What is the recommended dose for the combination of Lasix (furosemide) and spironolactone?

From the Guidelines

The recommended dose for the combination of Lasix (furosemide) and spironolactone is 100 mg of spironolactone and 40 mg of furosemide, with potential increases based on response and fluid status, as stated in the most recent guidelines 1.

Key Considerations

• The dose of spironolactone can be increased up to 400 mg/day, and furosemide up to 160 mg/day, with a ratio of 100:40 to maintain adequate serum potassium levels 1.
• Patients with the first episode of grade 2 (moderate) ascites should receive an anti-mineralocorticoid drug alone, starting at 100 mg/day, with stepwise increases every 72 h to a maximum of 400 mg/day if there is no response to lower doses 1.
• Furosemide should be added at an increasing stepwise dose from 40 mg/day to a maximum of 160 mg/day in patients who do not respond to anti-mineralocorticoids or in patients who develop hyperkalemia 1.

Monitoring and Adjustments

• Regular monitoring of kidney function, electrolytes (especially potassium), and blood pressure is essential, as hyperkalemia is a significant risk 1.
• Dosing should be adjusted based on clinical response, with morning administration preferred to avoid nighttime urination 1.
• Patients should be advised to monitor for signs of dehydration, dizziness, and electrolyte imbalances 1.

Special Considerations

• Diuretics should be discontinued if severe hyponatraemia (serum sodium concentration <125 mmol/L), AKI, worsening hepatic encephalopathy, or incapacitating muscle cramps develop 1.
• Furosemide should be stopped if severe hypokalemia occurs (<3 mmol/L), and anti-mineralocorticoids should be stopped if severe hyperkalemia occurs (>6 mmol/L) 1.

From the Research

Recommended Dose for Combination of Lasix and Spironolactone

The recommended dose for the combination of Lasix (furosemide) and spironolactone varies depending on the condition being treated.

• For congestive heart failure, a daily dose of 20 mg furosemide plus 50 mg spironolactone is recommended, with the option to increase to 40 mg furosemide and 100 mg spironolactone if necessary 2.
• For cirrhotic ascites, the recommended initial dose is spironolactone 100-200 mg/d and furosemide 20-40 mg/d, with usual maximum doses of 400 mg/d of spironolactone and 160 mg/d of furosemide 3.
• For resistant hypertension, a study compared the effect of intensifying diuretic treatment with loop diuretic (furosemide) or aldosterone antagonist (spironolactone) on blood pressure control, with doses of furosemide 40 mg/day and spironolactone 25 mg/day 4.

Important Considerations

When administering the combination of Lasix and spironolactone, it is essential to monitor serum potassium levels, especially when concomitantly using angiotensin II converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) 5.

• Furosemide's effects on renal and cardiovascular physiology are not fully understood, and its use can lead to undesirable consequences such as worsening kidney function and unpredictable effects on sodium balance 6.

Key Points

• The combination of Lasix and spironolactone is used to treat various conditions, including congestive heart failure and cirrhotic ascites.
• The recommended dose varies depending on the condition being treated.
• Monitoring of serum potassium levels is crucial when using this combination, especially with concomitant use of ACE-Is or ARBs.
• Furosemide's effects on renal and cardiovascular physiology are not fully understood and require further study.