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ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Pronunciation
(fyoor OH se mide)
Generic Available (U.S.)
Yes
Index Terms
U.S. Brand Names
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Management of edema associated with heart failure and hepatic or renal disease; acute pulmonary edema; treatment of hypertension (alone or in combination with other antihypertensives)
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal studies have demonstrated maternal death, fetal toxicity, and fetal loss. There are no adequate and well-controlled studies in pregnant women. Crosses the placenta. Increased fetal urine production, electrolyte disturbances reported. Generally, use of diuretics during pregnancy is avoided due to risk of decreased placental perfusion. Monitor fetal growth if used during pregnancy; may increase birth weight.
Lactation
Enters breast milk/use caution
Breast-Feeding Considerations
Crosses into breast milk; may suppress lactation
Contraindications
Hypersensitivity to furosemide or any component of the formulation; anuria
Warnings/Precautions
Concerns related to adverse effects:
• Fluid/electrolyte loss: [U.S. Boxed Warning]: If given in excessive amounts, furosemide, similar to other loop diuretics, can lead to profound diuresis, resulting in fluid and electrolyte depletion. Close medical supervision and dose evaluation are required. Watch for and correct electrolyte disturbances; adjust dose to avoid dehydration. When electrolyte depletion is present, therapy should not be initiated unless serum electrolytes, especially potassium, are normalized. Risk of hypokalemia may be increased by: rapid diuresis, poor oral potassium intake, cirrhosis, and combined use with large amounts of licorice, corticosteroids, or laxatives (chronic use).
• Hyperuricemia: Asymptomatic hyperuricemia has been reported with use; rarely, gout may precipitate.
• Nephrotoxicity: Monitor fluid status and renal function in an attempt to prevent oliguria, azotemia, and reversible increases in BUN and creatinine; close medical supervision of aggressive diuresis required. May increase risk of radiocontrast-induced nephropathy in high-risk patients.
• Ototoxicity: Rapid I.V. administration, renal impairment, excessive doses, hypoproteinemia, and concurrent use of other ototoxins is associated with ototoxicity.
• Photosensitivity: Photosensitization may occur.
• Sulfa allergy: Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). A risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe. Discontinue if signs of hypersensitivity are noted.
Disease-related concerns:
• Cirrhosis: In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy; correct electrolyte and acid/base imbalances prior to initiation when hepatic coma is present.
• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.
• Prostatic hyperplasia/urinary stricture: May cause urinary retention due to increased urine production, especially upon initiation of therapy.
• Systemic lupus erythematosus (SLE): May cause SLE exacerbation or activation.
Concurrent drug therapy issues:
• Antihypertensives: Coadministration of antihypertensives may increase the risk of hypotension; reduction in antihypertensive dosage may be necessary.
• Digoxin: Diuretic-induced hypokalemia may potentiate digoxin-related cardiac toxicity.
Special populations:
• Pediatrics: May lead to nephrocalcinosis or nephrolithiasis in premature infants or in children <4 years of age with chronic use. May prevent closure of patent ductus arteriosus in premature infants.
Adverse Reactions
Frequency not defined.
