Continuous Infusion of Furosemide in the Treatment of Patients with Congestive Heart Failure and Diuretic Resistance

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…To combat this, several strategies have been developed, such as repeated administration (often better than a large single dose) or addition of a thiazide-type diuretic to inhibit distal sodium resorption (92)(93)(94)(95)(96)(97)(98). Furosemide infusion is superior to, and at least as safe as, repeated large-dose boluses (95,(99)(100)(101)(102)(103). A disadvantage of intravenous infusions is that many hospitals mandate that such infusions be given in intermediate or even intensive care settings.…”

Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology

“…Administration of a loading dose followed by continued infusion of furosemide or torasemide have been shown to be more effective than bolus alone. 87,[91][92][93][94][95] Thiazides 96-98 and spironolactone 99 can be used in association with loop diuretics, the combination in low doses being more effective and having with fewer secondary effects than the use of higher doses of a single drug. [96][97][98][99] Combination of loop diuretics with dobutamine, dopamine 92 or nitrates 88 is also a therapeutic approach that is more effective and produces fewer secondary effects than increasing the dose of the diuretic.…”

The rational use of diuretics in heart failure

“…Inconsistent renal consequences exist with continuous infusion therapy. Studies have demonstrated similar increases in blood urea nitrogen and creatinine values with continuous infusion and bolus therapy [30,33], but effects on renal blood flow and GFR are lacking. Therefore, accurate deductions on renal effects of continuous-infusion therapy cannot be established.…”

“…Maximum infusion rates of 160 mg/h of furosemide were tolerated appropriately [33]; however, bumetanide infusion rates of at least 2 mg/h have been associated with severe musculoskeletal side effects [34]. If renal dysfunction is present, higher doses may be needed.…”