How to titrate lasix?

1.

Elsevier ClinicalKey Derived Clinical Overview

1.000000000000000e+00 Spironolactone: Start at 50 to 100 mg/day and titrate up every 3 to 4 days to a maximum dose of 400 mg/day (monotherapy or combination therapy with furosemide). 2.000000000000000e+00 Furosemide: Start at 40 mg/day and titrate up to 160 mg/day maximum (no role for monotherapy). A ratio of 40 mg/day of furosemide to 100 mg/day of spironolactone is an effective strategy in most patients but can modified based on kidney function and electrolytes. 3.000000000000000e+00 Monitor renal function and sodium levels carefully for signs of prerenal azotemia (in patients without edema, goal weight loss is 300 to 500 g/day; in patients with edema, goal weight loss is 800 to 1000 g/day). Furosemide alone is not recommended. 4.000000000000000e+00 Measurement of the urinary sodium level can be helpful to identify noncompliance with dietary sodium restriction and diuretic therapy. Patients excreting more than 78 mmol of sodium/day (24-h urine) and not losing weight likely have nonadherence with low Na diet. Patients with low Na excretion, less than 78 mmol daily, require up titration of diuretics and evaluation of compliance. 1.000000000000000e+00 Large-volume paracentesis: Defined as >5L removed during a single paracentesis. 2.000000000000000e+00 Diuretic therapy until loss of fluid is noted (maximum spironolactone 400 mg daily and furosemide 160 mg daily). a. No difference in long-term mortality rate was found; however, paracentesis is faster, more effective, and associated with fewer adverse effects.

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: March 4, 2024.

Administration * Infuse at a rate not to exceed 4 mg/minute in adults or 0.5 mg/kg/minute in children. * The risk of ototoxicity increases with more rapid parenteral administration. * Intramuscular Administration * * No dilution necessary. * Inject deeply into a large muscle mass (e.g., anterolateral thigh or deltoid [children and adolescents only]). * Subcutaneous Administration * **Subcutaneous lasix infusion via On-Body Infusor (Furoscix):** * Prior to preparing or applying the on-body infusor, read and become familiar with the manufacturer's 'Instructions for Use'. * During the 5-hour subcutaneous infusion, limit activity, especially bending movements, and avoid riding in a car or flying in an airplane. * Do not use the on-body infusor within 12 inches of mobile phones, tablets, computers or wireless accessories (e.g. TV remote control, computer keyboard or mouse). ** ** * Do not get the infusor wet. Avoid showering, bathing, swimming, and participating in activities that result in sweating. * If the indicator light blinks red and the on-body infusor beeps, the on-body infusor has either experienced an internal error or come off of the skin. Do not use the on-body infusor. If the on-body infusor is on the skin, instruct patients to carefully remove it and contact their care team for further instructions. Preparation: * Wash hands prior to handling the on-body infusor. Gather all materials (on-body infusor carton [contains on-body infusor, prefilled cartridge, instructions for use, and alcohol wipes], sharps container, and, if needed, hair clippers) and place on a clean surface. * Open the carton to remove supplies, check for any damage to either the on-body infusor or prefilled cartridge, and check the solution in the prefilled cartridge. The lasix solution should be clear to slightly yellow; do not use if liquid is discolored, cloudy, or contains particulates.

Administration * ### **General Administration Information** For storage information, see the specific product information within the How Supplied section. * ### **Route-Specific Administration** * Oral Administration * * Administer with meals to minimize indigestion and gastrointestinal irritation. * Oral Solid Formulations * * If patient has difficulty swallowing, lasix tablets may be crushed. * Oral Liquid Formulations * * When administering lasix to an infant or child using a medicine dropper or oral syringe, slowly squirt the solution into the side of the child's mouth so that he or she will swallow the liquid naturally. Do not squirt onto the back of the throat because this may cause gagging. Rinse the dropper or syringe in warm water after each use. * Injectable Administration * * Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. * Intravenous Administration * Dilution * Dilute in 0.9% Sodium Chloride Injection, Lactated Ringer's Injection, or 5% Dextrose Injection; adjust pH to more than 5.5 when necessary. * ASHP Recommended Standard Concentrations for Adult Continuous Infusions: 2 mg/mL or 10 mg/mL. * ASHP Recommended Standard Concentrations for Pediatric Continuous Infusions: 2 mg/mL or 10 mg/mL. IV Push * No dilution necessary. * Inject each 20 to 40 mg of lasix slowly IV over 1 to 2 minutes. * In pediatric patients, injection no faster than 0.5 mg/kg/minute; more rapid administration increased the risk of ototoxicity. * For patients receiving extracorporeal membrane oxygenation (ECMO), administer IV lasix outside the circuit; the drug is substantially adsorbed by circuit components. Intermittent IV Infusion * Infuse at a rate not to exceed 0.5 mg/kg/minute or for high dose therapy, do not exceed 4 mg/minute. Continuous IV Infusion NOTE: Lasix is not FDA-approved for continuous IV administration. * Infuse at a rate not to exceed 4 mg/minute in adults or 0.5 mg/kg/minute in children. * The risk of ototoxicity increases with more rapid parenteral administration.

