Drug Dosing for Aldosterone Receptor Antagonists Eplerenone Spironolactone Initial dose (only if K 5 mEq/L) 25 mg once daily 25 mg once every other day 12.5 to 25.0 mg once daily 12.5 mg once daily or every other day Maintenance dose (after 4 wk for K 50 mg once daily 25 mg once daily 25 mg once or twice daily 12.5 to 25.0 mg once daily *After dose initiation for K , increase6.0 mEq/L, or worsening renal function, hold until K <5.0 mEq/L. Consider restarting reduced dose after confirming resolution of hyperkalemia/renal insufficiency for at least 72 h. eGFR indicates estimated glomerular filtration rate; and K , potassium. Adapted from Butler et al. (200). JACC Vol. 62, No. 16, 2013 Yancy et al. October 15, 2013:1495 539 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary whenever possible (e.g., most antiarrhythmic drugs, most calcium channel blocking drugs [except amlodipine], nonsteroidal anti-in ammatory drugs, or thiazolidinediones) (233 244). (Level of Evidence: B) 2. Long-term use of infused positive inotropic drugs is poten- tially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage D). (Level of Evidence: C) 6.3.2.9.1. Calcium Channel Blockers CLASS III: NO BENEFIT 1. Calcium channel blocking drugs are not recommended as routine treatment for patients with HFrEF (238,245,246). (Level of Evidence: A) See Table 14 for a summary of recommendations from this section and Table 15 for strategies for achieving optimal GDMT. 6.3.3. Pharmacological Treatment for Stage C HFpEF See Table 16 for a summary of recommendations from this section. CLASS I 1. Systolic and diastolic blood pressure should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity (28,247). (Level of Evidence: B) 2. 