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● As usual you should exclude the most critical contraindications for the drugs to be used. Prospectively, especially important are the prokalemic and adverse renal effects of angiotensin converting enzyme inhibitors and of angiotensin and mineralocorticoid receptor antagonists. Therefore measure the plasma potassium concentration and estimate renal function. e.g. using the Cockroft-Gault formula.
● Start with a fraction (~25%) of the target dose and double at intervals of at least 2 weeks. Angiotensin converting enzyme inhibitors and angiotensin and mineralocorticoid receptor antagonists should be discontinued (or not administered in the first place) at values in the range of plasma potassium >5.5 mM, plasma creatinine >3.5 mg/dL, or eGFR<20 ml/min. Less critical but abnormal values of these parameters may necessitate dosage reductions to be conducted in a substance-specific manner.
● In addition to bradycardia and bradyarrhythmia, beta blockers, starting at ~10% of the target dosage, may initially depress cardiac function so watch out for weight gain and other symptoms of an acute cardiac decompensation.