From the Guidelines
Lasix (furosemide) should be used with caution in patients with pleural effusion, as its effectiveness is limited to transudative effusions and it may not be sufficient for exudative effusions, and its use requires careful monitoring of renal function and electrolytes 1. When considering the use of Lasix for pleural effusion, it's essential to determine the type of effusion, as transudative effusions are more likely to respond to diuretic therapy. The European Respiratory Journal study 1 suggests that intensification of medical therapies, including diuresis, may be considered for patients with fluid overload or heart failure. However, the study also notes that the effectiveness of diuretic therapy may be limited, and other interventions, such as thoracocentesis or pleurodesis, may be necessary. The typical starting dose of Lasix for pleural effusion is 20-40mg orally or intravenously, which can be increased as needed based on the patient's response. It's crucial to monitor electrolytes, especially potassium, renal function, and fluid status when administering Lasix. Patients should be advised about increased urination and potential orthostatic hypotension. In patients with end-stage renal failure and pleural effusion, the use of Lasix may be limited, and other interventions, such as indwelling pleural catheter (IPC) or surgical intervention, may be considered 1. The study by POTECHIN et al. 1 describes a case series of nine IPCs inserted in eight patients who had recurrent effusion and were already on maximal medical therapy, including furosemide 160 mg·day−1, and intolerant of dialysis. Overall, the use of Lasix for pleural effusion requires careful consideration of the patient's underlying condition, the type of effusion, and the potential risks and benefits of diuretic therapy. The most recent and highest quality study 1 suggests that a cautious approach to diuretic therapy is necessary, with careful monitoring of renal function and electrolytes, and consideration of other interventions, such as thoracocentesis or pleurodesis, as needed.
From the Research
Treatment of Pleural Effusion
- Pleural effusion is typically treated by addressing the underlying cause of the condition 2.
- For transudative effusions, treatment usually involves managing the underlying medical disorder 2.
- Diuretics, such as Lasix (furosemide), may be used to treat pleural effusions caused by congestive heart failure 3, 4.
- However, the use of diuretics may not always be effective in resolving the pleural effusion, and therapeutic thoracentesis may be necessary to provide symptomatic relief 5.
Use of Lasix in Pleural Effusion
- Lasix (furosemide) is a diuretic that may be used to treat pleural effusions caused by congestive heart failure 3, 4.
- A study published in 1990 found that aggressive diuresis with Lasix did not typically change the characteristics of pleural fluid from a transudate to an exudate 4.
- Another study published in 2001 found that patients with heart failure may have exudative pleural effusions without an obvious cause except heart failure, and that diuretic therapy may be associated with these effusions 3.
Alternative Treatment Options
- Therapeutic thoracentesis is a procedure that involves removing excess fluid from the pleural space to provide symptomatic relief 2, 5.
- This procedure may be necessary for patients with large, refractory pleural effusions, or for those who do not respond to diuretic therapy 2, 5.
- Lung ultrasound-guided therapeutic thoracentesis is a safe and effective procedure that can be used to treat pleural effusions in patients with heart failure 5.