Cardiovascular: Acute hypotension, chronic aortitis, necrotizing angiitis, orthostatic hypotension, vasculitis
Central nervous system: Dizziness, fever, headache, hepatic encephalopathy, lightheadedness, restlessness, vertigo
Dermatologic: Bullous pemphigoid, cutaneous vasculitis, erythema multiforme, exfoliative dermatitis, photosensitivity, pruritus, purpura, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Endocrine & metabolic: Cholesterol and triglycerides increased, glucose tolerance test altered, gout, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, metabolic alkalosis
Gastrointestinal: Anorexia, constipation, cramping, diarrhea, nausea, oral and gastric irritation, pancreatitis, vomiting
Genitourinary: Urinary bladder spasm, urinary frequency
Hematological: Agranulocytosis (rare), anemia, aplastic anemia (rare), eosinophilia, hemolytic anemia, leukopenia, thrombocytopenia
Hepatic: Intrahepatic cholestatic jaundice, ischemic hepatitis, liver enzymes increased
Local: Injection site pain (following I.M. injection), thrombophlebitis
Neuromuscular & skeletal: Muscle spasm, paresthesia, weakness
Ocular: Blurred vision, xanthopsia
Otic: Hearing impairment (reversible or permanent with rapid I.V. or I.M. administration), tinnitus
Renal: Allergic interstitial nephritis, fall in glomerular filtration rate and renal blood flow (due to overdiuresis), glycosuria, transient rise in BUN
Miscellaneous: Anaphylaxis (rare), exacerbate or activate systemic lupus erythematosus
Drug Interactions
ACE Inhibitors: Loop Diuretics may enhance the hypotensive effect of ACE Inhibitors. Specifically, postural hypotension which can accompany ACE Inhibitor initiation. Loop Diuretics may enhance the nephrotoxic effect of ACE Inhibitors. Risk C: Monitor therapy
Aliskiren: May decrease the serum concentration of Furosemide. Risk C: Monitor therapy
Allopurinol: Loop Diuretics may enhance the adverse/toxic effect of Allopurinol. Loop Diuretics may increase the serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinolol, an active metabolite of Allopurinol. Risk C: Monitor therapy
Amifostine: Antihypertensives may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, antihypertensive medications should be withheld for 24 hours prior to amifostine administration. If antihypertensive therapy can not be withheld, amifostine should not be administered. Risk D: Consider therapy modification
Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy
Antihypertensives: May enhance the hypotensive effect of other Antihypertensives. Risk C: Monitor therapy
Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Risk D: Consider therapy modification
CISplatin: Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin. Risk C: Monitor therapy
Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Corticosteroids (Systemic): May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Dofetilide: Loop Diuretics may enhance the QTc-prolonging effect of Dofetilide. Risk C: Monitor therapy
Ethacrynic Acid: Furosemide may enhance the ototoxic effect of Ethacrynic Acid. Risk X: Avoid combination
Fosphenytoin: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy
Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Hypotensive Agents: May enhance the adverse/toxic effect of other Hypotensive Agents. Risk C: Monitor therapy
Licorice: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Lithium: Loop Diuretics may decrease the serum concentration of Lithium. Loop Diuretics may increase the serum concentration of Lithium. Risk C: Monitor therapy
MAO Inhibitors: May enhance the orthostatic hypotensive effect of Orthostatic Hypotension Producing Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Neuromuscular-Blocking Agents: Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy
Pentoxifylline: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Phenytoin: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Probenecid: May enhance the adverse/toxic effect of Loop Diuretics. Probenecid may diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Management: Monitor for decreased diuretic effects or increased adverse effects of loop diuretics with concomitant use of probenecid. Bumetanide prescribing information recommends against concomitant use of probenecid. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
RiTUXimab: Antihypertensives may enhance the hypotensive effect of RiTUXimab. Risk D: Consider therapy modification
Salicylates: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates. Risk C: Monitor therapy
Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Risk D: Consider therapy modification
Yohimbine: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Furosemide serum levels may be decreased if taken with food.
Herb/Nutraceutical: Avoid bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng (American), kola, licorice (may worsen hypertension). Avoid black cohosh, California poppy, coleus, golden seal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse (may increase antihypertensive effect). Licorice may also cause or worsen hypokalemia.
Storage
Injection: Store at room temperature of 15°C to 30°C (59°F to 86°F). Protect from light. Exposure to light may cause discoloration; do not use furosemide solutions if they have a yellow color. Furosemide solutions are unstable in acidic media, but very stable in basic media. Refrigeration may result in precipitation or crystallization; however, resolubilization at room temperature or warming may be performed without affecting the drug's stability.
Tablet: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 89°F). Protect from light.
Reconstitution
I.V. infusion solution mixed in NS or D5W solution is stable for 24 hours at room temperature. May also be diluted for infusion to 1-2 mg/mL (maximum: 10 mg/mL).
Compatibility
Stable in D5LR, D5NS, D5W, D10W, D20W, mannitol 20%, LR, NS.
Y-site administration: Compatible: Allopurinol, amifostine, amphotericin B cholesteryl sulfate complex, anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, calcium gluconate, cefepime, ceftazidime, cefuroxime, cisplatin, cladribine, cyclophosphamide, cytarabine, dexmedetomidine, docetaxel, doripenem, doxorubicin liposome, epinephrine, etoposide phosphate, fentanyl, fludarabine, fluorouracil, foscarnet, gallium nitrate, granisetron, heparin, hetastarch in lactated electrolyte (Hextend®), hydrocortisone sodium succinate, hydromorphone, indomethacin, leucovorin calcium, linezolid, lorazepam, magnesium sulfate, melphalan, meropenem, methotrexate, micafungin, mitomycin, nitroprusside, norepinephrine, oxaliplatin, paclitaxel, piperacillin/tazobactam, potassium chloride, procainamide, propofol, ranitidine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, teniposide, thiopental, thiotepa, tirofiban, tobramycin. Incompatible: Amsacrine, azithromycin, caffeine citrate, caspofungin, chlorpromazine, ciprofloxacin, diltiazem, droperidol, eptifibatide, esmolol, fenoldopam, filgrastim, fluconazole, gemcitabine, gentamicin, hydralazine, idarubicin, labetalol, lansoprazole, levofloxacin, methocarbamol, metoclopramide, midazolam, milrinone, nesiritide, nicardipine, ondansetron, phenylephrine, promethazine, quinidine gluconate, tetracycline, vasopressin, vecuronium, vinblastine, vincristine, vinorelbine. Variable (consult detailed reference): Amikacin, amiodarone, cisatracurium, clarithromycin, dobutamine, dopamine, doxorubicin HCl, drotrecogin alfa, famotidine, kanamycin, meperidine, metoprolol, morphine, nitroglycerin, pantoprazole, vitamin B complex with C.
Compatibility in syringe: Compatible: Bleomycin, cisplatin, cyclophosphamide, dexamethasone sodium phosphate, fluorouracil, heparin, leucovorin calcium, methotrexate, mitomycin. Incompatible: Diphenhydramine, dimenhydrinate, doxapram, doxorubicin HCl, droperidol, meperidine, metoclopramide, milrinone, pantoprazole, protamine, reserpine, thiamine, vinblastine, vincristine.
Mechanism of Action
Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calcium
Pharmacodynamics/Kinetics
Onset of action: Diuresis: Oral, S.L: 30-60 minutes; I.M.: 30 minutes; I.V.: ~5 minutes
Symptomatic improvement with acute pulmonary edema: Within 15-20 minutes; occurs prior to diuretic effect
Peak effect: Oral, S.L.: 1-2 hours
Duration: Oral, S.L.: 6-8 hours; I.V.: 2 hours
Protein binding: 91% to 99%; primarily to albumin
Metabolism: Minimally hepatic
Bioavailability: Oral tablet: 47% to 64%; Oral solution: 50%; S.L. administration of oral tablet: ~60%; results of a small comparative study (n=11) showed bioavailability of S.L. administration of tablet was ~12% higher than oral administration of tablet (Haegeli, 2007)
Half-life elimination: Normal renal function: 0.5-2 hours; End-stage renal disease: 9 hours
Excretion: Urine (Oral: 50%, I.V.: 80%) within 24 hours; feces (as unchanged drug); nonrenal clearance prolonged in renal impairment
Dosage
Infants and Children: Edema, heart failure:
Oral: Initial: 2 mg/kg/dose increased in increments of 1-2 mg/kg/dose with each succeeding dose at intervals of 6-8 hours until a satisfactory response is achieved; maximum dose: 6 mg/kg/dose
I.M., I.V.: Initial: 1 mg/kg/dose; if response not adequate, may increase dose in increments of 1 mg/kg/dose and administer not sooner than 2 hours after previous dose, until a satisfactory response is achieved; may administer maintenance dose at intervals of every 6-12 hours; maximum dose: 6 mg/kg/dose
Children 1-17 years: Hypertension, resistant (unlabeled; AAP, 2004): Oral: Initial: 0.5-2 mg/kg/dose once or twice daily; maximum dose: 6 mg/kg/dose
Adults:
Edema, heart failure:
Oral: Initial: 20-80 mg/dose; if response not adequate, may repeat the same dose or increase dose in increments of 20-40 mg/dose at intervals of 6-8 hours; usual maintenance dose interval is once or twice daily; may be titrated up to 600 mg/day with severe edematous states. Note: May also be given on 2-4 consecutive days every week.
I.M., I.V.: Initial: 20-40 mg/dose; if response not adequate, may repeat the same dose or increase dose in increments of 20 mg/dose and administer 1-2 hours after previous dose (maximum dose: 200 mg/dose). Individually determined dose should then be given once or twice daily although some patients may initially require dosing as frequent as every 6 hours. Note: ACC/AHA 2009 guidelines for heart failure recommend a maximum single dose of 160-200 mg.
Continuous I.V. infusion (Howard, 2001; Hunt, 2009): Initial: I.V. bolus dose 20-40 mg over 1-2 minutes, followed by continuous I.V. infusion doses of 10-40 mg/hour. If urine output is <1 mL/kg/hour, double as necessary to a maximum of 80-160 mg/hour. The risk associated with higher infusion rates (80-160 mg/hour) must be weighed against alternative strategies. Note: ACC/AHA 2009 guidelines for heart failure recommend 40 mg I.V. load, then 10-40 mg/hour infusion.
Acute pulmonary edema: I.V.: 40 mg over 1-2 minutes. If response not adequate within 1 hour, may increase dose to 80 mg. Note: ACC/AHA 2009 guidelines for heart failure recommend a maximum single dose of 160-200 mg.
Hypertension, resistant (Chobanian, 2003; JNC 7): Oral: 20-80 mg/day in 2 divided doses
Refractory heart failure: Oral, I.V.: Doses up to 8 g/day have been used.
Elderly: Oral, I.M., I.V.: Initial: 20 mg/day; increase slowly to desired response.
Dosing adjustment/comments in renal impairment: Acute renal failure: High doses (up to 1-3 g/day - oral/I.V.) have been used to initiate desired response; avoid use in oliguric states.
Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.
Dosing adjustment/comments in hepatic disease: Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis; monitor effects, particularly with high doses.
Administration: Oral
Administer on an empty stomach (Bard, 2004). May be administered with food or milk if GI distress occurs; however, this may reduce diuretic efficacy.
Administration: I.V.
I.V. injections should be given slowly. In adults, undiluted direct I.V. injections may be administered at a rate of 20-40 mg per minute; maximum rate of administration for short-term intermittent infusion is 4 mg/minute; exceeding this rate increases the risk of ototoxicity. In children, a maximum rate of 0.5 mg/kg/minute has been recommended.
Administration: Other
When I.V. or oral administration is not possible, the sublingual route may be used. Place 1 tablet under tongue for at least 5 minutes to allow for maximal absorption. Patients should be advised not to swallow during disintegration time (Haegeli, 2007).
Administration: I.V. Detail
pH: 8-9.3
Monitoring Parameters
Monitor weight and I & O daily; blood pressure, orthostasis; serum electrolytes, renal function; monitor hearing with high doses or rapid I.V. administration
Dietary Considerations
May cause potassium loss; potassium supplement or dietary changes may be required.
Patient Education
For daily administration, may be taken with food or milk early in the day to reduce GI distress; if taken twice daily, take last dose in early afternoon in order to avoid sleep disturbance and to achieve maximum therapeutic effect. Follow dietary advice of prescriber; include potassium-rich foods in daily diet. Do not take potassium supplements without advice of prescriber. Weigh yourself each day at the same time when beginning therapy and weekly for long-term therapy. Report unusual or unanticipated weight gain or loss. May cause dizziness, blurred vision, drowsiness, or sensitivity to sunlight. Report signs of edema (eg, weight gain; swollen ankles, feet, or hands), trembling, numbness or fatigue, cramping or muscle weakness, chest pain or palpitations, unresolved nausea or vomiting, or any change in hearing.
Geriatric Considerations
Loop diuretics are potent diuretics; excess amounts can lead to profound diuresis with fluid and electrolyte loss; close medical supervision and dose evaluation is required, particularly in the elderly. Severe loss of sodium and/or increase in BUN can cause confusion. For any change in mental status in patients on furosemide, monitor electrolytes and renal function.
Anesthesia and Critical Care Concerns/Other Considerations
Clinical Pearls/Comments: It is important that patients be closely followed for hypokalemia, hypomagnesemia, and volume depletion because of significant diuresis. If given the morning of surgery, it may render the patient volume depleted and blood pressure may be labile during general anesthesia.
