What is the difference between IV push and continuous drip administration of Lasix (furosemide) in terms of effect?

From the Guidelines

The choice between IV push and continuous drip administration of Lasix (furosemide) should be based on clinical urgency, patient's renal function, and hemodynamic stability, with continuous drip administration being preferred for patients with refractory fluid overload, heart failure with volume overload, or those with kidney dysfunction who need gentler fluid removal, as recommended by the 2016 ESC guidelines 1. The main difference between IV push and continuous drip administration of Lasix (furosemide) is in the onset, duration, and intensity of diuretic effect. IV push administration delivers a bolus dose (typically 20-40mg) over 1-2 minutes, producing a rapid, intense diuretic effect within 5 minutes that lasts 2-3 hours. This approach is preferred for acute situations requiring immediate fluid removal, such as pulmonary edema. Some key points to consider when choosing between IV push and continuous drip administration of Lasix include:

• The initial recommended dose for IV furosemide is 20-40 mg, with the dose and duration adjusted according to the patient's symptoms and clinical status 1.
• Continuous drip administration provides a more gradual, sustained diuretic effect that helps maintain steady urine output over time, and may reduce the risk of ototoxicity compared to repeated bolus dosing 1.
• Monitoring of urine output, electrolytes (particularly potassium), and kidney function is crucial when using Lasix, as it can cause electrolyte imbalances and worsen kidney function in susceptible patients 1.
• The 2016 ESC guidelines recommend regular monitoring of symptoms, urine output, renal function, and electrolytes during use of IV diuretics, and suggest that diuretics be given either as intermittent boluses or a continuous infusion, with the dose and duration adjusted according to the patient's symptoms and clinical status 1.

From the FDA Drug Label

The onset of diuresis following intravenous administration is within 5 minutes and somewhat later after intramuscular administration. The peak effect occurs within the first half hour. The duration of diuretic effect is approximately 2 hours

The difference between IV push and continuous drip administration of Lasix (furosemide) in terms of effect is not explicitly stated in the provided drug labels. However, it can be inferred that:

• IV push may be preferred when a rapid onset of diuresis is desired, such as in acute pulmonary edema.
• Continuous drip may be used to maintain a steady diuretic effect over a longer period, but the labels do not provide specific information on the effects of continuous infusion. It is essential to note that the labels do not directly compare the effects of IV push and continuous drip administration, and the decision on which method to use should be based on individual patient needs and clinical judgment 2.

From the Research

Difference between IV Push and Continuous Drip Administration of Lasix (Furosemide)

• The difference between IV push (bolus injection) and continuous drip administration of Lasix (furosemide) lies in their efficacy, safety, and diuretic effects 3, 4.
• A study comparing the efficacy of high dose furosemide as a continuous infusion versus a bolus injection in patients with severe heart failure found that continuous infusion was more efficacious and caused less ototoxic side effects 3.
• The continuous infusion resulted in significantly higher daily urinary volume and sodium excretion compared to the bolus injection, despite lower urinary furosemide excretion 3.
• Another study evaluating the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU) found that both continuous and bolus diuretic regimens appeared equally effective in achieving negative fluid balance 4.

Efficacy and Safety of Furosemide Administration

• The efficacy and safety of furosemide administration can vary depending on the dosage and method of administration 5, 3, 4.
• A study on the diuretic and clinical effects of low-dose furosemide in congestive heart failure patients found that a dose of 20 mg furosemide produced a significant diuretic and natriuretic effect 5.
• The peak effect of furosemide was observed within 60-120 minutes in most patients, and the results suggested that a number of patients with cardiac decompensation can be controlled on a relatively low dosage of furosemide 5.

Comparison with Other Diuretic Regimens

• A study comparing bumetanide- and metolazone-based diuretic regimens to furosemide in acute heart failure found that combination furosemide plus metolazone and continuous infusion bumetanide resulted in greater increases in urine output compared to continuous infusion furosemide 6.
• However, the incidence of worsening renal function was not different between regimens, and electrolyte abnormalities may be more prevalent when furosemide is combined with metolazone or when bumetanide is used 6.