Furosemide 20mg Injection: Indications and Dosing
Primary Indications for Furosemide 20mg IV
Furosemide 20mg IV is indicated for the treatment of edema associated with heart failure, cirrhosis with ascites, nephrotic syndrome, and acute pulmonary edema when oral therapy is not feasible or in emergency situations. 1
Specific Clinical Scenarios
Edema (General):
- The initial dose is 20-40 mg IV given slowly over 1-2 minutes 1
- If inadequate response, another dose may be administered 2 hours later or the dose may be increased by 20 mg 1
- The individually determined dose should then be given once or twice daily 1
Acute Pulmonary Edema:
- Initial dose: 40 mg IV given slowly over 1-2 minutes 1
- If unsatisfactory response within 1 hour, increase to 80 mg IV slowly over 1-2 minutes 1
- The European Society of Cardiology recommends 20-40 mg IV bolus for acute heart failure with congestion, with the dose adjusted based on chronic diuretic use 2, 3
Cirrhosis with Ascites:
- Oral administration is preferred when possible due to good bioavailability and avoidance of acute GFR reduction 2
- Starting dose: 20-40 mg/day orally, combined with spironolactone 100 mg as a single morning dose 4
- Maximum dose: 160 mg/day 4
- IV furosemide 20mg would be reserved for patients unable to take oral medication 1
Nephrotic Syndrome:
- For severe edema: 0.5-2 mg/kg per dose IV up to six times daily (maximum 10 mg/kg per day) 2
- In adults with severe hypoalbuminemia and refractory edema, 20-40 mg IV may be given at the end of albumin infusions 2
Critical Pre-Administration Requirements
Before administering furosemide 20mg IV, verify the following:
- Systolic blood pressure ≥90-100 mmHg 2, 3
- Absence of marked hypovolemia 2, 3
- Serum sodium >120-125 mmol/L (severe hyponatremia is a contraindication) 4, 2
- Absence of anuria 2, 3
Administration Technique
The injection must be given slowly over 1-2 minutes to prevent ototoxicity. 1 For high-dose therapy or continuous infusion, the rate should not exceed 4 mg/minute 3, 1
Monitoring Requirements
Essential monitoring parameters include:
- Urine output (place bladder catheter in acute settings for rapid assessment) 2
- Blood pressure every 15-30 minutes in the first 2 hours 2
- Electrolytes (sodium, potassium) within 6-24 hours 2, 3
- Renal function (creatinine) within 24 hours 2
- Daily weights (target 0.5-1.0 kg/day loss) 4, 2
Common Pitfalls to Avoid
Never administer furosemide to hypotensive patients expecting hemodynamic improvement—it will worsen tissue perfusion and precipitate cardiogenic shock. 2 Furosemide does not improve blood pressure; it causes further volume depletion 2
Do not use furosemide to prevent or treat acute kidney injury itself—only to manage volume overload that complicates AKI. 2 Randomized trials demonstrate no benefit in preventing AKI and may increase mortality when used for this purpose 2
In acute pulmonary edema, do not use furosemide as monotherapy. IV nitroglycerin is superior and should be started concurrently, titrated to the highest hemodynamically tolerable dose 2
Dose Escalation Strategy
If inadequate response after 2 hours:
- Increase by 20 mg increments 1
- Maximum single dose should not exceed 80-100 mg in the first 6 hours 2
- Total dose should remain <240 mg in the first 24 hours 2, 3
For diuretic resistance:
- Consider combination therapy with thiazides (hydrochlorothiazide 25 mg) or aldosterone antagonists (spironolactone 25-50 mg) rather than escalating furosemide alone 2, 3
Pediatric Dosing
Initial dose: 1 mg/kg IV given slowly under close medical supervision 1
- May increase by 1 mg/kg increments (not sooner than 2 hours after previous dose) until desired effect 1
- Maximum: 6 mg/kg/day 1
- For premature infants: maximum 1 mg/kg/day 1
Absolute Contraindications
Stop or withhold furosemide if: