Therefore, erythropoietin-stimulating agent therapy cannot be recommended in patients with HF and anemia. Table 3. Drugs Commonly Used for HFrEF (Stage C HF) Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in Clinical Trials References ACE inhibitors Captopril 6.25 mg TID 50 mg TID 122.7 mg QD 158 Enalapril 2.5 mg BID 10 20 mg BID 16.6 mg QD 129 Fosinopril 5 10 mg QD 40 mg QD N/A Lisinopril 2.5 5 mg QD 20 40 mg QD 32.5 35.0 mg QD 130 Perindopril 2 mg QD 8 16 mg QD N/A Quinapril 5 mg BID 20 mg BID N/A Ramipril 1.25 2.5 mg QD 10 mg QD N/A Trandolapril 1 mg QD 4 mg QD N/A ARBs Candesartan 4 8 mg QD 32 mg QD 24 mg QD 137 Losartan 25 50 mg QD 50 150 mg QD 129 mg QD 136 Valsartan 20 40 mg BID 160 mg BID 254 mg QD 134 ARNI Sacubitril/valsartan 49/51 mg BID (sacubitril/valsartan) (therapy may be initiated at 24/26 mg BID) 97/103 mg BID (sacubitril/valsartan) 375 mg QD; target dose: 24/26 mg, 49/51 mg OR 97/103 mg BID If channel inhibitor Ivabradine 5 mg BID 7.5 mg BID 6.4 mg BID (at 28 d) 6.5 mg BID (at 1 y) Aldosterone antagonists Spironolactone 12.5 25 mg QD 25 mg QD or BID 26 mg QD 142 Eplerenone 25 mg QD 50 mg QD 42.6 mg QD 159 Beta blockers Bisoprolol 1.25 mg QD 10 mg QD 8.6 mg QD 160 Carvedilol 3.125 mg BID 50 mg BID 37 mg QD 161 Carvedilol CR 10 mg QD 80 mg QD N/A Metoprolol succinate extended release (metoprolol CR/XL) 12.5 25 mg QD 200 mg QD 159 mg QD 139 Isosorbide dinitrate and hydralazine Fixed-dose combination 20 mg isosorbide dinitrate/37.5 mg hydralazine TID mg hydralazine TID 90 mg isosorbide dinitrate/ ~175 mg hydralazine QD Isosorbide dinitrate and hydralazine mg hydralazine TID or QD 40 mg isosorbide dinitrate TID with 100 mg hydralazine TID Modified (Table 15) from the 2013 HF guideline.9 ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BID, twice daily; CR, controlled release; CR/XL, controlled release/extended release; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; N/A, not applicable; QD, once daily; and TID, 3 times daily. 