Can I start my heart failure patient on Lasix (furosemide) 20 mg and lisinopril 5 mg?

Starting Heart Failure Treatment with Furosemide and Lisinopril

Yes, starting your heart failure patient on Lasix (furosemide) 20 mg and lisinopril 5 mg is appropriate and follows guideline recommendations for initial heart failure therapy.

Rationale for Combination Therapy

• Diuretics (like furosemide) should always be administered in combination with ACE inhibitors (like lisinopril) in heart failure patients when fluid overload is present 1
• This combination addresses both symptom relief (diuretic) and disease-modifying treatment (ACE inhibitor) for improved outcomes 1
• Furosemide 20 mg is an appropriate starting dose for heart failure patients, producing significant diuretic and natriuretic effects within 60-120 minutes 2
• Lisinopril 5 mg is the recommended starting dose for heart failure patients when used with diuretics 3, 1

Administration Guidelines

For Lisinopril:

• Start with 5 mg once daily as recommended for heart failure patients 3, 1
• Check renal function and electrolytes before starting and 1-2 weeks after initiation 1
• Titrate gradually to target doses shown effective in clinical trials (10-20 mg daily) 1, 4
• Consider starting in the evening when supine to minimize potential blood pressure effects 1

For Furosemide (Lasix):

• 20 mg is an appropriate starting dose for heart failure patients 2, 1
• Adjust dose according to symptoms, signs of congestion, blood pressure, and renal function 1
• Monitor for electrolyte imbalances, particularly potassium levels 1

Important Precautions

• Avoid potassium-sparing diuretics during initiation of ACE inhibitor therapy 1
• Avoid excessive diuresis before starting lisinopril; consider reducing or withholding diuretics for 24 hours before first ACE inhibitor dose 1
• Monitor for hypotension, especially in patients with low baseline blood pressure 3, 1
• Check renal function and electrolytes 1-2 weeks after initiation and after dose increases 1
• Avoid NSAIDs and COX-2 inhibitors as they may reduce diuretic effectiveness and worsen renal function 1

Expected Benefits

• Furosemide will provide rapid improvement of dyspnea and increased exercise tolerance 1, 2
• Lisinopril will reduce signs and symptoms of heart failure including edema, rales, paroxysmal nocturnal dyspnea, and jugular venous distention 3
• The combination improves functional class and reduces hospitalizations 3, 4
• Lisinopril increases cardiac output and decreases pulmonary capillary wedge pressure in heart failure patients 3, 5

Monitoring Recommendations

• Check blood pressure, renal function, and electrolytes 1-2 weeks after initiation 1
• Monitor for symptomatic hypotension, especially during first few days 1, 3
• Assess for signs of improved fluid status (reduced edema, improved breathing) 1
• Consider patient education on self-monitoring weight and adjusting diuretic dose based on symptoms and weight changes 1

Potential Adjustments

• If renal function deteriorates substantially, consider stopping or reducing the dose of lisinopril 1
• If hypotension occurs, reduce diuretic dose if no signs of congestion remain 1
• If insufficient response to diuretic, increase dose or consider twice-daily administration 1
• Titrate lisinopril gradually to target doses shown to be effective in large trials (10-35 mg daily) 1, 4