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I am posting this for the Clinical PHarmacist at our hospital. I hope
someone can provide us with some help.
Are there any guidelines published for furosemide IV push
administration? The manufacturer states that 20-80 mg can be given IV
push over 1 to 2 minutes and that "high dose" parenteral therapy should
be administered as a controlled intravenous infusion at a rate of not
greater than 4 mg/min. Is it safe to give furosemide undiluted in doses
> 100mg IV push over 1- 2 minutes which would exceed 40 mg/min???
We have not found an answer in a search of the literature.
Appreciate you help!
B. Miers
Health Science Librarian
Methodist Medical Ctr.
Peoria, IL
bteam.at.mtco.com
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Dear Colleague,
The main problem associated with furosemide when given IV push is
ototoxicity. This appears to occur particularly as a result of high serum
peaks of loop diuretics (ethacrynic acid >> furosemide > bumetinide). Here
are some "rules" that I try observe when using furosemide:
1- Maximum rate of iv push = 40 mg/min (no need for dilution)
2- Dose may be doubled every 2 hrs until adequate response is achieved.
3- The individual dose should not exceed 160 mg.
4- Total daily (iv) load should not exceed 800 mg (that is five 160-mg doses).
5- Oral dose = 2 x iv dose (bioavailability is about 60%)
Furosemide is sometimes given as a bolus followed by cont iv
infusion(diluted appropriately) at the rate of 0.05 - 0.5 mg/kg/hr (to
achieve and maintain a serum level of 1-2 mg/L). This method of
administration may reduce the risk of ototoxicity, but it does not appear
to enhance the diuretic response.
I hope this information is useful!
Needless to say that I assume no legal responsibility.
Please feel free to comment or ask further questions
N. Anaizi, PhD RPh
Univ of Rochester Med Center
(nanaizi.-at-.pharmacy.urmc.rochester.edu)
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Thanks very much for the useful information on furosemide guidelines.
It was greatly appreciated!
B.Miers
Methodist Med. Ctr.
Peoria, IL
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I tend to disagree with Dr. N. Anaizi that the individual dose should
not exceed 160 mg. Many patients with severe renal failure may not
adequately respond to this dose, in which case the dose needs to be
doubled. For a wonderful discussion of diuretic resistance, I highly
recommend:
Brater DC. Resistance to diuretics: mechanisms and clinical
implications. Adv Nephrol Necker Hosp 1993;22:349-69.
Arasb Ateshkadi, Pharm.D.
Assistant Professor
Department of Pharmacy Practice
College of Pharmacy
University of Utah
258 Skaggs Hall
Salt Lake City, UT 84112
TEL: (801) 581-6159
FAX: (801) 585-6160
e-mail: arasb.at.deans.pharm.utah.edu
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The issue of diuretic resistance raised by Dr. Atashkadi is a more specific
one. I was addressing general guidelines for the more common, inpatient use
of loop diuretics. On a few occasions we have used furo doses in excess of
200 mg in pts with oliguric RF. In most of these cases furo was used in
combination with chlorthiazide to block Na reabsorption at the more distal
sites of the nephron.
A comprehensive discussion of the clinical pharmacology of diuretics may be
found in section V of Messerli's "Cardiovascular Drug Therapy" published by
Sauders (2nd edition, '96)
N. Anaizi
At 10:41 AM 10/23/96 -0500, you wrote:
>PharmPK - Discussions about Pharmacokinetics
> Pharmacodynamics and related topics
>
>I tend to disagree with Dr. N. Anaizi that the individual dose should
>not exceed 160 mg. Many patients with severe renal failure may not
>adequately respond to this dose, in which case the dose needs to be
>doubled. For a wonderful discussion of diuretic resistance, I highly
>recommend:
>
>Brater DC. Resistance to diuretics: mechanisms and clinical
>implications. Adv Nephrol Necker Hosp 1993;22:349-69.
>
>Arasb Ateshkadi, Pharm.D.
>Assistant Professor
>Department of Pharmacy Practice
>College of Pharmacy
>University of Utah
>258 Skaggs Hall
>Salt Lake City, UT 84112
>TEL: (801) 581-6159
>FAX: (801) 585-6160
>e-mail: arasb.-at-.deans.pharm.utah.edu
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