What is the renal dose of Furosemide (Lasix)?

From the Guidelines

The renal dose of Lasix (furosemide) should be initiated at 20-40 mg intravenous for patients with new-onset acute heart failure or those not receiving oral diuretics, and at least equivalent to the oral dose for those on chronic diuretic therapy. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.

Key Considerations

• For patients with mild to moderate renal impairment, the standard dose can be used, but careful monitoring is recommended.
• For severe renal impairment, higher doses may be needed to achieve the desired diuretic effect, typically starting with the usual dose and titrating upward if necessary.
• Doses up to 160-200 mg may be required in severe renal dysfunction.
• The medication should be administered slowly to prevent ototoxicity, especially at higher doses.
• Careful monitoring of electrolytes, particularly potassium, sodium, and magnesium, is essential as furosemide can cause significant electrolyte disturbances.
• Monitoring of renal function and clinical response is important to ensure efficacy while minimizing adverse effects.

Administration and Monitoring

• Furosemide works by inhibiting sodium and chloride reabsorption in the loop of Henle, and in renal impairment, more medication is needed to reach the site of action due to decreased renal blood flow and tubular secretion.
• It is recommended to regularly monitor symptoms, urine output, renal function, and electrolytes during use of i.v. diuretics 1.
• Diuretics can be given either as intermittent boluses or a continuous infusion, and the dose and duration should be adjusted according to the patient's symptoms and clinical status 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults: ... Edema The usual initial dose of furosemide is 20 to 40 mg given as a single dose, injected intramuscularly or intravenously If the physician elects to use high dose parenteral therapy, add the furosemide to either Sodium Chloride Injection USP, Lactated Ringer's Injection USP, or Dextrose (5%) Injection USP after pH has been adjusted to above 5. 5, and administer as a controlled intravenous infusion at a rate not greater than 4 mg/min.

• The renal dose of Lasix (furosemide) is not explicitly stated in the label for renal impairment.
• However, the label provides dosing information for adults with edema, which includes a usual initial dose of 20 to 40 mg given as a single dose, injected intramuscularly or intravenously.
• For high dose parenteral therapy, the label recommends administering furosemide as a controlled intravenous infusion at a rate not greater than 4 mg/min 2.

From the Research

Renal Dose of Lasix

The renal dose of Lasix, also known as furosemide, can vary depending on the patient's renal function and the specific clinical scenario.

• In patients with chronic renal insufficiency, a dose of 40 mg intravenously is recommended 3.
• In patients with severe renal impairment, the dose may need to be adjusted based on the patient's creatinine clearance, with a population mean renal clearance of 1.17 l/h for a subject with severe renal impairment (CLCR = 30 ml/min) 4.
• High doses of furosemide, up to 720 mg per day orally or 1400 mg per day intravenously, have been used in patients with resistant edematous states or renal disease, but this should be done with caution and close monitoring 5.
• In patients with chronic renal insufficiency, limited doses of furosemide, such as 120 to 160 mg intravenously, may be sufficient to achieve a maximal response, and larger doses may not be necessary 6.
• Small doses of furosemide, such as 40 mg, have been shown to increase urinary volume and sodium excretion in chronic kidney disease patients with residual renal function undergoing hemodialysis 7.