Usual Adult Dose for Ascites

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Congestive Heart Failure

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Edema

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Nephrotic Syndrome

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Renal Failure

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Liver Cirrhosis

IV/IM:
Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
Maximum dose: 600 mg/day in patients with clinically severe edematous states

Comments:

• Edema may be most efficiently and safely mobilized by giving this drug on 2 to 4 consecutive days each week.
• When doses greater than 80 mg/day are given for prolonged periods of time, careful clinical observation and laboratory monitoring are particularly advisable.

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Usual Adult Dose for Pulmonary Edema

40 mg IV slowly over 1 to 2 minutes; if a satisfactory response doesn't occur within one hour, may increase to 80 mg IV slowly over 1 to 2 minutes.

Use: Adjunctive therapy in acute pulmonary edema. IV administration of this drug is indicated when a rapid onset of diuresis is desired (e.g., in acute pulmonary edema).

Usual Adult Dose for Hypertension

Oral:
Initial dose: 80 mg/day, usually divided into 40 mg orally twice a day

Use: Treatment of hypertension alone or in combination with other antihypertensive agents.

Usual Pediatric Dose for Edema

IV/IM:
1 mg/kg IV or IM slowly; if the diuretic response to the initial dose is not satisfactory, may increase by 1 mg/kg and administer no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.

Maximum dose: 6 mg/kg (1 mg/kg/day for premature infants)

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Oral:
Initial dose: 2 mg/kg orally once; if the diuretic response to the initial dose is not satisfactory, may increase by 1 or 2 mg/kg and administer no sooner than 6 to 8 hours after the previous dose.
Maintenance dose: Adjust to minimum effective dose.

Maximum dose: 6 mg/kg

Use: Treatment of edema associated with congestive heart failure, cirrhosis of the liver and renal disease, including the nephrotic syndrome, especially when an agent with greater diuretic potential is desired.

Renal Dose Adjustments

If increasing azotemia and oliguria occur during treatment of severe progressive renal disease: Discontinue this drug

Liver Dose Adjustments

Use with caution

Dose Adjustments

Hypertension:
When this drug is added to a antihypertensive regimen, the dosage of the other agents should be reduced by at least 50% when this drug is added. A further reduction in dosage or even discontinuation of the other agents may be required.

Precautions

US BOXED WARNING:

• FLUID/ELECTROLYTE DEPLETION: This drug is a potent diuretic which, if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose schedule must be adjusted to the individual patient's needs.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice: Parenteral administration should be used only in patients unable to take oral medication or in emergency situations and should be replaced with oral therapy as soon as practical.

Storage requirements: Protect from light.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility: Acid solutions, including other parenteral medications (e.g., labetalol, ciprofloxacin, amrinone, milrinone) must not be administered concurrently in the same infusion. Do not add this drug to a running IV line containing any of these acidic products.

Monitoring:

• Metabolic: Serum electrolytes and carbon dioxide frequently during the first few months and periodically thereafter.
• Renal: BUN and creatinine frequently during the first few months and periodically thereafter.

Patient advice:

• Advise patients that they may experience symptoms of fluid and/or electrolyte loss, such as postural hypotension.
• Encourage patients to protect exposed skin from the sun and artificial ultraviolet radiation.
• Inform patients with diabetes mellitus that this drug may increase blood glucose levels.

Frequently asked questions

• What are the equivalent dosages of bumetanide, furosemide & torsemide?