Precautions
The mean bioavailability of oral furosemide is 51% compared with the bioavailability of intravenously administered furosemide. Although more furosemide gets excreted in the urine after IV administration, there is no difference in the amount of unchanged furosemide excretion in urine between the two formulations.
What is the difference between oral and intravenous furosemide?
For example, for patients taking 40 mg of oral furosemide twice daily as an outpatient, initial intravenous (IV) dosing would be 100 mg of furosemide IV twice daily. For patients not receiving long-term loop diuretic agents, 40-80 mg IV BID of furosemide or the equivalent is a reasonable, empiric, starting dose.
How many milligrams of furosemide can you give a patient?
It is extremely well absorbed (80-90%), regardless of the presence of edema, because it undergoes substantial hepatic elimination. The dosage of intravenously administered furosemide is usually half of that of the oral dose; oral bioavailability is approximately 50%(10-90%)2,3,4).
How well is furosemide absorbed?
In patients with normal renal function, the oral dose equivalence of furosemide relative to other oral diuretics is as follows: 40 mg of furosemide = 20 mg of torsemide = 1 mg of bumetanide Furosemide oral tablet formulations are available in 20 mg, 40 mg, and 80 mg dosages.
What is the equivalence between furosemide and torsemide?
How quickly does IV furosemide work?
The diuretic effect of furosemide is established within 15 minutes of an intravenous administration.
Why is furosemide given IV?
Furosemide injection is used to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease (cirrhosis), kidney disease, or other medical conditions.
What percentage of bioavailability will intravenous furosemide have?
It is extremely well absorbed (80-90%), regardless of the presence of edema, because it undergoes substantial hepatic elimination. The dosage of intravenously administered furosemide is usually half of that of the oral dose; oral bioavailability is approximately 50%(10-90%)2,3,4).
When do you switch from IV to oral diuretics?
Background. Current heart failure guidelines recommend transition of intravenous (IV) diuretics to oral > 24 h prior to hospital discharge.
What are the side effects of IV furosemide?
Furosemide can cause dehydration and electrolyte imbalance. If you experience any of the following symptoms, call your doctor immediately: decreased urination; dry mouth; thirst; nausea; vomiting; weakness; drowsiness; confusion; muscle pain or cramps; or rapid or pounding heartbeats.
Does IV furosemide lower blood pressure?
Furosemide is a type of medicine called a diuretic. It's used to treat high blood pressure (hypertension), heart failure and a build up of fluid in the body (oedema). It's also sometimes used to help you pee when your kidneys are not working properly.
Does intravenous route give 100% bioavailability?
Usually 100% bioavailability is assured only for IV medications and not for other routes like intramuscular or subcutaneous route. When a medication is administered intravenously it can directly reach the blood circulation and thereby assure 100% bioavailability.
What is the conversion from po furosemide to IV furosemide?
Patients with fluid overload When switching from furosemide PO to IV a 1:1 conversion is generally used.
What diuretic is better than furosemide?
However, Bumex is a more potent loop diuretic. Bumex also has a higher bioavailability than Lasix. Meaning, Bumex is more efficiently absorbed in the body than Lasix. In a comparative study, bumetanide was found to have an 80% bioavailability while furosemide was found to have a 40% bioavailability.
Why is IV preferred over oral?
Intravenous (IV) antibiotics are used for: Severe life-threatening infections, such as sepsis. Deep seated infections in parts of the body where oral antibiotics are less effective, such as in the spinal fluid and bone. Infections resistant to oral antibiotics.
Does IV work faster than oral?
Among physicians and patients alike, it is generally accepted that IV antibiotics are better than oral. They are stronger. They will work faster.
Why is the IV route preferred over oral route?
Intravenous administration is the best way to deliver a precise dose quickly and in a well-controlled manner throughout the body. It is also used for irritating solutions, which would cause pain and damage tissues if given by subcutaneous or intramuscular injection.
