Furosemide :: administration & dosage
Latest Paper:
Mesh-terms: Biological Markers :: blood; Contrast Media :: adverse effects; Coronary Angiography; Creatinine :: blood; Diuresis :: drug effects; Diuretics :: administration & dosage; Diuretics :: adverse effects; Furosemide :: administration & dosage; Furosemide :: adverse effects; Humans; Iodine Radioisotopes :: adverse effects; Journalism, Medical :: standards; Mannitol :: administration & dosage; Mannitol :: adverse effects; Odds Ratio; Publication Bias; Randomized Controlled Trials as Topic :: methods; Renal Insufficiency, Acute :: blood; Renal Insufficiency, Acute :: chemically induced; Renal Insufficiency, Acute :: complications; Renal Insufficiency, Acute :: physiopathology; Renal Insufficiency, Acute :: prevention & control; Research Design; Sample Size; Sodium Chloride :: administration & dosage; Time Factors; Treatment Outcome;
Most cited papers:
M A Stevens,
P A McCullough,
K J Tobin,
J P Speck,
D C Westveer,
D A Guido-Allen,
G C Timmis,
W W O'Neill
William Beaumont Hospital, Royal Oak, Michigan, USA.
OBJECTIVES: This study was done to test the hypothesis that a forced diuresis with maintenance of intravascular volume after contrast exposure would reduce the rate of contrast-induced renal injury. BACKGROUND: We have previously shown a graded relationship with the degree of postprocedure renal failure and the probability of in-hospital death in patients undergoing percutaneous coronary intervention. Earlier studies of singular prevention strategies (atrial natriuretic factor, loop diuretics, dopamine, mannitol) have shown no clear benefit across a spectrum of patients at risk. METHODS: A prospective, randomized, controlled, single-blind trial was conducted where 98 participants were randomized to forced diuresis with intravenous crystalloid, furosemide, mannitol (if pulmonary capillary wedge pressure <20 mm Hg), and low-dose dopamine (n = 43) versus intravenous crystalloid and matching placebos (n = 55). RESULTS: The groups were similar with respect to baseline serum creatinine (2.44+/- .80 and 2.55+/- .91 mg/dl), age, weight, diabetic status, left ventricular function, degree of prehydration, contrast volume and ionicity, and extent of peripheral vascular disease. The forced diuresis resulted in higher urine flow rate (163.26+/-54.47 vs. 122.57+/-54.27 ml/h) over the 24 h after contrast exposure (p = .001). Two participants in the experimental arm versus five in the control arm required dialysis, with all seven cases having measured flow rates <145 ml/h in the 24 h after the procedure. The mean individual change in serum creatinine at 48 h, the primary end point, was .48+/- .86 versus .51+/- .87, in the experimental and control arms, respectively, p = .87. There were no differences in the rates of renal failure across six definitions of renal failure by intent-to-treat analysis. However, in all participants combined, the rise in serum creatinine was related to the degree of induced diuresis after controlling for baseline renal function, r =- .36, p = .005. The rates of renal failure in those with urine flow rates greater than 150 ml/h in the postprocedure period were significantly lower, 8/37 (21.6%) versus 28/61 (45.9%), p = .03. CONCLUSIONS: Forced diuresis with intravenous crystalloid, furosemide, and mannitol if hemodynamics permit, beginning at the start of angiography provides a modest benefit against contrast-induced nephropathy provided a high urine flow rate can be achieved.
Mesh-terms: Aged; Cardiotonic Agents :: administration & dosage; Cardiotonic Agents :: therapeutic use; Comparative Study; Contrast Media :: adverse effects; Coronary Angiography; Coronary Disease :: radiography; Creatinine :: blood; Diuresis; Diuretics :: administration & dosage; Diuretics :: therapeutic use; Dopamine :: administration & dosage; Dopamine :: therapeutic use; Drug Therapy, Combination; Female; Follow-Up Studies; Furosemide :: administration & dosage; Furosemide :: therapeutic use; Human; Kidney Diseases :: blood; Kidney Diseases :: chemically induced; Kidney Diseases :: prevention & control; Male; Mannitol :: administration & dosage; Mannitol :: therapeutic use; Plasma Substitutes :: administration & dosage; Plasma Substitutes :: therapeutic use; Prospective Studies; Pulmonary Wedge Pressure; Rehydration Solutions :: administration & dosage; Rehydration Solutions :: therapeutic use; Risk Factors; Single-Blind Method; Support, Non-U.S. Gov't; Treatment Outcome;
Institute of Lung Disease, University of Siena, Italy.
To determine whether inhaled frusemide, a diuretic able to interfere with ion and water movement across airway epithelium, can modify exercise-induced bronchoconstriction, a three-part randomised, double-blind, placebo-controlled study was done in asthmatic patients who had a fall in FEV1 of at least 20% after running up and down a corridor. In the first part the effect of approximately 28 mg frusemide given as an aerosol was compared with that of a placebo. In the second part two doses of inhaled frusemide (approximately 14 mg and 28 mg) were examined. In the third part the effect of 20 mg oral frusemide was tested. Inhaled frusemide had a good and dose-related protective effect, whereas oral frusemide was ineffective. The mean (95% CI) maximum percentage falls in the FEV1 were: 11.5 (14.3-8.7) with frusemide and 33.8 (39.1-28.5) with placebo in the first part of the study; 13.6 (21.6-6. ) with 28 mg frusemide, 19.7 (28.2-11.3) with 14 mg frusemide, and 34.6 (39.4-30. ) with placebo in the second part of the study; and 15.2 (19.9-10.5) with inhaled frusemide, 38.2 (47.1-29.3) with oral frusemide, and 35.3 (45.9-24.7) with placebo in the last part of the study. The findings lend support to the hyperosmolarity hypothesis of exercise-induced asthma and may have therapeutic implications.
