CIDMUS is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure with a reduced ejection fraction

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.

Dose Adjustment for Patients Not Taking an ACE Inhibitor or ARB or Previously Taking Low Doses of These Agents In patients not currently taking an ACE inhibitor or an angiotensin II receptor blocker (ARB) and for patients previously taking low doses of these agents, start CIDMUS at half the usual recommended starting dose. After initiation, increase the dose every 2 to 4 weeks in adults.

Dose Adjustment for Severe Renal Impairment in adults patients with severe renal impairment (eGFR < 30 mL/min/1.73 m2 ), start CIDMUS at half the usual recommended starting dose. After initiation, increase the dose to follow the recommended dose escalation thereafter.

No starting dose adjustment is needed for mild or moderate renal impairment.

Dose Adjustment for Hepatic Impairment In adults with moderate hepatic impairment (Child-Pugh B classification), start CIDMUS at half the usual recommended starting dose. After initiation, increase the dose to follow the recommended dose escalation thereafter. No starting dose adjustment is needed for mild hepatic impairment. Use in patients with severe hepatic impairment is not recommended. 

1. Angioedema

2. Hypotension

3. Impaired Renal Function

4. Hyperkalemia

5. Hypersensitivity including rash, pruritus, and anaphylactic reaction