Is furosemide given IV?
The usual initial dose of furosemide is 40 mg injected slowly intravenously (over 1 to 2 minutes). If a satisfactory response does not occur within 1 hour, the dose may be increased to 80 mg injected slowly intravenously (over 1 to 2 minutes).
How does IV furosemide work?
It mainly works by inhibiting electrolyte reabsorption from the kidneys and enhancing the excretion of water from the body. Furosemide has a fast onset and short duration of action and has been used safely and effectively in both pediatric and adult patients.
What is IV diuretic used for?
The main indication of DCIDT treatment was the need to use iv diuretics to treat fluid overload caused by heart failure in patients who were safe to receive this form of treatment.
Does furosemide come IV?
NOTE: Furosemide is not FDA-approved for continuous IV administration. Infuse at a rate not to exceed 4 mg/minute in adults or 0.5 mg/kg/minute in children. The risk of ototoxicity increases with more rapid parenteral administration. No dilution necessary.
How long does it take to take nephrotic medication?
Usual Adult Dose for Nephrotic Syndrome. IV/IM: Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
What is the use of edema?
Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome , especially when an agent with greater diuretic potential is desired.
How long does it take to take a cirrhosis pill?
Usual Adult Dose for Liver Cirrhosis. IV/IM: Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
How long does it take to take a 20 mg IV?
Usual Adult Dose for Congestive Heart Failure. Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
What is the US BOXED WARNING?
US BOXED WARNING:#N#-FLUID/ELECTROLYTE DEPLETION: This drug is a potent diuretic which, if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose schedule must be adjusted to the individual patient's needs.#N#Consult WARNINGS section for additional precautions.
What is IV therapy?
IV therapy is a type of therapy in which fluids (sometimes containing medication or nutrients) are administered directly into a vein via a small tube called a catheter. IV therapy can quickly supply your body with:
What is oral supplement?
Oral supplements are substances you consume via the mouth and must travel through your digestive system. Oral supplements come in many forms, including liquids, tablets, capsules, and chewable tablets.
When was IV therapy first used?
Although the idea of intravenous (IV) therapy was first noted in medical journals from medieval times, it wasn’t until the 1930s that the true power of IV therapy was discovered — used by Dr. Thomas Latta to reduce cholera symptoms. And IV therapy remains just as important today. You know that IVs are used during surgeries and even during labor ...
Can supplements cause stomach upset?
For instance, certain vitamins might aggravate acid reflux disease while other supplements may cause an upset stomach.
When to use IVs?
You know that IVs are used during surgeries and even during labor and delivery. IV therapy can also be used outside of a hospital setting in order to quickly provide you with fluids, medications, and even nutrients.
Does Shine offer IV therapy?
At Shine Health and Wellness, Dr. Ki mberly Shine and our experienced team are proud to offer IV therapy so you can get the nutrients and fluids you need when you need them. If you’re contemplating IV therapy, here’s what you need to know.
Does IV therapy require a quick stick?
IV therapy does require a quick stick with a needle, which allows the catheter access to your vein.
How long does furosemide take to absorb?
Furosemide is absorbed from the gastrointestinal tract, and its peak diuretic effect occurs between 1 and 1.5 hours after oral administration, and between 10 and 30 minutes after intravenous administration. Furosemide (>95%) binds to plasma proteins. Protein-bound furosemide is delivered to the proximal tubule, and secreted via organic transporters that are expressed at the luminal site of action1,2,3). Approximately 50% of the furosemide load is excreted unchanged in urine, and the rest is metabolized into glucuronide in the kidney. Thus, patients with renal dysfunction show a decreased response and increased plasma half-life of furosemide due to the reduction of urinary excretion1,2,3).
How do diuretics help with edema?
Diuretics are commonly used to control edema in a number of clinical fields. Diuretics reduce sodium(Na+) reabsorption in specific renal tubules, resulting in an increase in urinary sodium and water excretion. The thick ascending limb of the loop of Henle reabsorbs about 25% of the Na+of the glomerular filtrate. The distal convoluted tubule reabsorbs approximately 5% of the Na+through a thiazide-sensitive sodium-chloride (Na+-Cl-) co-transporter. About 1-2% of the Na+is transported at the distal segment of the distal convoluted tubule and the collecting duct. Loop diuretics can inhibit the largest amount of Na+reabsorption by acting on the thick ascending limb of the loop of Henle. Furosemide inhibits the sodium-potassium-chloride (Na+-K+-2Cl-) co-transporter in the apical membrane of tubular epithelial cells in the thick ascending limb1).
What are the adverse effects of furosemide?
There are three major types of adverse events associated with furosemide: hypovolemia and electrolyte imbalance due to diuresis, hypersensitivity, and ototoxicity. Excessive diuresis due to high doses of the drug can induce extracellular fluid volume contraction, resulting in contraction alkalosis. This side effect occurs more commonly in the elderly, CKD patients, and patients taking nonsteroidal anti-inflammatory drugs (NSAIDs)22,23,24). NSAIDs reduce the vasodilation and natriuretic effects of furosemide by inhibiting the synthesis of prostaglandins, resulting in Na+retention, azotemia, and hyperkalemia25).
Can furosemide cause ototoxicity?
Furosemide can lead to reversible ototoxicity, although permanent deafness had also been reported. Ototoxicity is related to both the peak serum drug concentration and the rate of infusion. However, lower doses can also cause ototoxicity in patients with renal dysfunction or those undergoing concurrent aminoglycoside therapy27). Therefore, one must be cautious when considering a bolus infusion of a high furosemide dose. It is recommended that the maximum rate of furosemide infusion should be 4 mg/min to avoid this complication27). To avoid an abrupt increase in peak serum concentration, doses higher than 80mg of furosemide need to be infused slowly.
Does furosemide affect nephrotic syndrome?
Patients with nephrotic syndrome also experience decreased furosemide activity. The tubular secretion of furosemide is reduced in patients with hypoalbuminemia, because the delivery of furosemide is dependent on the level of plasma albumin1,2,3). Moreover, Na+reabsorption is increased in the proximal and/or more distal segments due to an activated renin-angiotensin system3,17). Additionally, furosemide can bind to albumin within the tubular lumen, which reduces the level of active and unbound drug that is capable of binding to the tubular receptor2). Consequently, a furosemide dose two to three times greater than the usual dose is required to maintain an effective concentration of free drug at the action site.
Is continuous infusion of bumetanide effective?
Continuous intravenous infusion is more effective than, or in some cases, similar to, intravenous bolus therapy7,8,9). It maintains an effective rate of furosemide excretion and inhibition of Na+reabsorption over time. A continuous infusion of furosemide tends to increase urine output and is associated with less ototoxicity, a significant side effect associated with furosemide, in patients with acute decompensated heart failure10). Continuous infusion of bumetanide results in a 30% increase in sodium excretion compared with bolus infusion11). Recently, a randomized double-blind multicenter study was published, which reported on the comparison between bolus and continuous infusions without loading doses in patients with acute decompensated heart failure12). There was no difference between the groups. However, meta-analysis showed that the continuous infusion of loop diuretics preceded by a loading dose was more diuretic than intermittent dosing13).
Does furosemide increase sodium?
The bolus therapy of furosemide rapidly increases sodium excretion. However, this excretion is at its maximum for the first 1-2 hours and then it progressively declines1). The peak natriuretic effect with the second dose is 25% less than that of the first dose. Post-diuretic renal sodium and fluid retention are inevitable6). This compensatory sodium retention occurs along the other segments of the nephron that are not related to furosemide. To avoid this compensation, furosemide should be injected at short intervals or infused continuously.
Why are IV antibiotics overused?
