Optimal way of administration of high dose intravenous furosemide – continuous infusion or bolus?

Česká verzia

Authors: Jana Gallusová; Milada Halačová; Dalibor Černý
Authors place of work: Oddělení klinické farmacie Nemocnice Na Homolce Praha, vedoucí oddělení PharmDr. Milada Halačová, Ph. D.
Published in the journal: Vnitř Lék 2014; 60(10): 885-892
Category: Reviews

Summary

Introduction:
Furosemide is a loop diuretic used in states of volume overload. The need for high doses is due to its reduced efficacy caused by lower concentration of furosemide achieved at the site of action in the renal tubule lumen and adaptation mechanisms. High doses have been associated with the development of ionic dysbalance, direct toxicity and intravascular volume fluctuations. The way of furosemide administration (intermitent versus continuously) to influence efficacy and safety is contradictory evaluated in EBM.

Aim:
The aim of this study is to analyze the available data for evaluation of the efficacy and safety of intermittent versus continuous dose regimens.

Methods:
A systematic search on PubMed from 1990 to 2013 using the keywords – furosemide, loop diuretic, bolus, continuous infusion, efficacy, safety, heart failure, ICU, critical care.

Conclusion:
The pharmacokinetic and pharmacodynamic knowledge of furosemide create a theoretical assumption for the preference of continuous infusions before intermittent boluses. Assessement of available studies, however, yet in clinical practice did not proof the advantage of one over the other route of administration.

Key words:
bolus – continuous infusion – critical care – efficacy – furosemide– heart failure – ICU – loop diuretic – safety

Zdroje

1. Peacock WF, Costanzo MR, De Marco T et al. Impact of intravenous loop diuretics on outcomes of patients hospitalizes with acute decompensated heart failure: insights from the ADHERE registry. Cardiology 2009; 113(1): 12 -19.

2. Ho KM, Power BM Benefits and risks of furosemide in acute kidney injury. Anaesthesia 2010; 65(3): 283–293.

3. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal 2012; 33(14): 1787–1847.

4. HFSA 2010 Comprehensive heart failure practice guideline. J Card Fail 2010; 16(6): e1-e194. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cardfail.2010.04.004>.

5. Wilcox CS. New insights into diuretic use in patients with chronic renal disease. J Am Soc Nephrol 2002; 13(3): 798–805.

6. Ellison DH. Diuretic therapy and resistence in congestive heart failure. Cardiology 2001; 96(3–4): 132–143.

7. Felker GM, O´Connor ChM, Braunwald E. Loop diuretics in acute decompensated heart failure. Necessary? Evil? A necessary evil? Circ Heart Fail 2009; 2(1): 56–62.

8. Dormans TP, Pickkers P, Russel FG et al. Vascular effects of loop diuretics. Cardiovasc Res 1996; 32(6): 988–997.

9. Brater DC, Polavat C, Selwell R. Furosemide in patients with heart failure: shift in dose-response curves. Clin Pharmacol Ther 1980; 28(2): 182–186.

10. Kaissling B, Bachmann S, Kriz W. Structural adaptation of the distal convoluted tubule to prolonged furosemide treatment. Am J Physiol 1985; 248(3 Pt 2): F374-F381.

11. Aravindan N, Shaw A. Effect of Furosemide Infusion on Renal Hemodynamics and Angiogenesis Gene Expression in Acute Renal Ischemia/Reperfusion. Renal Failure 2006; 28(1): 25–35.

12. Townsend DR, Bagshaw SM. New insights on intravenous fluids, diuretics and acute kidney injury. Nephron Clin Pract 2008; 109(4): c206-c216. Dostupné z DOI: <http://doi: 10.1159/000142930>.

13. Francis GS, Siegel RM, Goldsmith SR et al. Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med 1985, 103(1): 1–6.

14. Miller ML, Blankenship CS. Ototoxicity. In: Tisdale JE, Miller DA. Drug-Induced Diseases: Prevention, Detection, and Management 2nd ed. American Society of Health-System Pharmacist: Bethesda, Maryland 2010: 1051. ISBN 978–1585282050.

15. Dormans TPJ, van Meyel JJM, Gerlag PGG et al. Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. J Am Coll Cardiol 1996; 28(2): 376–382.

