Congestive Heart Failure (CHF)
Initial Dose
– 5 mg by mouth twice daily
– 2.5 mg by mouth twice daily in patients with a history of conduction defects or who may experience hemodynamic compromise due to bradycardia
Maintenance Dose
– After 2 weeks, adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm)
– Thereafter, adjust dose as needed based on resting heart rate and tolerability
Maximum Dose
– 7.5 mg by mouth twice daily
Adjustment Based on Resting HR
HR >60 bpm
– Increase dose by 2.5 mg by mouth twice daily
– Maximum Dose: 7.5 mg by mouth twice daily
HR: 50 to 60 bpm
– Maintenance Dose
HR <50 bpm or Signs and Symptoms of Bradycardia
– Decrease dose by 2.5 mg by mouth twice daily
– If current dose is 2.5 mg by mouth twice daily, discontinue therapy
Inappropriate Sinus Tachycardia
Initial Dose
– 5 mg by mouth twice daily
Maintenance Dose
– 7.5 mg by mouth twice daily
Stable Angina (Adults <75 years)
Initial Dose
– 2.5 to 5 mg by mouth twice daily
Maintenance Dose
– Titrate up in increments of 2.5 mg after 3 to 4 weeks if symptoms persist and heart rate is greater than 60 bpm to a
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maximum dose of 7.5 mg twice daily
