What medications are used to treat pulmonary edema?

From the Guidelines

Medications used to treat pulmonary edema primarily include diuretics, vasodilators, and other supportive medications, with loop diuretics like furosemide being the first-line treatment, as recommended by the most recent guidelines 1. The treatment of pulmonary edema involves a combination of medications to reduce fluid overload, improve cardiac function, and address the underlying cause of the condition.

• Loop diuretics, such as furosemide (Lasix), are typically the first-line treatment, working rapidly to reduce fluid overload by increasing urine output, as stated in the European Heart Journal 1.
• Vasodilators, including nitroglycerin and nitroprusside, reduce preload and afterload, decreasing the workload on the heart and improving cardiac output, as recommended by the European Society of Cardiology 1.
• Oxygen therapy is essential, with supplemental oxygen administered to maintain adequate blood oxygen levels, as emphasized in the guidelines for the diagnosis and treatment of acute and chronic heart failure 1.
• In cases related to heart failure, ACE inhibitors like enalapril or lisinopril help manage underlying cardiac dysfunction, and beta-blockers such as metoprolol or carvedilol may be introduced once the patient is stabilized, as suggested by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines 1.
• For severe cases, inotropic agents like dobutamine may be necessary to improve cardiac contractility, as recommended by the European Society of Cardiology 1. These medications work together to remove excess fluid from the lungs, improve cardiac function, and address the underlying cause of pulmonary edema, which is crucial for effective treatment and prevention of recurrence, as highlighted in the most recent guidelines 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Edema Therapy should be individualized according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that response. The medication used to treat pulmonary edema is furosemide (IV) 2.

• The usual initial dose of Furosemide tablets is 20 to 80 mg given as a single dose.
• The dose may be raised by 20 or 40 mg and given not sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.

From the Research

Medications for Pulmonary Edema

The following medications are used to treat pulmonary edema:

• Nitrates, such as nitroglycerin, which cause both preload and afterload reduction 3, 4
• Diuretics, such as furosemide and torsemide, which help to lower pulmonary capillary pressure and left ventricular end-diastolic pressure 5, 6
• Non-invasive positive pressure ventilatory support, which is used in conjunction with nitrates and diuretics to help stabilize the patient 3, 4
• β-receptor blockers, which may be used to treat left ventricular hyperdynamic status due to hypovolemic status caused by excessive diuretic therapy 7

Specific Medications and Dosages

• Nitroglycerin: high-dose bolus intravenous nitroglycerin, such as 9mg intravenous bolus with 76mg infusion, has been shown to be effective in managing sympathetic crashing acute pulmonary edema 4
• Torsemide: intravenous administration of torsemide has been found to be both efficacious and well tolerated in cardiogenic pulmonary edema 5
• Furosemide: although commonly used, furosemide may not be as effective as nitrates in the management of acute pulmonary edema, and its use may be associated with a higher risk of clinical treatment failure 6