Download Table 2. Dosage regimens of injectable loop diuretics7

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