Medically reviewed on July 25, 2017.
Applies to the following strengths: 5 mg; 7.5 mg
Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Congestive Heart Failure
Initial dose: 5 mg orally twice a day with meals
Maximum dose: 7.5 mg orally twice a day
-In patients with a history of conduction defects or in patients whom bradycardia could lead to hemodynamic compromise, start with 2.5 mg orally twice a day.
-Assess after 2 weeks and adjust dose to maintain tolerability and achieve resting heart rate between 50 and 60 beats per minute (bpm); if resting heart rate is greater than 60 bpm, increase by 2.5 mg twice daily to a maximum of 7.5 mg twice daily; if resting heart rate is less than 50 bpm or bradycardia signs and symptoms occur, decrease by 2.5 mg twice daily (discontinue if current dose is 2.5 mg orally twice a day).
Use: To reduce worsening heart failure hospitalization risk in patients with stable, symptomatic chronic heart failure and left ventricular ejection fraction (LVEF) at or below 35%, who are in sinus rhythm with resting heart rate at or above 70 bpm and are either unable to tolerate or have a contraindication to beta-blockers.
Renal Dose Adjustments
CrCl 15 to 60 mL/min: No adjustment recommended
CrCl less than 15 mL/min: Data not available
Liver Dose Adjustments
Mild to moderate liver dysfunction: No adjustment recommended
Severe liver dysfunction (Child-Pugh C): Contraindicated
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Data not available
Administration advice: Take with meals.
-Monitor cardiac rhythm regularly.
-Monitor heart rate decreases and bradycardia symptoms.
-Apprise pregnant women of the potential risks to a fetus.
-Instruct females of reproductive potential to use effective contraception and to notify their healthcare provider with a known or suspected pregnancy.
-Encourage patients to report significant decreases in heart rate or symptoms such as dizziness, fatigue, or hypotension.
-Notify patients to report symptoms of atrial fibrillation such as heart palpitations or racing, chest pressure, or worsened shortness of breath.
-Advise patients of the possible occurrence of luminous phenomena (phosphenes) and to use caution if they are driving or using machines in situations where sudden changes in light intensity may occur, especially when driving at night.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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