What determines if Furosemide (Lasix) will be a long-term or short-term medication?

From the Guidelines

The decision to use furosemide as a regular or short-term medication should be based on the underlying condition being treated, with chronic conditions like heart failure, chronic kidney disease, or cirrhosis with ascites typically requiring long-term therapy and acute conditions like pulmonary edema or hypertensive crisis requiring short-term use. The most recent and highest quality study, 1, provides guidelines on the management of ascites in cirrhosis, recommending the use of furosemide in combination with spironolactone for patients with moderate ascites. Key considerations in deciding whether to use furosemide as a regular or short-term medication include:

• The underlying condition being treated, with chronic conditions typically requiring long-term therapy and acute conditions requiring short-term use
• The patient's response to treatment, with ongoing clinical assessment and monitoring of laboratory values guiding adjustments to the treatment plan
• Potential side effects and interactions, with careful monitoring and management of electrolyte imbalances and other adverse effects Some important points to consider when using furosemide include:
• The medication's half-life is relatively short, requiring twice daily dosing for sustained effect in chronic conditions
• Regular monitoring of electrolytes and kidney function is necessary for patients on long-term therapy
• Furosemide works by inhibiting sodium and chloride reabsorption in the loop of Henle, promoting diuresis to reduce fluid overload
• The dose of furosemide should be adjusted based on the patient's response to treatment, with a maximum dose of 160 mg/day recommended for patients with ascites 1. Overall, the decision to use furosemide as a regular or short-term medication should be based on a thorough evaluation of the patient's condition and response to treatment, with careful monitoring and management of potential side effects and interactions.

From the Research

Deciding on Furosemide as a Regular or Short-Term Medication

To determine whether furosemide should be used as a regular or short-term medication, several factors must be considered, including the patient's condition, the drug's efficacy, and its potential side effects.

• Patient Condition: Furosemide is commonly used to treat edematous states associated with cardiac, renal, and hepatic failure, as well as hypertension 2. The decision to use furosemide as a regular or short-term medication depends on the severity and nature of the patient's condition. For example, in patients with heart failure, torsemide may be more efficacious and safer than furosemide 3.
• Efficacy and Safety: Studies have compared the efficacy and safety of furosemide with other diuretics, such as torsemide and bumetanide. While furosemide is effective in treating edema, it may not always be the best choice due to its variable bioavailability and potential for adverse effects 2, 3. In some cases, alternative diuretics may be more effective or have a better safety profile.
• Route of Administration: The route of administration can also impact the decision to use furosemide as a regular or short-term medication. For example, nebulized furosemide has been shown to be effective in treating pulmonary edema and may have fewer hemodynamic changes compared to intravenous furosemide 4.
• Clinical Guidelines: Clinical guidelines recommend a systematic approach to managing fluid overload in conditions such as cardiac failure, cirrhosis, and nephrotic syndrome, starting with thiazides and proceeding to loop diuretics 5. Furosemide may be used as part of this approach, but the decision to use it as a regular or short-term medication should be based on individual patient needs and responses.
• Comparative Effects: A systematic review and meta-analysis of randomized controlled trials compared the effects of furosemide and other diuretics in the treatment of heart failure, finding that azosemide and torasemide caused significant reductions in brain natriuretic peptide levels and edema 6. These findings can inform decisions about the use of furosemide as a regular or short-term medication in patients with heart failure.