Dose equivalency (approximate): Bumetanide 1 mg = furosemide 40 mg = torsemide 10 mg = ethacrynic acid 50 mg
Cardiovascular Considerations
It is important that patients be closely followed for hypokalemia, hypomagnesemia, and volume depletion because of significant diuresis.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Dizziness is common
Mental Health: Effects on Psychiatric Treatment
Orthostatic hypotension is common; use caution with low potency antipsychotics and TCAs; may rarely cause agranulocytosis; caution with clozapine and carbamazepine; may decrease renal clearance of lithium resulting in elevated serum levels and risk for toxicity; more common with thiazide diuretics; monitor lithium levels
Nursing: Physical Assessment/Monitoring
Assess for allergy to sulfonylurea before beginning therapy. For intravenous use. Monitor for dehydration, electrolyte imbalance, and postural hypotension on a regular basis during therapy.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Injection, solution: 10 mg/mL (2 mL [DSC])
Injection, solution [preservative free]: 10 mg/mL (2 mL, 4 mL, 10 mL)
Solution, oral: 40 mg/5 mL (5 mL, 500 mL); 10 mg/mL (4 mL, 60 mL, 120 mL)
Tablet, oral: 20 mg, 40 mg, 80 mg
Lasix®: 20 mg
Lasix®: 40 mg, 80 mg [scored]
Pricing: U.S. (www.drugstore.com)
Solution (Furosemide)
10 mg/mL (60): $17.99
10 mg/mL (120): $15.99
Tablets (Furosemide)
20 mg (100): $13.99
40 mg (100): $13.99
80 mg (30): $12.99
Tablets (Lasix)
20 mg (30): $24.25
40 mg (30): $25.99
80 mg (30): $35.99
References
American Academy of Pediatrics Committee on Drugs, "Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics, 2001, 108(3):776-89.
Bard RL, Bleske BE, and Nicklas JM, “Food: An Unrecognized Source of Loop Diuretic Resistance,” Pharmacotherapy, 2004, 24(5):630-7.
Brown CB, Ogg CS, and Cameron JS, “High-Dose Frusemide in Acute Renal Failure: A Controlled Trial,” Clin Nephrol, 1981, 15(2):90-6.
Chaudhry AY, Bing RF, Castleden CM, et al, “The Effect of Aging on the Response to Frusemide in Normal Subjects,” Eur J Clin Pharmacol, 1984, 27(3):303-6.
Chobanian AV, Bakris GL, Black HR, et al, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,” JAMA, 2003, 289(19):2560-71.
Gerlag PG and van Meijel JJ, “High-Dose Furosemide in the Treatment of Refractory Congestive Heart Failure,” Arch Intern Med, 1988, 148(2):286-91.
Haegeli L, Brunner-La Rocca HP, Wenk M, et al, “Sublingual Administration of Furosemide: New Application of an Old Drug,” Br J Clin Pharmacol, 2007, 64(6):804-9.
Howard PA and Dunn MI, “Aggressive Diuresis for Severe Heart Failure in the Elderly,” Chest, 2001, 119(3):807-10.
Hunt SA, Abraham WT, Chin MH, et al, “2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation,” J Am Coll Cardiol, 2009, 53(15):e1-90.
Kuchar DL and O'Rourke MF, “High Dose Furosemide in Refractory Cardiac Failure,” Eur Heart J, 1985, 6(11):954-8.
Lindenfeld J, Albert NM, Boehmer JP, et al, “HFSA 2010 Comprehensive Heart Failure Practice Guideline,” J Card Fail, 2010, 16(6):e1-194.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, 2004, 114(2 Suppl):555-76.
Rudy DW, Voelker JR, Greene PK, et al, “Loop Diuretics for Chronic Renal Insufficiency: A Continuous Infusion Is More Efficacious Than Bolus Therapy,” Ann Intern Med, 1991, 115(5):360-6.
Runyon BA, “Management of Adult Patients With Ascites Due to Cirrhosis: An Update,” Hepatology, 2009, 49(6):2087-107.
Schuller D, Lynch JP, and Fine D, “Protocol-Guided Diuretic Management: Comparison of Furosemide by Continuous Infusion and Intermittent Bolus,” Crit Care Med, 1997, 25(12):1969-75.
International Brand Names
Lexi-Comp.com
Last full review/revision May 2011
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