What medication is recommended for my condition?

Medication Recommendations Based on Clinical Condition

For patients with heart failure with reduced ejection fraction (HFrEF), a combination of an ACE inhibitor (such as lisinopril), a beta-blocker, and an aldosterone antagonist is strongly recommended as first-line therapy to reduce mortality and improve quality of life. 1

Heart Failure with Reduced Ejection Fraction (HFrEF)

First-Line Medications

• ACE inhibitors (e.g., lisinopril) are recommended for all patients with HFrEF to reduce mortality and hospitalizations 1
• Beta-blockers should be initiated along with ACE inhibitors as cornerstone therapy for HFrEF 1
• Aldosterone antagonists (e.g., spironolactone) are recommended for patients with NYHA class II-IV symptoms and an ejection fraction ≤35% 1

Dosing Considerations

• For lisinopril in heart failure, start with 5 mg once daily, especially when used with diuretics 2
• For patients with hyponatremia (serum sodium <130 mEq/L), start with 2.5 mg once daily 2
• Titrate up as tolerated to a maximum of 40 mg once daily 2
• Diuretic doses may need adjustment to minimize hypovolemia which can contribute to hypotension 2

Medications to Avoid in HFrEF

• Dihydropyridine and non-dihydropyridine calcium channel blockers are not recommended and may be harmful (Class III: Harm, Level A) 1
• Thiazolidinediones increase the risk of worsening heart failure symptoms and hospitalizations (Class III: Harm, Level A) 1
• NSAIDs worsen heart failure symptoms and should be avoided or withdrawn whenever possible (Class III: Harm, Level B-NR) 1
• DPP-4 inhibitors saxagliptin and alogliptin increase the risk of heart failure hospitalization and should be avoided (Class III: Harm, Level B-R) 1

Hypertension Management

First-Line Medications

• For initial therapy in adults with hypertension, lisinopril 10 mg once daily is recommended, with dosage adjusted according to blood pressure response 2
• The usual dosage range is 20-40 mg per day administered as a single daily dose 2
• If blood pressure is not controlled with lisinopril alone, a low-dose diuretic (e.g., hydrochlorothiazide 12.5 mg) may be added 2

Special Populations

• For patients with renal impairment (creatinine clearance ≥10 mL/min and ≤30 mL/min), reduce the initial dose to half of the usual recommended dose 2
• For patients on hemodialysis or with creatinine clearance <10 mL/min, the recommended initial dose is 2.5 mg once daily 2

Antithrombotic Therapy for Coronary Syndromes

• For patients with chronic coronary syndrome (CCS) with prior MI or remote PCI, aspirin 75-100 mg daily is recommended lifelong after an initial period of dual antiplatelet therapy (DAPT) 1
• Clopidogrel 75 mg daily is recommended as a safe and effective alternative to aspirin monotherapy 1
• For patients without prior MI or revascularization but with evidence of significant obstructive coronary artery disease, aspirin 75-100 mg daily is recommended lifelong 1

Medications That May Cause or Worsen Hypertension

Be cautious with the following medications that may elevate blood pressure:

• NSAIDs - avoid systemic use when possible; consider alternative analgesics 1
• Oral contraceptives - use low-dose agents or consider alternative forms of birth control 1
• Systemic corticosteroids - avoid or limit use when possible 1
• Decongestants containing phenylephrine or pseudoephedrine - use for shortest duration possible 1
• Antidepressants (MAOIs, SNRIs, TCAs) - consider alternative agents like SSRIs 1

Important Monitoring Considerations

• Regular assessment of blood pressure response to medication is essential 1
• For heart failure patients, monitor for hypotension, especially after initial dosing 2
• Monitor renal function and electrolytes, particularly potassium levels when using ACE inhibitors and aldosterone antagonists 1
• Patiromer may be considered for patients with hyperkalemia receiving renin-angiotensin-aldosterone system inhibitors (RAASi) 1

The selection of appropriate medication should be guided by the specific diagnosis, comorbidities, and potential drug interactions, with careful attention to monitoring for efficacy and adverse effects.