Stop the thiazide diuretic, and commence:
Frusemide (O) 40-200 mg once daily in the morning
Plus
Potassium chloride (O) 600 mg once daily, for each 40 mg Frusemide given.
If still unsatisfactory, stop Potassium supplement and add a Potassium-sparing diuretic:
Spironoloctone (O) 5-20 mg once daily.
Monitor potassium levels.
If still unsatisfactory add a vasodilator to reduce cardiac afterload:
Hydralazine (O) initial dose 25 mg twice daily; increasing to 50 mg two to three times a day Monitor BP regularly.
If still unsatisfactory consider referral
Further management under specialist care:
Captopril (O) initially 6.25 mg once daily gradually increasing to 25 mg three times a day. The first dose should be followed by careful BP monitoring.
CAUTION Potassium supplements to be stopped and levels monitored regularly. |
Use and Indications for Digoxin
Digoxin toxicity is a very common problem especially in the elderly and paediatric age groups. Although digoxin may be tried in patients in sinus rhythm its continued use when heart failure under control is to be discouraged.
Digoxin is indicated in:
• children in heart failure
• tachycardia of greater than 100/beats/minute
• fast atrial fibrillation or flutter
To digitalise (check serum potassium levels before starting)
Adults |
Digoxin (O)
average dose 500 micrograms stat followed by 125-250 micrograms once daily |
Children |
10 micrograms/kg/24 hrs (once daily); However when starting treatment give this dose three times in the first 24 hours then continue with one dose daily. |
