Related Subjects:
Chronic Heart Failure |
Heart Failure and Pulmonary Oedema |
Loop Diuretics |
Entresto Sacubitril with Valsartan |
Ivabradine |
Furosemide |
Angiotensin Converting Enzyme Inhibitors |
Cardiac Resynchronisation Therapy (CRT) Pacemaker |
About: Always check the BNF or equivalent for prescribing advice
- See BNF or equivalent for UpToDate prescribing advice
- These are potent diuretics useful for the rapid excretion of Salt, other electrolytes and water. Often used in the acute treatment of Left ventricular failure.
Mode of action
- They block primarily the absorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle. Heavily bound to albumin.
- Effect depends on renal clearance so may be diminished in older patients
Indications
- Acute LVF, Congestive cardiac failure
- Hypertension - not recommended as a single agent
- Fluid overload - Liver failure. Nephrotic syndrome
- Treat hypercalcaemia, Treat hyperkalaemia
Contraindications
- Avoid with ototoxic drugs
- Monitor renal function and electrolytes
- Hypokalaemia can increase Digoxin toxicity
Dose
- The usual initial dose of furosemide is 20 to 80 mg given as a single oral dose
- The usual initial dose of Bumetanide is 1 to 2 mg given as a single oral dose
- In the treatment of acute LVF doses such as furosemide 40 to 80 mg given as a single iv dose
Side effects
- Volume depletion and orthostatic hypotension and falls especially in elderly
- Hypokalaemia and metabolic alkalosis
- Hypomagnesaemia
- Hypocalcaemia and Hypercalciuria and calcium excretion
- Hyperuricaemia (can lead to gout)
- Ototoxicity - tinnitus especially avoid with aminoglycosides
- Diabetes and Hyperglycaemia
Interactions
- Digoxin toxicity as causes hypokalaemia
- Can cause lithium toxicity through its actions on renal clearance