Myocardial Infarction

ramipril 1.25 mg bd then double every 2 days to max 5mg bd, withdraw treatment if dose cannot be increased to 2.5 mg twice daily

titrate dose upwards at short intervals (for example, every 12–24 hours) before the person leaves hospital until the maximum tolerated or target dose is reached. If it is not possible to complete the titration during this time, it should be completed within 4–6 weeks of hospital discharge.

offer an ACE inhibitor to people who have had an MI more than 12 months ago. Titrate to the maximum tolerated or target dose (over a 4-6-week period) 

offer people after an MI who are intolerant to ACE inhibitors an ARB instead of an ACE inhibitor

continue indefinately

aspirin 75mg od 

continue indefinitely

unless:

• aspirin intolerant
• have an indication for anticoagulation
• clopidogrel or modified-release dipyridamole instead of aspirin for people who also have other clinical vascular disease

carvedilol 3.125 mg bd then double every 2 weeks if tolerated to  max 50mg bd (max 25mg bd if weight <85kg) 

nebivolol 1.25 mg od then double every 1-2 weeks if tolerated to max 10mg od

bisoprolol 1.25 mg od then double every 7 days if tolerated to 5 mg once daily for 4 weeks then increase if tolerated to 7.5 mg once daily for 4 weeks, then increased if tolerated to  max 10 mg once daily

titrate beta-blockers up to the maximum tolerated or target dose

• potential drug interactions
• high risk of adverse effects
• patient preference.