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2025 Canadian Guide — Top 5 Combination Cardiac Therapies for Dogs (Vetmedin, Fortekor, Lasix, Enacard, Cardalis) — Evidence-Based, Vet-Reviewed Multi-Drug Regimens to Protect Your Dog's Heart

Published on Thursday, August 21, 2025

Combination cardiac therapies involve validated multi-drug regimens that combine ACE inhibitors, diuretics, inotropes, beta blockers, and vasodilators to manage complex cardiac disease in dogs. In Canada in 2025, owners and veterinary teams increasingly choose combination approaches because they provide more precise symptom control, slow disease progression, and can be tailored to the dog's disease stage and comorbidities. Practical factors driving preference include wide availability of generics and brand-name prescriptions, clear clinical guidelines from veterinary cardiology groups, predictable monitoring protocols, and the ability to balance efficacy with tolerability. For Canadian pet owners, the appeal is also economic and logistical: many of the top cardiac agents are accessible through local vets and Canadian pharmacies, making multi-drug protocols easier to implement and adjust under veterinary supervision.

Quick Menu

1. Primary Inodilator (Core)

2. ACE Inhibitor (Adjunct)

3. Loop Diuretic (Cost-effective)

4. Alternative ACE Inhibitor

5. ACE + Aldosterone Combo

1
PRIMARY INODILATOR (CORE)

Vetmedin (Pimobendan)

Vetmedin (Pimobendan)

Vetmedin is widely regarded as the cornerstone positive inotrope/vasodilator for canine congestive heart failure and holds a best-in-class position for combination cardiac regimens because it reliably improves cardiac output and quality of life when paired with diuretics and RAAS inhibitors. Compared with the ACE inhibitors and diuretics on this list, Vetmedin is more frequently the foundational agent in multi‑drug protocols — its clinical impact often justifies a higher unit cost by reducing hospitalization days and enabling lower doses of adjunctive drugs in many dogs.

4.7
★★★★☆
  • Stronger heart pump

  • More playtime

  • Stronger heart pump

  • More playtime

Review Summary

92%

"Most long-term users report marked improvement in energy, appetite, and quality of life in dogs with congestive heart failure, with relatively few adverse effects; widely praised as a cornerstone therapy."

  • Tail-wag booster

  • Pimobendan increases cardiac contractility and causes vasodilation to improve cardiac output.

  • Tail-wag booster

  • Pimobendan increases cardiac contractility and causes vasodilation to improve cardiac output.

Increased Safety & Security

Vetmedin is widely regarded as the cornerstone positive inotrope/vasodilator for canine congestive heart failure and holds a best-in-class position for combination cardiac regimens because it reliably improves cardiac output and quality of life when paired with diuretics and RAAS inhibitors. Compared with the ACE inhibitors and diuretics on this list, Vetmedin is more frequently the foundational agent in multi‑drug protocols — its clinical impact often justifies a higher unit cost by reducing hospitalization days and enabling lower doses of adjunctive drugs in many dogs.

  • Stronger heart pump

  • More playtime

  • Tail-wag booster

  • Pimobendan increases cardiac contractility and causes vasodilation to improve cardiac output.

  • Proven to prolong quality and survival in dogs with symptomatic mitral valve disease and dilated cardiomyopathy.

  • Stronger heart pump

  • More playtime

  • Tail-wag booster

  • Pimobendan increases cardiac contractility and causes vasodilation to improve cardiac output.

  • Proven to prolong quality and survival in dogs with symptomatic mitral valve disease and dilated cardiomyopathy.

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$80-180 CAD

2
ACE INHIBITOR (ADJUNCT)

Fortekor (Benazepril)

Fortekor (Benazepril)

Fortekor is a leading ACE inhibitor for dogs used to blunt RAAS activation in chronic cardiac disease and is valued in multi‑drug regimens for a favorable pharmacokinetic profile and once‑daily dosing that can improve owner compliance versus some alternatives. Financially and operationally it is often more cost‑effective than brand‑only options because benazepril is widely available as generics and pairs synergistically with Vetmedin and loop diuretics to reduce progressive remodeling and diuretic requirements.

4.3
★★★★☆
  • Reduces heart strain

  • Kidney-friendly

  • Reduces heart strain

  • Kidney-friendly

Review Summary

82%

"Owners generally find benazepril effective at reducing heart-failure signs and controlling blood pressure with good tolerability, though some dogs experience mild gastrointestinal upset or lethargy."

  • Quiet-chest nights

  • Benazepril inhibits the renin–angiotensin system to reduce afterload and limit cardiac remodeling.

  • Quiet-chest nights

  • Benazepril inhibits the renin–angiotensin system to reduce afterload and limit cardiac remodeling.

Increased Safety & Security

Time-Saving Convenience

Fortekor is a leading ACE inhibitor for dogs used to blunt RAAS activation in chronic cardiac disease and is valued in multi‑drug regimens for a favorable pharmacokinetic profile and once‑daily dosing that can improve owner compliance versus some alternatives. Financially and operationally it is often more cost‑effective than brand‑only options because benazepril is widely available as generics and pairs synergistically with Vetmedin and loop diuretics to reduce progressive remodeling and diuretic requirements.

