Loop diuretics

(NEJM 2017;377:1964)

Drugs: furosemide (Lasix), torsemide, bumetanide (Bumex), ethacrynic acid

Mechanisms-Loop diuretics

Dosing: bioavailability PO furosemide ~50%, PO torsemide & bumetanide ~90%

• 40 mg IV = 80 mg PO Lasix = 20 mg PO/IV torsemide = 1 mg IV/PO bumetanide
• Dose furosemide bid-qid; qd dosing can yield initial diuresis, but then → anti-natriuresis. Cont. vs. bolus IV similar in acute CHF (NEJM 2011;364:797). Ethacrynic acid if sulfa allergy.
• ? ↑ diuresis w/ co-administration of albumin if ↓ serum albumin (Crit Care Med 2005;33:1681)

Adverse effects

• ↑ Na,
• ↓ K
• ↓ Mg
• ↓ Ca
• hyperuricemia,
• ototoxicity
• hypersensitivity (sulfa)