From the Guidelines
Albumin and furosemide (Lasix) should be used together in specific clinical situations, particularly in patients with cirrhosis and ascites, or in those with hypoalbuminemia and edema, as this combination enhances the diuretic effect of furosemide and helps maintain intravascular volume and blood pressure, as supported by the most recent evidence from 2024 1.
Key Points to Consider
- The combination of albumin and furosemide is particularly useful in patients with liver disease who have low albumin levels and are resistant to diuretics alone, as it helps mobilize fluid from the third space back into the circulation where it can be eliminated by the kidneys.
- The use of albumin in patients with spontaneous bacterial peritonitis (SBP) has been shown to reduce the risk of renal dysfunction and mortality, with a recommended dose of 1.5 g/kg on day 1 and 1 g/kg on day 3, as indicated by recent studies 1.
- However, albumin should not be used in patients with cirrhosis and uncomplicated ascites, as standard therapy for cirrhotic ascites is sodium restriction plus diuretics (spironolactone with or without furosemide) 1.
- The combination therapy should be used cautiously in patients with heart failure or kidney dysfunction, as it may worsen their condition.
Clinical Recommendations
- Administer albumin (25% solution, 25-50g) intravenously, followed by furosemide (20-80mg IV), in patients with cirrhosis and ascites, or in those with hypoalbuminemia and edema, as supported by recent evidence 1.
- Monitor patients closely for signs of hypotension, fluid overload, and renal dysfunction, and adjust the dose of albumin and furosemide accordingly.
- Consider alternative treatments, such as terlipressin, in patients who do not respond to albumin and furosemide, as suggested by recent studies 1.
From the FDA Drug Label
Furosemide is extensively bound to plasma proteins, mainly to albumin Plasma concentrations ranging from 1 to 400 mcg/mL are 91 to 99% bound in healthy individuals. The use of albumin and Lasix (furosemide) together is likely due to the fact that furosemide is extensively bound to albumin in the blood. This means that albumin can help to increase the circulation of furosemide in the body, potentially enhancing its diuretic effect.
- Key points:
- Furosemide binding to albumin may be reduced in elderly patients 2
- Furosemide is predominantly excreted unchanged in the urine However, the exact reason for using albumin and Lasix together is not explicitly stated in the provided drug label.
From the Research
Rationale for Using Albumin and Lasix Together
- The combination of albumin and Lasix (furosemide) is used to treat diuretic-resistant edema in patients with nephrotic syndrome and cirrhosis 3.
- Albumin supplementation is indicated in patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, and the treatment of type 1 hepatorenal syndrome 4.
- The use of albumin and Lasix together may provide clinical benefits for select patients with recalcitrant edema or ascites in whom diuretic doses have been maximized and those with severe hypoalbuminemia 3.
Mechanism of Action
- The combination of albumin and Lasix increases urine volume and sodium excretion by enhancing diuresis and natriuresis 5, 6.
- Albumin administration alone and with Lasix in patients with nephrotic syndrome results in different urine volumes and sodium levels, with co-administration increasing the urine volume and sodium level due to an increase in the glomerular filtration rate (GFR) as well as the diuretic effects of Lasix 6.
Clinical Evidence
- Studies have reported conflicting results regarding the efficacy of combined Lasix and albumin in the management of nephrotic syndrome and cirrhosis 3.
- A systematic review found that urine excretion was greater after treatment with Lasix and albumin versus Lasix alone, but the results for sodium excretion were inconclusive 7.
- The current evidence is not sufficient to make definitive conclusions about the role of albumin in treating nephrotic edema, and high-quality randomized studies with adequate sample sizes are needed 7.