One reason that IV antibiotics are overused is an incorrect diagnosis of “treatment failure.” All too often, patients with skin and soft tissue infections are deemed to have failed oral antibiotics after fewer than 48 hours of oral antibiotics. They then are needlessly switched to IV antibiotics. There is no evidence to support this practice. Treatment failure of simple cellulitis should only be entertained after a 48- to 72-hour trial of oral antibiotics. Even in many of these cases, switching classes of oral antibiotics is sufficient. IV antibiotics are not the automatic answer to “treatment failures.”
Should IV antibiotics be given instead of oral?
In a sense, the decision to administer IV antibiotics instead of oral formulations represents a line in the sand between infections we are worried might kill a patient and ones that won’t. But for the vast majority of common infections we treat in the emergency department, oral antibiotics should actually be preferred over IV antibiotics ...
Is oral antibiotics as effective as IV antibiotics?
Of course, there are various physiological arguments that support oral antibiotics being theoretically as effective as IV antibiotics. But I know that, in order for us to change our behavior, the only thing that matters is whether data on outcomes support us.
Is IV antibiotic better than oral?
8 A Cochrane review of 25 studies including 2,588 patients comparing oral and IV antibiotics for uncomplicated cellulitis looking at “symptoms rated by participant or medical practitioner or proportion symptom-free” found that IV antibiotics were no better than oral ones. In fact, two of the studies suggested that oral antibiotics were more effective! 9
Can UTIs be managed in the outpatient setting?
Most urinary tract infections (UTIs) can be managed in the outpatient setting. In a Cochrane review of 15 randomized controlled trials (RCTs) comprising 1,743 children and adults with severe UTI, pooled outcomes showed no significant differences between oral and IV antibiotics. 1
What is diuretic resistance?
Qualitatively, diuretic resistance can be described as an inadequate rate/quantity of natriuresis despite an adequate diuretic regimen. A major problem in transitioning from a qualitative to a useful quantitative definition is that an adequate diuretic regimen is subjective and varies with the clinical context. Chronic diuretic treatment greatly increases the capacity of the distal nephron to reabsorb delivered sodium chloride (NaCl), leading to the secondary decline in natriuresis (the “braking phenomenon”). This process occurs in every patient given a diuretic agent, as net NaCl excretion returns to equal NaCl intake at steady state; when this occurs despite persistent congestion, these same mechanisms contribute to diuretic resistance.
Why is a Na+ monitoring important?
Because the dose-response curve to loop diuretic agents is logarithmic, substantial increases in dose (i.e., doubling) are usually required for improved diuretic response. Urine Na + monitoring may also be an effective strategy to guide diuretic dosing, although not yet tested in large studies.
How long does it take for a loop diuretic to increase?
For a sufficient dose of loop diuretic agent, urine output should measurably increase within 2 hours. If there is not an adequate response to initial dose, there is no need to wait until the next scheduled dose to increase dosing.
How many steps are involved in the action of diuretics?
Effective diuretic action requires four discrete steps: 1) ingestion and gastrointestinal absorption (if given orally), 2) delivery to the kidney, 3) secretion into the tubule lumen; and 4) binding to the transport protein—each one of these steps is discussed in this review. Initial loop diuretic dosing in patients hospitalized with HF ...
What are the steps of HF?
Effective diuretic action requires four discrete steps: 1) ingestion and gastrointestinal absorption (if given orally), 2) delivery to the kidney, 3) secretion into the tubule lumen; and 4) binding to the transport protein —each one of these steps is discussed in this review.
What is the effect of chronic kidney disease on HF?
Chronic kidney disease (CKD) is a strong predictor of adverse outcome in HF, and CKD impairs the “reserve” available for the kidneys to respond to the insult posed by congestion. In normal circumstances, renal blood flow (RBF) is around 20% of cardiac output and mainly determined by differences in renal arterial and venous pressure.
Can HF patients be treated without a loop diuretic?
