Does furosemide (Lasix) help with ascites?

From the Guidelines

Furosemide (Lasix) is effective in treating ascites, particularly when used in combination with spironolactone, as it helps reduce fluid buildup in the abdomen by increasing urine output. According to the most recent guidelines on the management of ascites in cirrhosis 1, furosemide should be added to spironolactone in patients with recurrent severe ascites or when faster diuresis is needed. The recommended starting dose of furosemide is 40 mg, which can be increased to 160 mg daily as needed.

Key Considerations

• Patients should be monitored for adverse events, such as electrolyte imbalances, particularly potassium depletion, and regular blood tests are necessary 1.
• Dietary sodium restriction is an important complementary measure, with a recommended intake of 5-6.5 gms/day 1.
• The diuretic response should be defined as a weight loss of 1kg/day if oedema is present and 0.5 kg/day if no oedema is present 1.
• Furosemide should be discontinued if severe hyponatraemia, AKI, worsening hepatic encephalopathy, or incapacitating muscle cramps develop 1.

Treatment Approach

• For patients with the first presentation of moderate ascites, spironolactone monotherapy is reasonable, starting at 100 mg and increasing to 400 mg as needed 1.
• In patients with recurrent severe ascites, combination therapy with spironolactone and furosemide is recommended, with a starting dose of 40 mg for furosemide and increasing to 160 mg as needed 1.
• Patients should be aware of the potential side effects of furosemide, including increased urination, thirst, dizziness, and muscle cramps.

Monitoring and Adjustments

• Patients should monitor their weight daily to track fluid loss and adjust their diuretic dose accordingly 1.
• Regular clinical and biochemical monitoring is necessary, particularly during the first weeks of treatment 1.
• The dose of diuretics should be reduced to the lowest effective dose once ascites has largely resolved 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.

Furosemide (Lasix) may help with ascites, as it is indicated for the treatment of edema associated with cirrhosis of the liver, which often presents with ascites. However, therapy should be initiated in a hospital setting and with caution, as sudden alterations of fluid and electrolyte balance can precipitate hepatic coma 2. Key considerations include:

• Hospital initiation of therapy for patients with hepatic cirrhosis and ascites
• Strict observation during the period of diuresis to prevent complications
• Supplemental potassium chloride and aldosterone antagonists to prevent hypokalemia and metabolic alkalosis 2

From the Research

Furosemide (Lasix) and Ascites

• Furosemide is a loop diuretic that can be used to treat ascites in patients with cirrhosis, but it is not the first-line treatment 3, 4, 5.
• The use of furosemide in treating ascites is associated with several side effects, including prerenal azotemia, hepatic encephalopathy, and electrolyte and acid-base disorders 5.
• Spironolactone, an aldosterone antagonist, is often considered the drug of choice for treating ascites in cirrhotic patients, as it is more effective than furosemide in eliminating ascites 3, 4, 6, 5.
• The combination of spironolactone and furosemide can increase the natriuretic effect and reduce the risk of potassium metabolism disorders 3, 4.

Alternative Treatments for Ascites

• Therapeutic paracentesis with intravenous albumin infusion is a more effective treatment for cirrhotic patients with tense ascites, with a lower incidence of complications compared to diuretic therapy 3, 4, 7.
• Peritoneovenous shunt (PVS) is an effective treatment for ascites, but its use is limited by the high incidence of complications and the risk of obstruction 3, 7.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment option for patients with refractory ascites, but it may precipitate hepatic encephalopathy in some patients 6.

Treatment Approach

• A stepped-care approach, with careful monitoring of patients, is recommended to reduce the incidence of complications associated with diuretic therapy 5.
• The treatment of ascites should be individualized, taking into account the severity of the condition, the presence of complications, and the patient's response to therapy 3, 4, 6, 5, 7.