  • Reduces heart strain

  • Kidney-friendly

  • Quiet-chest nights

  • Benazepril inhibits the renin–angiotensin system to reduce afterload and limit cardiac remodeling.

  • Commonly used alongside pimobendan and diuretics to manage chronic heart failure in dogs.

  • Reduces heart strain

  • Kidney-friendly

  • Quiet-chest nights

  • Benazepril inhibits the renin–angiotensin system to reduce afterload and limit cardiac remodeling.

  • Commonly used alongside pimobendan and diuretics to manage chronic heart failure in dogs.

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$40-120 CAD

3
LOOP DIURETIC (COST-EFFECTIVE)

Lasix (Furosemide)

Lasix (Furosemide)

Lasix is the prototypical loop diuretic and remains the market leader for rapid control of congestion and pulmonary edema in canine patients, making it essential to most multi‑drug cardiac regimens. Its technical advantage is rapid onset and predictable fluid removal; economically, generic furosemide is inexpensive and widely available, which lowers short‑term treatment costs though it increases the need for laboratory monitoring and electrolyte management when used alongside ACE inhibitors and spironolactone.

4.5
★★★★☆
  • Drains excess fluid

  • Eases breathing

  • Drains excess fluid

  • Eases breathing

Review Summary

86%

"Users consistently report rapid relief of fluid overload, reduced coughing and improved breathing, but note frequent urination and the need for close monitoring of hydration and electrolytes."

  • Frequent-walk cue

  • Furosemide is a potent loop diuretic used for rapid mobilization of pulmonary and peripheral edema.

  • Frequent-walk cue

  • Furosemide is a potent loop diuretic used for rapid mobilization of pulmonary and peripheral edema.

Increased Safety & Security

Time-Saving Convenience

Lasix is the prototypical loop diuretic and remains the market leader for rapid control of congestion and pulmonary edema in canine patients, making it essential to most multi‑drug cardiac regimens. Its technical advantage is rapid onset and predictable fluid removal; economically, generic furosemide is inexpensive and widely available, which lowers short‑term treatment costs though it increases the need for laboratory monitoring and electrolyte management when used alongside ACE inhibitors and spironolactone.

  • Drains excess fluid

  • Eases breathing

  • Frequent-walk cue

  • Furosemide is a potent loop diuretic used for rapid mobilization of pulmonary and peripheral edema.

  • Often dosed multiple times per day in acute decompensation and adjusted for chronic maintenance.

  • Drains excess fluid

  • Eases breathing

  • Frequent-walk cue

  • Furosemide is a potent loop diuretic used for rapid mobilization of pulmonary and peripheral edema.

  • Often dosed multiple times per day in acute decompensation and adjusted for chronic maintenance.

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$15-60 CAD

4
ALTERNATIVE ACE INHIBITOR

Enacard (Enalapril)

Enacard (Enalapril)

Enacard is a veteran ACE inhibitor with a long clinical track record in veterinary cardiology and remains commonly used in combination therapies for chronic heart disease due to its well‑known safety profile. Compared with Fortekor (benazepril), Enacard is often viewed as equally effective but may require different dosing frequency; it can be a lower‑cost alternative in regions where enalapril generics are widely available, though some clinicians prefer benazepril’s pharmacokinetics in multi‑drug regimens.

4.1
★★★★☆
  • Lowers blood pressure

  • Slows remodeling

  • Lowers blood pressure

  • Slows remodeling

Review Summary

78%

"Many long-term users see symptomatic benefit in cardiac patients, though some consider enalapril slightly less potent than alternatives and report occasional vomiting or low blood pressure."

  • Couch-friendly calm

  • Enalapril provides ACE inhibition to lower blood pressure and reduce cardiac workload.

  • Couch-friendly calm

  • Enalapril provides ACE inhibition to lower blood pressure and reduce cardiac workload.

Increased Safety & Security

Enacard is a veteran ACE inhibitor with a long clinical track record in veterinary cardiology and remains commonly used in combination therapies for chronic heart disease due to its well‑known safety profile. Compared with Fortekor (benazepril), Enacard is often viewed as equally effective but may require different dosing frequency; it can be a lower‑cost alternative in regions where enalapril generics are widely available, though some clinicians prefer benazepril’s pharmacokinetics in multi‑drug regimens.

  • Lowers blood pressure

  • Slows remodeling

  • Couch-friendly calm

  • Enalapril provides ACE inhibition to lower blood pressure and reduce cardiac workload.

  • Used as an alternative ACE inhibitor when benazepril is not preferred or available in a multi-drug protocol.

  • Lowers blood pressure

  • Slows remodeling

  • Couch-friendly calm

  • Enalapril provides ACE inhibition to lower blood pressure and reduce cardiac workload.

  • Used as an alternative ACE inhibitor when benazepril is not preferred or available in a multi-drug protocol.

