From the Guidelines
Furosemide continuous infusion should be prepared by adding 100 mg to 90 mL of compatible fluid to create a 1 mg/mL concentration, with a loading dose of 20-40 mg IV push, followed by an initial infusion rate of 5-10 mg/hour, titrated upward every 1-2 hours based on urine output and clinical response, as recommended by the 2016 ESC guidelines 1.
Key Considerations
- The maximum recommended rate is generally 40 mg/hour, though some refractory cases may require higher doses.
- Continuous monitoring of electrolytes, renal function, and fluid status is essential during therapy.
- Patients should have strict intake and output measurements and daily weights.
Preparation and Administration
- Furosemide continuous infusion can be administered as an intermittent bolus or a continuous infusion, with the dose and duration adjusted according to the patient's symptoms and clinical status 1.
- The initial recommended dose should be 20–40 mg i.v. furosemide (or equivalent) for patients with new-onset AHF or those with chronic, decompensated HF not receiving oral diuretics 1.
Clinical Context
- The continuous infusion approach provides more consistent diuresis and potentially fewer adverse effects than intermittent bolus dosing, as it avoids the peaks and troughs in drug concentration that can lead to ototoxicity and rebound sodium retention.
- This method is particularly useful in patients with heart failure, cirrhosis, or nephrotic syndrome who have developed resistance to conventional bolus dosing.
Monitoring and Adjustments
- Regular monitoring of symptoms, urine output, renal function, and electrolytes during use of i.v. diuretics is recommended 1.
- The dose and duration of furosemide continuous infusion should be adjusted according to the patient's symptoms and clinical status.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... If the physician elects to use high dose parenteral therapy, add the furosemide to either Sodium Chloride Injection USP, Lactated Ringer's Injection USP, or Dextrose (5%) Injection USP after pH has been adjusted to above 5. 5, and administer as a controlled intravenous infusion at a rate not greater than 4 mg/min.
Furosemide Injection is a buffered alkaline solution with a pH of about 9 and drug may precipitate at pH values below 7. Care must be taken to ensure that the pH of the prepared infusion solution is in the weakly alkaline to neutral range.
The preparation of a furosemide drip involves adding the drug to Sodium Chloride Injection USP, Lactated Ringer's Injection USP, or Dextrose (5%) Injection USP after adjusting the pH to above 5.5. The infusion should be administered at a rate not greater than 4 mg/min 2.
- Key considerations for preparation:
- Adjust pH to above 5.5
- Use a compatible infusion solution
- Avoid mixing with acidic products
- Administer at a controlled rate not exceeding 4 mg/min
- Important: The furosemide injection should be inspected visually for particulate matter and discoloration before administration 2.
From the Research
Furosemide Drip Preparation and Dosing
- The provided study 3 does not directly address the preparation and dosing of furosemide drips, but it does mention that patients received background intravenous furosemide therapy with a total daily dose of ≥ 160 mg.
- The study 3 focuses on the comparison of combination diuretic therapy with oral hydrochlorothiazide or intravenous chlorothiazide in patients receiving intravenous furosemide therapy for the treatment of heart failure.
- Key points about the furosemide dosing in the study 3 include:
- Total daily dose of ≥ 160 mg
- No specific information on drip preparation or infusion rates
- It is essential to consult other sources or guidelines for specific information on furosemide drip preparation and dosing, as the provided study 3 does not provide detailed information on this topic.