Can Amifru (frusemide) be administered at night?

From the Guidelines

Amifru should not be given at night due to its diuretic effects, which can disrupt sleep patterns and lead to poor rest quality, unless specifically prescribed by a doctor for a particular condition. Taking Amifru at night may cause increased urination during sleeping hours, potentially leading to poor rest quality and disrupting sleep patterns.

• It's typically better to take diuretics like Amifru in the morning or early afternoon to avoid nighttime bathroom trips.
• The medication works by blocking sodium reabsorption in the kidneys and increasing urine output to reduce fluid retention and lower blood pressure.
• If you're experiencing significant sleep disruption due to nighttime dosing, consult your healthcare provider about potentially adjusting the timing of your medication while maintaining effective treatment of your condition, as suggested by 1.
• According to 1, the risk of electrolyte depletion is markedly enhanced when 2 diuretics are used in combination, and concomitant administration of ACEIs alone or in combination with potassium-retaining agents can prevent electrolyte depletion in most patients with HF who are taking a loop diuretic.
• Excessive use of diuretics can decrease blood pressure and impair renal function and exercise tolerance, but hypotension and azotemia may also occur as a result of worsening HF, which may be exacerbated by attempts to reduce the dose of diuretics, as noted in 1.

From the FDA Drug Label

The individually determined single dose should then be given once or twice daily (eg, at 8 am and 2 pm)

The FDA drug label does not explicitly state that Amifru (Furosemide) can or cannot be given at night. However, it provides examples of administration times as 8 am and 2 pm, suggesting that daytime administration is typical.

• Administration timing is not explicitly restricted to daytime hours, but the provided examples do not include nighttime administration.
• No direct information is available in the label to support the administration of Amifru at night 2.

From the Research

Administration of Amifru (Furosemide) at Night

• The administration of furosemide at night is explored in the context of treating nocturnal polyuria, a condition characterized by excessive urine production at night 3.
• A study published in the British Journal of Urology found that an afternoon dose of frusemide (40 mg) taken 6 hours before bedtime significantly reduced nocturnal voiding frequency and voided volume in elderly men with lower urinary tract symptoms 3.
• However, the pharmacokinetic behavior of furosemide is marked by a large degree of variability, which may affect its efficacy when administered at night 4.
• Another study suggests that loop diuretics like furosemide can be effective in treating nocturia caused by cardiovascular diseases such as hypertension and heart failure, but recommends administration in the morning 5.

Considerations for Nighttime Administration

• The bioavailability of furosemide from oral dosage forms is highly variable, which may impact its effectiveness when taken at night 4.
• Furosemide is highly bound to plasma proteins, which restricts its apparent volume of distribution and may affect its duration of action 4.
• The use of furosemide at night may require careful monitoring of the patient's response to therapy, as well as their fluid and electrolyte balance 6.