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PHARMACOLOGICAL TREATMENT OF HEART FAILURE (HF) - page 24 / 48

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Selection of patients

Decisions regarding the selection of patients for aldosterone antagonists reflect the balance between potential benefit to decrease death and hospitalization from HF and potential risks of life-threatening hyperkalemia, due to inhibition of potassium excretion.

Serum creatinine levels often underestimate renal dysfunction, particularly in the elderly, in whom estimated creatinine clearance less than 50 ml per min should trigger a reduction of the initial dose of spironolactone to 12.5 mg daily or of eplerenone to 25 mg daily, and aldosterone antagonists should not be given when clearance is less than 30 ml per min.

The recommendations for minimizing the risk of hyperkalemia in patients treated with aldosterone antagonist are summarized in the table below:

Initiation and monitoring

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