Loop diuretic: Difference between revisions
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== Key Agents == | == Key Agents == | ||
* '''[[Furosemide]]''' (Lasix) | * '''[[Has DrugName::Furosemide]]''' (Lasix) | ||
** '''Bioavailability:''' Highly variable PO absorption (10-90%, avg ~50%) | ** '''Bioavailability:''' Highly variable PO absorption (10-90%, avg ~50%) | ||
*** IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO) | *** IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO) | ||
** '''Dosing:''' In [[CHF]], usually start with 1-2.5x the patient's daily home dose IV | ** '''Dosing:''' In [[CHF]], usually start with 1-2.5x the patient's daily home dose IV | ||
* '''[[Has | * '''[[Has DrugName::Bumetanide]]''' (Bumex) | ||
** '''Potency:''' ~40x more potent than furosemide | ** '''Potency:''' ~40x more potent than furosemide | ||
*** 1 mg Bumetanide ≈ 40 mg Furosemide | *** 1 mg Bumetanide ≈ 40 mg Furosemide | ||
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** Often reserved for patients refractory to furosemide or with severe gut edema | ** Often reserved for patients refractory to furosemide or with severe gut edema | ||
* '''[[Has | * '''[[Has DrugName::Torsemide]]''' (Demadex) | ||
** '''Kinetics:''' Longer half-life than furosemide | ** '''Kinetics:''' Longer half-life than furosemide | ||
** '''Bioavailability:''' Excellent oral absorption | ** '''Bioavailability:''' Excellent oral absorption | ||
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** Less common in acute resuscitation; helpful for chronic management | ** Less common in acute resuscitation; helpful for chronic management | ||
* '''[[Has | * '''[[Has DrugName::Ethacrynic acid]]''' (Edecrin) | ||
** '''Class:''' Phenoxyacetic acid derivative (not a sulfonamide) | ** '''Class:''' Phenoxyacetic acid derivative (not a sulfonamide) | ||
** '''Indication:''' The only alternative for patients with ''severe'' or anaphylactic '''sulfa allergy''' | ** '''Indication:''' The only alternative for patients with ''severe'' or anaphylactic '''sulfa allergy''' | ||
Revision as of 00:45, 28 January 2026
Background
- Mechanism: Inhibits Na-K-2Cl carrier in the thick ascending Loop of Henle^1^
- Potency: Highest among diuretic classes
- Adverse Effects
- Hypokalemia (most common)
- Hypomagnesemia, hyponatremia, hypocalcemia
- Ototoxicity (associated with rapid IV push)
- Pre-renal AKI (due to over-diuresis)
- Sulfa Allergy: Most are sulfonamide derivatives; cross-reactivity is rare but possible
Key Agents
- Furosemide (Lasix)
- Bioavailability: Highly variable PO absorption (10-90%, avg ~50%)
- IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO)
- Dosing: In CHF, usually start with 1-2.5x the patient's daily home dose IV
- Bioavailability: Highly variable PO absorption (10-90%, avg ~50%)
- Bumetanide (Bumex)
- Potency: ~40x more potent than furosemide
- 1 mg Bumetanide ≈ 40 mg Furosemide
- Bioavailability: High and reliable absorption (>80%)
- Often reserved for patients refractory to furosemide or with severe gut edema
- Potency: ~40x more potent than furosemide
- Torsemide (Demadex)
- Kinetics: Longer half-life than furosemide
- Bioavailability: Excellent oral absorption
- PO dose is essentially equivalent to IV dose
- Less common in acute resuscitation; helpful for chronic management
- Ethacrynic acid (Edecrin)
- Class: Phenoxyacetic acid derivative (not a sulfonamide)
- Indication: The only alternative for patients with severe or anaphylactic sulfa allergy
- Toxicity: Highest risk of ototoxicity among loop diuretics
- Seldom used as first-line due to side effect profile