<p><strong>Adult Heart Failure</strong>: The recommended starting dose is 49/51 mg orally twice daily. Double the dose after 2 to 4 weeks to the target maintenance dose of 97/103 mg twice daily, as tolerated by the patient.<br />
<br />
Reduce the starting dose to 24/26 mg twice daily for:</p>

<ul>
	<li>Patients not currently taking an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) or previously taking a low dose of these agents.</li>
	<li>Patients with severe renal impairment.</li>
	<li>Patients with moderate hepatic impairment.</li>
</ul>

<p><strong>Pediatric Heart Failure</strong>: Refer to Table 1 for the recommended dose for pediatric patients aged one year and older. Take the recommended dose orally twice daily. Adjust pediatric patient doses every 2 weeks, as tolerated by the patient.<br />
<br />
<strong>Recommended Dose Titration-</strong><br />
<br />
Pediatric Patients Less than 40 kg:</p>

<ul>
	<li>Starting: 1.6 mg/kg</li>
	<li>Second: 2.3 mg/kg</li>
	<li>Final: 3.1 mg/kg</li>
</ul>

<p>Pediatric Patients At least 40 kg, less than 50 kg:</p>

<ul>
	<li>Starting: 24/26 mg</li>
	<li>Second: 49/51 mg</li>
	<li>Final: 49/51 mg</li>
</ul>

<p>Pediatric Patients At least 50 kg:</p>

<ul>
	<li>Starting: 49/51 mg</li>
	<li>Second: 72/78 mg</li>
	<li>Final: 97/103 mg</li>
</ul>