Withdrawal of diuretics: Observational data suggest that HF patients who can be managed chronically without a loop diuretic agent generally have a good prognosis. One question that arises clinically, but for which there are very little data, is whether oral diuretic agents can be withdrawn in patients with HF who are clinically stable.
How does furosemide affect embryos?
The effects of furosemide on embryonic and fetal development and on pregnant dams were studied in mice, rats and rabbits. Furosemide caused unexplained maternal deaths and abortions in the rabbit at the lowest dose of 25 mg/kg (2 times the maximal recommended human oral dose of 600 mg/day).
How long does it take for furosemide to absorb?
Although furosemide is more rapidly absorbed from the oral solution (50 minutes) than from the tablet (87 minutes), peak plasma levels and area under the plasma concentration-time curves do not differ significantly. Peak plasma concentrations increase with increasing dose but times-to-peak do not differ among doses.
How much furosemide is toxic to dogs?
In all three, the oral LD 50 exceeded 1000 mg/kg body weight, while the intravenous LD 50 ranged from 300 to 680 mg/kg. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats.
How long does furosemide stay in your system?
The terminal half-life of furosemide is approximately 2 hours. Significantly more furosemide is excreted in urine following the intravenous injection than after the tablet or oral solution. There are no significant differences between the two oral formulations in the amount of unchanged drug excreted in urine.
What are the symptoms of furosemide?
All patients receiving furosemide therapy should be observed for these signs or symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia): dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia or gastrointestinal disturbances such as nausea and vomiting.
What is the chemical name for furosemide?
Chemically, it is 4-chloro- N -furfuryl-5-sulfamoylanthranilic acid. Furosemide Injection, USP 10 mg/mL is a sterile, non-pyrogenic solution in vials for intravenous and intramuscular injection. Furosemide USP is a white to slightly yellowish, odorless crystalline powder.
When should furosemide be reduced?
Whenever adverse reactions are moderate or severe, furosemide dosage should be reduced or therapy withdrawn.
What is lasix used for?
LASIX is particularly useful when an agent with greater diuretic potential is desired.
What is the active ingredient in Lasix?
LASIX® is a diuretic which is an anthranilic acid derivative. LASIX tablets for oral administration contain furosemide as the active ingredient and the following inactive ingredients: lactose monohydrate NF, magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF. Chemically, it is 4-chloro-N-furfuryl-5-sulfamoylanthranilic acid. LASIX is available as white tablets for oral administration in dosage strengths of 20, 40 and 80 mg. Furosemide is a white to off-white odorless crystalline powder. It is practically insoluble in water, sparingly soluble in alcohol, freely soluble in dilute alkali solutions and insoluble in dilute acids.
Can you use lasix while pregnant?
There are no adequate and well-controlled studies in pregnant women. LASIX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Is furosemide carcinogenic?
Furosemide was tested for carcinogenicity by oral administration in one strain of mice and one strain of rats. A small but significantly increased incidence of mammary gland carcinomas occurred in female mice at a dose 17.5 times the maximum human dose of 600 mg. There were marginal increases in uncommon tumors in male rats at a dose of 15 mg/kg (slightly greater than the maximum human dose) but not at 30 mg/kg.
Can lasix cause hypokalemia?
Patients receiving LASIX should be advised that they may experience symptoms from excessive fluid and/or electrolyte losses. The postural hypotension that sometimes occurs can usually be managed by getting up slowly. Potassium supplements and/or dietary measures may be needed to control or avoid hypokalemia.
Can lasix cause dehydration?
Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients. As with any effective diuretic, electrolyte depletion may occur during LASIX therapy, especially in patients receiving higher doses and a restricted salt intake. Hypokalemia may develop with LASIX, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives. Digitalis therapy may exaggerate metabolic effects of hypokalemia, especially myocardial effects.
Can lasix be used alone?
Oral LASIX may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents. Hypertensive patients who cannot be adequately controlled with thiazides will probably also not be adequately controlled with LASIX alone.