Intermittent Administration of Furosemide vs Continuous Infusion Preceded by a Loading Dose for Congestive Heart Failure

Comparison of continuous versus intermittent furosemide administration in dogs with acute heart failure

“…As a consequence of the higher doses and rapid volume depletion, several changes were found: hypokalaemia was detected to be significant in both groups; increased creatinine and phosphorus was observed in the CRI group and increased BUN was also detected in the bolus injection group. Our findings are consistent with those reported in a human study by Lahav et al (1992) where people were hospitalized with class 3-4 chronic heart failure (CHF, New York Heart Association classification). The serum creatinine was increased after CRI furosemide more than bolus therapy.…”

Open Access to an Outpatient Intravenous Diuresis Program in a Systolic Heart Failure Disease Management Program

“…In an abstract presented by Durango and colleagues, 6 based on an outpatient setting similar to our own study, the administration of outpatient continuous IV furosemide infusion proved to be safe, effective, and inexpensive. In the literature, we can find several inpatient studies [7][8][9] that support the greater efficacy of continuous infusion of furosemide when compared with intermittent bolus injection. More recently, in a review by Salvador and colleagues, 10 although based on small and relatively heterogeneous studies, greater diuresis and a better safety profile (fewer adverse effects such as tinnitus and hearing loss) seems to be achieved when loop diuretics are given as continuous infusion.…”

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.…”

“…Although diuretics can be used safely in the majority of patients, secondary effects are frequent and may be life-threatening. They include neurohormonal activation, especially of the angiotensin-aldosterone system and the sympathetic nervous system 97 , hypokalaemia, hypomagnesaemia, and hypochloraemic alkalosis that may lead to severe arrhythmias 92 , and nephrotoxicity and aggravation of renal failure. 100,105 Excessive diuresis may reduce venous pressure, pulmonary wedge pressure and diastolic filling excessively, leading to a reduction in stroke volume and cardiac output, particularly in patients with severe heart failure and predominant diastolic failure or ischaemic RV dysfunction.…”