Article Figures & Data
Figures
- FIGURE 1
Loop diuretic dose-response curves in patients with heart failure (green line) and without heart failure (blue line). Heart failure shifts the curve down and to the right, translating to the need for higher doses of diuretics to achieve the same degree of diuresis and decreased maximal diuretic response.
FENa = fractional excretion of sodium
Based on data from reference 2.
- FIGURE 2
Algorithm for initiation (day 1) of diuretic titration in patients with acute decompensated heart failure.
aHigher dose for reduced glomerular filtration rate.
bSee Table 1 for maximum recommended total daily dosing. IV = intravenous; UNa = urine sodium; UOP = urine output
Based on data from references 1 and 2.
Tables
Drug Starting daily dose Maximum recommended total daily dose Duration of action Loop diuretics Bumetanide PO/IV: 0.5–1.0 mg once or twice PO/IV: 10 mg 4–6 hr Furosemide PO/IV: 20–40 mg once or twice PO/IV: 600 mg 6–8 hr Torsemide PO: 10–20 mg once PO/IV: 200 mg 12–16 hr Thiazide diureticsa Chlorothiazide PO: 250–500 mg once or twice PO: 1,000 mg 6–12 hr Chlorthalidone PO: 12.5–25 mg once PO: 100 mg 24–2 hr Hydrochlorothiazide PO: 25 mg once or twice PO: 200 mg 6–12 hr Indapamide PO: 2.5 mg once PO: 5 mg 36 hr Metolazone PO: 2.5 mg once PO: 20 mg 12–24 hr Carbonic anhydrase inhibitors Acetazolamide PO: 250–375 mg once
IV: 500 mg oncePO/IV: 1,500 mg PO: 18–24 hr
IV: 4–5 hrPotassium-sparing diuretics Amiloride PO: 5 mg once PO: 20 mg 24 hr Triamterene PO: 50–75 mg twice PO: 200 mg 7–9 hr Spironolactone PO: 12.5–25 mg once PO: 100 mg 24 hrb ↵a Sequential nephron blockade dose of metolazone is 2.5 to 10 mg once daily (PO), hydrochlorothiazide 25 to 100 mg once or twice daily (PO), and chlorothiazide 500 to 1,000 mg once daily (IV), all 30 minutes before loop diuretics.
↵b Duration of action based on half-life of canrenone, the active metabolite of spironolactone. IV = intravenous; PO = oral
Based on data from references 1, 4, and 5.
