. Some drugs are not listed. Click on drug or drug class names in the table below for drug trial summaries.
|Drug class||Brand name
|Starting dose||Target dose|
|ACE Inhibitor||Prinivil or Zestril
|5 mg once daily||20 mg once daily||maximum dose might be 40 mg once daily|
|10 mg once daily
5 mg if weak kidneys
|40 mg once daily|
|2.5 mg BID||20 mg BID||maximum dose might be 40 mg BID|
|one mg once daily||4 mg once daily|
|25 mg 2 to 3 times a day||100mg TID (450 mg per day maximum)|
|5 mg once daily if on diuretic
10 mg once daily if not on diuretic
|40 mg per day in one 40 mg dose or two 20 mg doses|
|5 mg BID
2.5 mg BID if weak kidneys
|20 mg BID|
|1.25 mg to 2.5 mg BID||10 mg BID|
|1 mg BID if on diuretic
2 mg BID if not on diuretic
|4 mg BID (8 mg BID maximum)|
|25 mg BID or 50 mg once daily
12.5 mg BID or 25 mg once daily if weak liver function
|50 mg BID|
|4 to 8 mg once daily||32 mg once daily|
|80 mg once daily||160 mg once daily||80 mg once daily if weak liver function|
|150 mg||300 mg once daily|
|3.125 mg BID||25 mg BID under 188 pounds||50 mg BID over 187 pounds|
metoprolol extended release
|12.5 mg for class 3 to 4 patients
25 mg for class 1 to 2 patients
|190 mg once daily|
|2.5 mg once daily||10 mg once daily|
|25 mg once daily||25 mg once daily
See this article
|25 mg once daily||50 mg once daily
See this article
All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Jon C.