When should Furosemide (Lasix) be discontinued?

From the Guidelines

Lasix (furosemide) should be stopped when the patient experiences severe adverse effects, such as severe hyponatraemia (serum sodium concentration <125 mmol/L), AKI, worsening hepatic encephalopathy, or incapacitating muscle cramps, as recommended by the most recent guidelines 1. When considering the discontinuation of Lasix, it is crucial to evaluate the patient's clinical condition, fluid status, and kidney function. The decision to stop Lasix should always be made under medical supervision to prevent rebound fluid retention, especially in patients with heart failure or chronic kidney disease.

• Key considerations for stopping Lasix include:
  • Severe adverse effects, such as profound electrolyte imbalances (particularly hypokalemia), dehydration, kidney injury, or allergic reactions
  • Ineffectiveness of the medication
  • Resolution of the underlying condition, such as pulmonary edema
  • Need for switching to another diuretic, which may require an overlap period rather than abrupt discontinuation According to the guidelines, diuretics should be discontinued if severe hyponatraemia, AKI, worsening hepatic encephalopathy, or incapacitating muscle cramps develop 1. Additionally, furosemide should be stopped if severe hypokalemia occurs (<3 mmol/L) 1.
• Monitoring and follow-up are essential when stopping Lasix, as abrupt discontinuation without medical guidance can lead to rapid fluid accumulation and worsening of underlying conditions like heart failure. The most recent guidelines recommend a cautious approach to diuretic therapy, with frequent clinical and biochemical monitoring, especially during the first weeks of treatment 1.
• It is also important to note that the dose of diuretics should be reduced to the lowest effective dose once ascites has largely resolved 1.

From the FDA Drug Label

In patients with hepatic cirrhosis and ascites, Furosemide tablets therapy is best initiated in the hospital. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved If increasing azotemia and oliguria occur during treatment of severe progressive renal disease, Furosemide tablets should be discontinued.

When to stop Lasix (Furosemide):

• If increasing azotemia and oliguria occur during treatment of severe progressive renal disease 2
• In cases of tinnitus, reversible or irreversible hearing impairment, and deafness, especially when associated with rapid injection, severe renal impairment, or concomitant therapy with ototoxic drugs 2

From the Research

When to Stop Lasix

• Lasix, also known as furosemide, is a loop diuretic used to treat fluid overload and edema in various medical conditions 3.
• The decision to stop Lasix should be based on the individual patient's response to treatment and their underlying medical condition.
• In patients with acute decompensated heart failure, Lasix can be stopped when the patient achieves euvolemia and their symptoms improve 4.
• In patients with end-stage renal disease, Lasix may need to be continued to manage fluid overload, but the dose may need to be adjusted due to changes in renal clearance 5.
• In general, Lasix should be stopped when the patient's fluid overload is resolved, and their renal function is stable.

Monitoring and Adjustments

• Patients on Lasix should be closely monitored for signs of dehydration, electrolyte imbalances, and changes in renal function 6.
• The dose of Lasix may need to be adjusted based on the patient's response to treatment and their underlying medical condition.
• In patients with pediatric conditions, the use of Lasix should be carefully monitored due to the potential for side effects and the need for dose adjustments based on the patient's weight and renal function 7.

Special Considerations

• In patients with severe renal impairment, Lasix may not be effective, and alternative treatments may be needed 3.
• In patients with hyperkalemia, potassium-sparing diuretics may be preferred over Lasix to avoid worsening the condition 5.
• The use of Lasix in combination with other diuretics, such as thiazides and potassium-sparing diuretics, may be necessary to achieve optimal diuresis in some patients 4.