Recommended dosing of diuretics in renal insufficiency
Loop diuretics: maximum intravenous bolus dose | |||
---|---|---|---|
Drug | Creatinine clearance < 25 mL/min | Creatinine clearance 25–75 mL/min | Creatinine clearance > 75 mL/min |
Furosemide | 160–200 mga | 80–160 mga | 40–80 mga |
Bumetanide | 8–10 mga | 4–8 mga | 1–2 mga |
Torsemide | 50–100 mga | 20–50 mga | 10–20 mga |
Loop diuretics: continuous infusion | |||
Drug | Creatinine clearance < 25 mL/min | Creatinine clearance 25–75 mL/min | Creatinine clearance > 75 mL/min |
Furosemide | 40-mg loading dose, then 20 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 40 mg/hour | 40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour | 40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour |
Bumetanide | 1-mg loading dose, then 1 mg/hour × 1 hour; if response is inadequate, increase infusion to 2 mg/hour | 1-mg loading dose, then 0.5 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 1 mg/hour | 1-mg loading dose, then 0.5 mg/hour |
Torsemide | 20-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, increase infusion to 20 mg/hour | 20-mg loading dose, then 5 mg/hour × 1 hour; if response is inadequate, increase infusion to 10 mg/hour | 20-mg loading dose, then 5 mg/hour |
Thiazide diuretics | |||
Drug | Creatinine clearance < 20 mL/min | Creatinine clearance 20–50 mL/min | Creatinine clearance > 50 mL/min |
Hydrochlorothiazide | 100–200 mg/day | 50–100 mg/day | 25–50 mg/day |
Chlorothiazide | Usual dosage range: 500–2,000 mg/day in 1 or 2 divided dosesb | ||
Metolazone | Usual dosage range: 2.5–20 mg once dailyb | ||
Carbonic anhydrase inhibitor | |||
Acetazolamide | Usual dosage range: 250–1,000 mg/day in 1 or 2 divided doses |