Can albumin and furosemide (Lasix) be mixed?

Albumin and Furosemide Should Not Be Mixed Together

Albumin and furosemide should not be mixed together for administration as this can cause precipitation of the drug and reduce its effectiveness. 1

Pharmaceutical Compatibility Issues

• Furosemide is a buffered alkaline solution with a pH of about 9, and the drug may precipitate at pH values below 7 1
• The FDA label specifically states that acid solutions and other parenteral medications must not be administered concurrently in the same infusion as furosemide because they may cause precipitation 1
• When preparing furosemide for intravenous infusion, it should only be added to either Sodium Chloride Injection USP, Lactated Ringer's Injection USP, or Dextrose (5%) Injection USP after pH has been adjusted to above 5.5 1

Administration Recommendations

• If both albumin and furosemide are indicated for a patient, they should be administered separately rather than mixed together 1
• For patients requiring both medications (such as those with cirrhosis and ascites):
  • Administer furosemide and albumin separately, using different infusion sites 2
  • When sequential administration is needed, complete the albumin infusion first, then administer furosemide afterward 2

Clinical Evidence on Combined Use

• While some clinicians have attempted to use albumin with furosemide to enhance diuresis in hypoalbuminemic patients, studies have shown mixed results 3
• A randomized crossover study found that albumin failed to enhance the diuretic effects of furosemide in cirrhotic patients with ascites 4
• A more recent meta-analysis (2021) suggested that co-administration (but not mixing) of furosemide and albumin might enhance diuresis in specific patient populations, particularly those with:
  • Serum albumin levels below 2.5 g/dL
  • Impaired renal function (baseline creatinine >1.2 mg/dL)
  • When higher albumin doses (>30g) are used 3

Appropriate Clinical Scenarios for Sequential Use

• In patients with cirrhosis and large volume ascites requiring paracentesis, albumin is recommended as plasma volume expansion after the procedure, with diuretics administered separately 2
• In spontaneous bacterial peritonitis, albumin is recommended in addition to antibiotics, but furosemide should be administered separately if needed 2
• In nephrotic syndrome with severe edema, sequential administration (not mixing) may be considered in specific cases 5

Important Precautions

• Monitor electrolytes, kidney function, and hemodynamic parameters closely when using both medications, even when administered separately 6
• Be particularly cautious in patients with hypovolemia, hypotension, severe hyponatremia, or anuria 6
• Discontinue diuretics if severe hyponatremia (serum sodium <125 mmol/L), acute kidney injury, worsening hepatic encephalopathy, or incapacitating muscle cramps develop 2

In conclusion, while both albumin and furosemide are valuable medications in managing conditions like cirrhosis with ascites, heart failure, and nephrotic syndrome, they should never be mixed together in the same solution due to pharmaceutical incompatibility. When both are indicated, they should be administered separately, with careful monitoring of the patient's clinical response and laboratory parameters.