From the Guidelines
Lasix (furosemide) should typically be held if your systolic blood pressure is below 90 mmHg. This recommendation is based on the medication's mechanism of action as a loop diuretic, which causes increased urination and can lower blood pressure by reducing blood volume, as noted in the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1. Taking Lasix when your blood pressure is already low could lead to symptomatic hypotension, causing dizziness, lightheadedness, or even fainting. The 2012 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure also support this threshold, suggesting that a systolic blood pressure below 85 mmHg may require re-evaluation of the patient's clinical status and potential adjustment of medications, including diuretics 1. However, the more recent 2016 guidelines 1 provide a clearer recommendation for managing systolic blood pressure in the context of diuretic use. If you're monitoring your blood pressure at home and find it below this threshold, you should contact your healthcare provider before taking your scheduled dose. They may adjust your medication regimen or provide specific instructions tailored to your situation.
Some key points to consider when taking Lasix include:
- Monitoring for signs of dehydration, such as excessive thirst, dry mouth, or decreased urination, as these might indicate that the medication is causing too much fluid loss
- Regularly monitoring symptoms, urine output, renal function, and electrolytes during use of intravenous diuretics, as recommended by the 2016 ESC guidelines 1
- Adjusting the dose and duration of diuretics according to the patient's symptoms and clinical status, as suggested by the 2016 ESC guidelines 1
- Considering alternative medications or therapies if the patient experiences symptomatic hypotension or other adverse effects.
Always follow your healthcare provider's specific instructions regarding when to hold your medication, as individual circumstances may vary.
From the Research
Systolic Blood Pressure and Lasix Administration
- The decision to hold Lasix (furosemide) due to low systolic blood pressure is guided by clinical judgment and patient-specific factors 2.
- In patients with heart failure and reduced ejection fraction (HFrEF), symptomatic or severe persistent hypotension (systolic blood pressure < 90 mmHg) may require a decrease in blood pressure-reducing drugs, including loop diuretics like Lasix 2.
- There is no specific systolic blood pressure threshold provided in the studies for holding Lasix, but a value below 90 mmHg is considered severe hypotension in the context of HFrEF 2.
- The blood pressure-lowering efficacy of loop diuretics, including Lasix, has been evaluated in several studies, with a modest effect of -8/-4 mmHg reported 3, 4.
- The choice of diuretic and the decision to hold or adjust the dose should be individualized based on patient factors, such as the presence of congestion, renal function, and electrolyte balance 5.