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Table 2. Dosage regimens of injectable loop diuretics7-12 Drug Usual Adult Dosage Furosemide Edema, initial dose: 20-40 mg/dose IV or IM every 2 hours as needed. Increase the dose by 20 mg every 2 hours until desired effects are seen. Edema, maintenance dosage: Give the effective dose once or twice daily. Up to 4 grams/day in patients with congestive heart failure and 6 grams/day in patients with chronic renal failure is being investigated. Comments Administer small doses (20-80 mg) IV over 1-2 min. Administer large doses (1 gram) IV over 30 min. Avoid use in patients with oliguria. Rates up to 4 mg/minute have been used. Acute pulmonary edema: 40 mg IV. After 1 hour, may increase the dose to 80 mg if diuretic response is inadequate. Bumetanide Torsemide Ethacrynic acid Continuous infusion: 20-40 mg bolus IV, followed by 1040 mg/hour. Double the rate every 2 hours, up to a maximum 80-160 mg/hour. Edema, initial dose: 0.5-1 mg IV or IM. Repeat in 2-3 hours if response is inadequate, up to a maximum of 10 mg/day. Edema, maintenance dose: give the effective dose (from titration) intermittently as needed. 10-20 mg IV once daily. Double the dose (maximum of 200 mg/dose) until desired therapeutic response is achieved. Hepatic cirrhosis: 5-10 mg IV once daily. Double the dose (maximum of 40 mg/dose) until desired therapeutic response is achieved. Edema, initial dose: 50 mg IV or 0.5-1 mg/kg (up to 100 mg/dose). Usually only a single dose is necessary; may repeat in 2-4 hours if additional diuresis is needed. Edema, maintenance dose: Give the effective dose every 8-12 hours. Administer IV over 1-2 minutes. Risk of cross-reactivity in patients with furosemide allergy is low (1:40); bumetanide may be a good choice in these patients. Administer IV over 2 minutes. Extensively metabolized in the liver; dosage may need adjustment in patients with hepatic impairment. Administer IV over several minutes. Causes pain and irritation at the injection site; do not inject IM or SC. If a second dose is needed, use a new injection site to reduce the risk of thrombophlebitis. Has higher risk than other loop diuretics of causing ototoxicity. Avoid use in patients with a creatinine clearance of< 10 mL/minute. Abbreviations: IM = intramuscular; IV = intravenous; SC = subcutaneous