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$40-100 CAD

5
ACE + ALDOSTERONE COMBO

Cardalis (Benazepril/Spironolactone)

Cardalis (Benazepril/Spironolactone)

Cardalis combines benazepril with spironolactone to deliver dual RAAS modulation — ACE inhibition plus aldosterone antagonism — in a single product, positioning it as a market leader for simplifying multi‑drug cardiac protocols and improving owner adherence. The bundled formulation can provide technical advantages by addressing aldosterone breakthrough seen with ACE inhibitors alone and offers financial and compliance benefits by reducing pill burden and potentially lowering total pharmacy costs compared with prescribing the two agents separately.

4.2
★★★★☆
  • Dual heart protection

  • Saves potassium

  • Dual heart protection

  • Saves potassium

Review Summary

84%

"Buyers appreciate the convenience and added aldosterone blockade of the combination pill, reporting improved symptom control and fewer hospital visits, with cautions about monitoring for hyperkalemia."

  • Salt-control superhero

  • Cardalis combines benazepril (ACE inhibitor) with spironolactone (aldosterone antagonist) for dual RAAS blockade.

  • Salt-control superhero

  • Cardalis combines benazepril (ACE inhibitor) with spironolactone (aldosterone antagonist) for dual RAAS blockade.

Increased Safety & Security

Time-Saving Convenience

Cardalis combines benazepril with spironolactone to deliver dual RAAS modulation — ACE inhibition plus aldosterone antagonism — in a single product, positioning it as a market leader for simplifying multi‑drug cardiac protocols and improving owner adherence. The bundled formulation can provide technical advantages by addressing aldosterone breakthrough seen with ACE inhibitors alone and offers financial and compliance benefits by reducing pill burden and potentially lowering total pharmacy costs compared with prescribing the two agents separately.

  • Dual heart protection

  • Saves potassium

  • Salt-control superhero

  • Cardalis combines benazepril (ACE inhibitor) with spironolactone (aldosterone antagonist) for dual RAAS blockade.

  • Simplifies multi-drug regimens by delivering ACE inhibition and aldosterone blockade in one tablet to reduce fluid retention and remodeling.

  • Dual heart protection

  • Saves potassium

  • Salt-control superhero

  • Cardalis combines benazepril (ACE inhibitor) with spironolactone (aldosterone antagonist) for dual RAAS blockade.

  • Simplifies multi-drug regimens by delivering ACE inhibition and aldosterone blockade in one tablet to reduce fluid retention and remodeling.

Order Now

$60-160 CAD

What the Research and Clinical Guidelines Say

Clinical trials and consensus statements have shaped modern combination therapy for canine heart disease. Research shows that combining targeted drugs — such as an inotrope, an ACE inhibitor, and a loop diuretic — improves symptom control, reduces episodes of congestive heart failure, and can prolong quality-adjusted survival for many dogs. Major veterinary cardiology guidelines and randomized studies provide clear, practical recommendations for when to start each drug class and how to monitor therapy safely.

Pimobendan (inotrope/vasodilator) has been shown in randomized clinical trials to improve clinical signs and survival in dogs with symptomatic mitral valve disease and heart failure compared with ACE inhibitor monotherapy; it frequently serves as a cornerstone of multi-drug protocols.

ACE inhibitors (benazepril, enalapril) reduce activation of the renin-angiotensin-aldosterone system, helping slow remodeling and reduce progression; they are commonly paired with diuretics to manage congestion.

Loop diuretics (furosemide, brand Lasix) provide rapid control of pulmonary edema and congestive signs; they are central to acute management and long-term dose-titration strategies.

Aldosterone antagonists such as spironolactone (component of Cardalis when combined with benazepril) offer additional neurohormonal blockade that can reduce fibrosis and may improve outcomes when added to ACE inhibitors.

Consensus guidelines from veterinary cardiology organizations recommend individualized, stage-based combination therapy and routine monitoring of renal function, electrolytes, and blood pressure to balance benefit and safety.

Clinical practice in Canada emphasizes evidence-based selection, cost and access considerations, and regular re-evaluation to adjust doses or swap agents based on response and side effects.

In the Canadian context, combination cardiac therapy gives veterinarians and owners multiple, evidence-based tools to manage canine heart disease. This page focuses on five commonly used prescription options: Vetmedin (Pimobendan), Fortekor (Benazepril), Lasix (Furosemide), Enacard (Enalapril), and Cardalis (Benazepril/Spironolactone). Each has a defined role within multi-drug regimens—Lasix for rapid diuresis, Fortekor and Enacard for ACE inhibition, Cardalis for combined ACE and aldosterone antagonism, and Vetmedin as the inotrope/vasodilator. Among these, Vetmedin (Pimobendan) often serves as the cornerstone for systolic support in many protocols and is commonly highlighted by cardiologists when building combination plans. We hope you found the guidance you were looking for; you can refine or expand your search using the site search to compare dosing strategies, monitoring checklists, or product availability across Canadian pharmacies.

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