Loop Diuretics in Clinical Practice

Abstract

Diuretics are commonly used to control edema across various clinical fields. Diuretics inhibit sodium reabsorption in specific renal tubules, resulting in increased urinary sodium and water excretion. Loop diuretics are the most potent diuretics. In this article, we review five important aspects of loop diuretics, in particular furosemide, which must be considered when prescribing this medicine: (1) oral versus intravenous treatment, (2) dosage, (3) continuous versus bolus infusion, (4) application in chronic kidney disease patients, and (5) side effects. The bioavailability of furosemide differs between oral and intravenous therapy. Additionally, the threshold and ceiling doses of furosemide differ according to the particular clinical condition of the patient, for example in patients with severe edema or chronic kidney disease. To maximize the efficiency of furosemide, a clear understanding of how the mode of delivery will impact bioavailability and the required dosage is necessary.

Impact of the induced organic anion transporter 1 (Oat1) renal expression by furosemide on the pharmacokinetics of organic anions

“…Furosemide inhibits the sodium-potassiumchloride (Na + -K + -2Cl -) co-transporter located in the apical membrane of tubular cells in the thick ascending limb in the kidney. 1,3 Furosemide binds to plasmatic proteins and is not filtrated by the glomeruli in a large proportion. Therefore, as many other diuretics, it needs to be secreted by proximal tubular cells in order to reach its site of action.…”

Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta‐analysis of randomised controlled trials

“…In a secondary analysis excluding Shah et al's study, we found that continuous infusion was associated with significantly higher total urine output in 24 h in comparison with bolus administration (p < 0.01). This may be explained by the fact that peak effects of bolus administration are achieved in the first 1–2 h by rapidly increasing sodium excretion, which then declines progressively over time . A consistent plasma drug concentration of furosemide from continuous infusion may have a more consistent diuretic effect, producing greater weight reduction and total urine output in 24 h than following bolus administration.…”

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

“…Furthermore, CRI potentially reduces the so-called diuretic resistance like the rebound phenomenon and maintains more consistent diuresis (Adin et al 2003). In addition, CRI has been associated with lower peak plasma concentrations of furosemide, which may be associated with a lower incidence of side effects (Michael Felker 2010;Oh and Han 2015).…”