16. Rybak LP. Pathophysiology of furosemide ototoxicity. Journal of Otolaryngology 1982; 11(2): 127–133.

17. van Meyel JJ, Smits P, Dormans T et al. Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistence. J Intern Med 1994; 235(4): 329–334.

18. Salvador DRK, Punzalan FE, Ramos GC et al. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database Syst Rev 2005; (3): CD003178.

19. Zangrillo A, Cabrini L, Monti G et al. Continuous infusion versus bolus injection of furosemide in critically ill patients. A systematic review and meta-analysis. Signa Vitae 2011; 6(2): 58–63.

20. Aaser E, Gullestad L, Tollofsrud S et al. Effect of bolus injection versus continuous infusion of furosemide on diuresis and neurohormonal activation in patients with severe congestive heart failure. Scandinavian J Clin Lab Invest 1997; 57(4): 361–367.

21. Lahav M, Regev A, Raanani P et al. Intermittent administration of furosemide vs continuous infusion preceded by a loading dose for congestive heart failure. Chest 1992; 102(3): 725–731.

22. Licata G, DiPasquale P, Parinello G et al. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J 2003; 145(3): 459–466.

23. Pivac N, Rumboldt Z, Sardelic S et al. Diuretic effects of furosemide infusion versus bolus injection in congestive heart failure. Int J Clin Pharmacol Res 1998; 18(3): 121–128.

24. Schuller D, Lynch JP, Fine D. Protocol-guided diuretic management: comparison of furosemide by continuous infusion and intermittent bolus. Crit Care Med 1997; 25(12): 1969–1975.

25. Allen LA, Turer AT, DeWald T et al. Continuous versus bolus dosing of Furosemide for patients hospitalized for heart failure. Am J Cardiol 2010; 105(12): 1794–1797.

26. Thomson MR, Nappi JM, Dunn SP et al. Continuous versus intermittent infusion of furosemide in acute decompensated heart failure. J Cardiac Fail 2010; 16(3): 188–193.

27. Felker GM, Lee KL, Bull DA et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011; 364(9): 797–805.

28. Copeland JG, Campbell DW, Plachetka JR et al. Diuresis with continuous infusion of furosemide after cardiac surgery. Am J Surg 1983; 146(6): 796–799.

29. Mojtahedzadeh M, Salehifar E, Vazin A et al. Comparison of hemodynamic and biochemical effects of furosemide by continuous infusion and intermittent bolus in critically ill patients. J Infus Nurs 2004; 27(4):255–261.

30. Ostermann M, Alvarez G, Sharpe MD et al. Frusemide administration in critically ill patients by continuous compared to bolus therapy. Nephron Clin Pract 2007; 107(2): c70-c76.

31. Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1. J AmColl Cardiol 2012; 60(12): 1031–1042.

32. House AA, Haapio M, Lassus J et al. Therapeutic strategies for heart failure in cardiorenal syndromes. Am J Kidney Dis 2010; 56(4): 759–773.

33. Tůma P, Hrdý P Diuretika v terapii ,,diuretické rezistence“ u pacientů s městnavou srdeční slabostí. Vnitř Lék 2006; 52(9): 782–789.

34. Micromedex Drug Summary Information. Version 2.0. Truven Health Anylytics 2014. Dostupnné z WWW: <http://www.micromedexsolutions.com/micromedex2/4.34.0/WebHelp/Search_Results/360_View/Drug_Dashboards.htm>.

35. Mullens W, Abrahams Z, Skouri HN et al. Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 2008; 51(3): 300–306.

36. Mehta RL, Pascual MT, Soroko S et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002; 288(20): 2547–2553.

37. Uchino S, Doig GS, Bellomo R et al. Diuretics and mortality in acute renal failure. Crit Care Med 2004; 32(8): 1669–1677.

38. Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 2006; 333:420. Dostupné z DOI: < http://dx.doi.org/10.1136/bmj.38902.605347.7C>.

39. Seabra VF, Balk EM, Liangos O et al. Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis. Am J Kidney Dis 2008; 52(2): 272–284.

40. Cotter G, Metzkor E, Kaluski E Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 1998; 351(9100): 389–393.

41. Giamouzis G, Butler J, Starling RC et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the dopamine in acute decompensated heart failure (DAD-HF) trial. J Card Fail 2010; 16(12): 922–930.

42. Felker GM, Mentz RJ Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol 2012; 59(24): 2145–2153. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2011.10.910>.