Diuretics Used In Heart Failure
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Oral Diuretics Recommended for Use in the Treatment of Chronic Heart Failure

Drug Initial Daily Dose(s) Maximum Total Daily Dose Duration of action
Loop Diuretics
Bumetanide Oral: 0.5 to 1 mg qd-bid 10 mg 4 to 6 hours
Furosemide Oral: 20 to 40 mg qd-bid 600 mg 6 to 8 hours
Torsemide Oral: 10 to 20 mg qd 200 mg 12 to 16 hours
Thiazide Diuretics
Chlorthiazide 250-500 mg qd-bid 1000 mg 6 to 12 hours
Chlorthalidone 12.5 to 25 mg qd 100 mg 24 to 72 hours
Hydrochlorothiazide 25 mg qd - bid 200 mg 6 to 12 hours
Indapamide 2.5 mg qd 5 mg 36 hours
Metolazone 2.5 mg qd 20 mg 12 to 24 hours
Potassium-sparing diuretics
Amiloride 5 mg qd 20 mg 24 hours
Spironolactone 12.5 to 25 mg qd 50 mg (possibly higher doses in select cases) 2 to 3 days
Triamterene 50 to 75 mg bid 200 mg 7 to 9 hours
Sequential Nephron blockade
Metolazone 2.5 to 10 mg qd plus loop diuretic
Hydrochlorothiazide 25 to 100 mg qd-bid plus loop diuretic
Chlorthiazide (IV) 500 to 1000 mg qd plus loop diuretic
Intravenous Diuretic Medications Useful for the Treatment of Severe Heart Failure
Loop Diuretics
Drug Initial dose Max single dose  
Bumetanide 1 mg 4 to 8 mg  
Furosemide 40 mg 160 to 200 mg  
Torsemide 10 mg 100 to 200 mg  
Thiazide Diuretics
Chlorthiazide 500mg 1000 mg  
Intravenous Infusions
Bumetanide 1 mg IV load, then 0.5 to 2 mg per hour
Furosemide 40 mg IV load, then 10 to 40 mg per hour
Torsemide 20 mg IV load, then 5 to 20 mg per hour


Direct quotes from this valuable reference:
Hunt SA, Abraham WT, Chin MH, Feldman AM, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20;112(12):e154-235. Epub 2005.  
Link: http://circ.ahajournals.org/cgi/content/full/112/12/e154


All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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