CONTINUING EDUCATION
Appendices Appendix A: Oral Diuretics Recommended for Use in the Treatment of Chronic HF 22-35 DRUG/STRENGTH(S)/ MANUFACTURER(S)
INITIAL DOSE & TITRATION IN ADULTS
INITIAL DOSE & TITRATION IN ELDERLY
MAXIMUM DAILY DOSE IN ADULTS/ ELDERLY
DURATION OF ACTION
POSSIBLE ADVERSE REACTIONS
COMMENTS
LOOP DIURETICS-(ORAL DOSE EQUIVALENCE (APPROXIMATE) -FUROSEMIDE 40 MG = BUMETANIDE 1 MG = TORSEMIDE 20 MG) Mechanism of Action: Inhibit the reabsorption of sodium or chloride in the loop of Henle in the renal tubes Bumetanide
0.5 to 1 mg once or twice daily
0.5 to 1 mg once or twice daily
Furosemide
20 to 40 mg once or twice daily
Torsemide
10 to 20 mg once daily
0.5mg tablet 1mg tablet 2mg tablet 0.25mg/ml injection Various manufacturers (Bumex®)
20mg tablets 40mg tablets 80mg tablets 8mg/ml oral solution 10mg/ml oral solution 10mg/ml injection Various manufacturers (LASIX®)
5mg tablet 10mg tablet 20mg tablet 100mg tablet 20mg/ml injection 50mg/5ml injection Various manufacturers (Demadex® -Roche)
10 mg
4 to 6 hours
Electrolyte and fluid depletion-may need Potassium supplementation -contraindication in patients with a prior allergic reaction to sulfonamides
Renal impairmentcontraindicated in those with low urine output/Use with caution Hepatic impairmentcontraindicated in hepatic coma/Use with caution in cirrhosis/ascites due to increased risk of precipitating hepatic coma; initiate with conservative doses and monitoring -Useful in those that high dosed of furosamide are ineffective
20 mg/day 600mg increase slowly to desired response
6 to 8 hours
Electrolyte and fluid depletion-may need Potassium supplementation -contraindication in patients with a prior allergic reaction to sulfonamides
Renal impairment -avoid if low urine output Hepatic impairmentDiminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis
10 to 20 mg once daily
12 to 16 hours
Electrolyte and fluid depletion-may need Potassium supplementation -contraindication in patients with a prior allergic reaction to sulfonamides
Renal impairment no dosage adjustments provided in the manufacturer’s labeling Hepatic impairmentn -no dosage adjustments provided in the manufacturer’s labeling
200mg
THIAZIDE DIURETICS Mechanism of Action: Inhibit the reabsorption of sodium or chloride at the distal portion of the renal tubes Chlorothiazide
250 to 500 mg once or twice daily
Use with caution
1,000mg
6 to 12 hours
Electrolyte disturbances/ Photosensitivity/ contraindication in patients with a prior allergic reaction to sulfonamides
Chlorthalidone
12.5 to 25 mg once daily
Use with caution
100mg
24 to 72 hours
Electrolyte disturbances/ Photosensitivity/ contraindication in patients with a prior allergic reaction to sulfonamides
250mg tablet 500mg tablet 250 mg/5 mL oral suspension 500 mg injection Various manufacturers (Diuril®)
25mg tablets 50mg tablets Various manufacturers
Renal impairment-CrCl <10 mL/minute: Avoid use. Ineffective with CrCl <30 mL/minute unless in combination with a loop diuretic Hepatic impairment -No dosage adjustments provided in manufacturer’s labeling; use with caution Renal impairmentThere are no dosage adjustments provided in the manufacturer's labeling -CrCl ≥10 mL/minute: No dosage adjustment necessary. CrCl <10 mL/minute: Avoid use. Ineffective with low GFR Hepatic impairment -There are no dosage adjustments provided in the manufacturer's labeling
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