3.

Food and Drug Administration (DailyMed).

Publish date: February 1, 2023.

Dosage And Administration DOSAGE AND ADMINISTRATION Edema Therapy should be individualized according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that response. Adults -- The usual initial dose of Lasix (furosemide) is 20 mg to 80mg given as a single dose. Ordinarily a prompt diuresis ensues. If needed, the same dose can be administered 6 to 8 hours later or the dose may be increased. The dose may be raised by 20 mg or 40mg and given not sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained. The individually determined single dose should then be given once or twice daily (e.g., at 8 am and 2 pm). The dose of Lasix (furosemide) may be carefully titrated up to 600 mg/day in patients with clinically severe edematous states. Edema may be most efficiently and safely mobilized by giving Lasix (furosemide) on 2 to 4 consecutive days each week. When doses exceeding 80 mg/day are given for prolonged periods, careful clinical observation and laboratory monitoring are particularly advisable ( s ee PRECAUTIONS: Laboratory Test ). Geriatric patients -- In general, dose selection for the elderly patient should be cautious, usually starting at the low end of the dosing range ( see PRECAUTIONS: Geriatric Use ). Pediatric patients -- The usual initial dose of oral Lasix (furosemide) in pediatric patients is 2 mg/kg body weight, given as a single dose. If the diuretic response is not satisfactory after the initial dose, dosage may be increased by 1 or 2 mg/kg no sooner than 6 to 8 hours after the previous dose. Doses greater than 6 mg/kg body weight are not recommended. For maintenance therapy in pediatric patients, the dose should be adjusted to the minimum effective level. Hypertension Therapy should be individualized according to the patient’s response to gain maximal therapeutic response and to determine the minimal dose needed to maintain the therapeutic response. Adults -- The usual initial dose of Lasix (furosemide) for hypertension is 80mg, usually divided into 40mg twice a day. Dosage should then be adjusted according to response. If response is not satisfactory, add other antihypertensive agents.

4.

Food and Drug Administration (DailyMed).

Publish date: November 4, 2023.

Clinical Pharmacology The pharmacokinetic parameters of FUROSCIX (furosemide injection 80 mg/ 10 ml) are presented in Table 1 below: Table 1: Pharmacokinetic Data of FUROSCIX (furosemide injection 80 mg/ 10 ml) Following Subcutaneous Infusion (n = 15) Dose C max (ng/mL) AUC t (ng×hr/mL) T 1/2 (hr) AUC ∞ (ng×hr/mL) FUROSCIX (furosemide injection 80 mg/ 10 ml): 30 mg subcutaneously infused over the first hour followed by 12.5 mg per hour for the subsequent 4 hours (total dose: 80 mg furosemide) 2040 ± 449 13000 ± 4000 3.2 ± 0.9 13100 ± 4010 Furosemide administered as 2 x 40 mg bolus doses intravenously, separated by 120 minutes (total dose: 80 mg furosemide) 8580 ± 2540 13000 ± 4050 2.6 ± 0.3 13200 ± 4170 The terminal half-life of furosemide is approximately 2 hours. Distribution Furosemide is extensively bound to plasma proteins, mainly to albumin. Plasma concentrations ranging from 1 mcg per mL to 400 mcg per mL are 91% to 99% bound in healthy individuals. The unbound fraction averages 2.3% to 4.1% at therapeutic concentrations. Furosemide binding to albumin may be reduced in elderly patients. Metabolism Furosemide glucuronide is the only or at least the major biotransformation product of furosemide in man. Elimination Significantly more furosemide is excreted in urine following the intravenous injection than after the tablet or oral solution. Furosemide is predominantly excreted unchanged in the urine. The renal clearance of furosemide after intravenous administration in older healthy male subjects (60 to 70 years of age) is significantly less than in younger healthy male subjects (20 to 35 years of age).