From the Guidelines
Yes, Furosemide (Lasix) can be used to treat ascites, but it's typically not the first-line treatment, and its use should be guided by the most recent and highest quality evidence, such as the 2021 guidelines on the management of ascites in cirrhosis 1. The standard approach usually begins with spironolactone, an aldosterone antagonist, at a starting dose of 100 mg daily. If ascites persists, Lasix may be added, starting at 40 mg daily. The doses can be gradually increased as needed, maintaining a ratio of 100 mg spironolactone to 40 mg furosemide. Some key points to consider when using Furosemide to treat ascites include:
- Monitoring for diuretic adverse events, such as electrolyte imbalance, worsening hypokalaemia, hyperkalaemia, serum creatinine, hepatic encephalopathy, and muscle cramps 1
- Temporarily discontinuing diuretics if electrolyte imbalance (Na < 125 mmol), worsening hypokalaemia, hyperkalaemia, serum creatinine, hepatic encephalopathy, and muscle cramps occur 1
- Reducing diuretic dose to the lowest possible if resolution of ascites is achieved 1
- Maintaining a maximal diuretic dose that is often not achieved in clinical practice, with typical maximum doses being 400 mg spironolactone and 160 mg furosemide daily 1 It's essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to use the most recent and highest quality evidence to guide treatment, such as the 2021 guidelines on the management of ascites in cirrhosis 1.
From the FDA Drug Label
In patients with hepatic cirrhosis and ascites, Furosemide tablets therapy is best initiated in the hospital. Furosemide tablets are indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome.
Yes, Furosemide (Lasix) is used to treat ascites, specifically in patients with hepatic cirrhosis and ascites 2 and edema associated with cirrhosis of the liver 2.
- Key points to consider when treating ascites with Furosemide include:
- Initiating therapy in a hospital setting for patients with hepatic cirrhosis and ascites
- Monitoring for potential complications such as hypokalemia and metabolic alkalosis
- Adjusting treatment as needed to avoid sudden alterations of fluid and electrolyte balance 2
From the Research
Furosemide (Lasix) in Ascites Treatment
- Furosemide is used in the treatment of ascites, particularly in patients with cirrhosis, as part of a diuretic regimen to enhance sodium excretion 3.
- The recommended initial dose of furosemide for ascites treatment is 20-40 mg/d, with a maximum dose of 160 mg/d 3.
- Furosemide is often used in combination with spironolactone, with the initial dose of spironolactone being 100-200 mg/d and the maximum dose being 400 mg/d 3.
- Studies have compared the efficacy of furosemide and spironolactone in treating ascites in non-azotemic cirrhotic patients, with results indicating that spironolactone may be more effective than furosemide at the dosages used 4.
- The diuretic response to furosemide and spironolactone is related to the activity of the renin-aldosterone system, with patients having higher renin and aldosterone levels potentially requiring higher doses of spironolactone to achieve a diuretic response 4.
Combination Therapy and Treatment Outcomes
- Combination therapy with furosemide and spironolactone is commonly used to treat ascites, with the goal of achieving a diuretic response and reducing ascites formation 3, 5.
- Treatment outcomes for ascites patients using furosemide and spironolactone have been evaluated in several studies, with results indicating that approximately 90% of patients respond well to medical therapy for ascites 3.
- Refractory ascites, defined as fluid overload unresponsive to sodium-restricted diet and high-dose diuretic treatment, has a poor prognosis and may require alternative treatment options such as serial therapeutic paracentesis, transjugular intrahepatic portosystemic shunt (TIPS), or liver transplantation 3, 6.