Mesh-terms: Administration, Inhalation; Administration, Oral; Adolescent; Adult; Asthma :: prevention & control; Asthma, Exercise-Induced :: physiopathology; Asthma, Exercise-Induced :: prevention & control; Child; Clinical Trials; Comparative Study; Dose-Response Relationship, Drug; Double-Blind Method; Drug Evaluation; Female; Forced Expiratory Volume; Furosemide :: administration & dosage; Furosemide :: therapeutic use; Human; Male; Random Allocation;
Department of Diagnostic Radiology, University of Technology, Aachen, Germany.
PURPOSE: To evaluate the clinical utility and morphologic accuracy of gadolinium-enhanced excretory magnetic resonance (MR) urography after low-dose diuretic injection and to correlate the results with those of conventional urography. MATERIALS AND METHODS: In 71 patients with urologic symptoms, excretory MR urography was performed after intravenous injection of 5-10 mg furosemide and, 30-60 seconds later, .1 mmol of gadopentetate dimeglumine per kilogram of body weight. The MR urograms were interpreted by three radiologists, who were blinded to the clinical outcome, and subsequently compared with conventional urograms. RESULTS: Injection of furosemide before contrast material led to rapid, uniform gadolinium distribution inside a sufficiently distended collecting system such that there was no excessive concentration of gadolinium in the urine. In patients with normal or moderately reduced excretory function, this effect allowed complete visualization of the urinary tract within 5-20 minutes of contrast material injection while minimizing gadolinium-related endoluminal T2* effects. The clinical course helped verify almost all MR urographic results. The MR urographic technique was significantly superior to conventional urography in the assessment of the ureters and bladder (P <.0001). Delineation of small caliceal abnormalities is still problematic. The best depiction of the pelvicaliceal system was obtained with fat-suppressed MR imaging, although it was still slightly inferior to conventional urography (P <.05). CONCLUSION: Gadolinium-enhanced excretory MR urography performed after low-dose diuretic injection is a promising and accurate alternative to conventional excretory urography for imaging the morphology of the urinary tract.
Mesh-terms: Adult; Aged; Comparative Study; Contrast Media; Diuretics, Sulfamyl :: administration & dosage; Diuretics, Sulfamyl :: diagnostic use; Female; Furosemide :: administration & dosage; Furosemide :: diagnostic use; Gadolinium DTPA :: diagnostic use; Human; Iohexol :: analogs & derivatives; Iohexol :: diagnostic use; Magnetic Resonance Imaging :: methods; Magnetic Resonance Imaging :: statistics & numerical data; Male; Middle Aged; Observer Variation; Sensitivity and Specificity; Urinary Tract :: pathology; Urography :: methods; Urography :: statistics & numerical data;
To identify patients with low-renin hypertension, we measured plasma renin activity after the administration of 40 mg of furosemide intravenously and 30 minutes of upright posture in 127 normotensive subjects and 363 patients with essential hypertension. Plasma renin activity 30 minutes after intravenous furosemide was found to be closely correlated to the level found after either 2 or 4 h of standing or 3 days of a low-salt diet plus 2 h of upright posture. Renin responsiveness was significantly lower in hypertensive patients, blacks, and women, compared with normotensive subjects, whites, and men respectively. The level of plasma renin activity in most normal white subjects was greater than 1. ng/ml - h and in most normal blacks was greater than .5 ng/ml - h. It was below those levels in 23% of white hypertensive and 25.2% of black hypertensive patients respectively. The mean level of plasma renin activity fell with increasing age of hypertensive patients. This procedure is recommended as a safe, easy, and reliable test for assessing renin responsiveness and identifying the low-renin state.
After an oral or intravenous dose of furosemide, there is considerable interindividual variability in the amount of unchanged drug delivered into the urine. On average, approximately half as much reaches the intraluminal site of action with an oral compared to an intravenous dose. However, the natriuretic response to the same dose administered by either route is virtually the same. Similarly, after pretreatment with probenecid, the same total amount of furosemide in urine causes a greater overall response. It has been presumed that this paradox is accounted for by differences in rate of delivery of furosemide to the active site such that after an oral dose, or after pretreatment with probenecid, amounts of drug are for longer periods of time at the "steep" portion of the dose-response curve. Our analysis shows this not to be the case. For furosemide, the "slope factor" of the dose-response curve is such that the amount of diuretic delivered into the urine which is maximally efficient (21.5 micrograms/min) is considerably less than the amount causing half-maximal response (69.8 micrograms/min). Oral administration or pretreatment with probenecid maintains drug close to this maximally efficient amount more persistently than does intravenous administration. By so doing, total response to an oral dose approaches that of intravenous dosing despite delivering half the amount of drug to the active site, and after probenecid an intravenous dose causes a greater response than intravenous dosing alone despite delivering the same amount of drug to the active site. These data emphasize the importance of the time course of delivery of drug to the active site as an independent determinant of overall response.
Mesh-terms: Administration, Oral; Binding Sites; Comparative Study; Dose-Response Relationship, Drug; Furosemide :: administration & dosage; Furosemide :: urine; Human; Injections, Intravenous; Kinetics; Natriuresis :: drug effects; Premedication; Probenecid :: therapeutic use; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. ; Time Factors;
Department of Clinical Pharmacology, Royal Postgraduate Medical School, London.
Minoxidil in combination with propranolol and diuretics controlled the blood-pressure in a group of hypertensive patients who were resistant to treatment with large doses of standard drugs. The main problem was fluid retention but subjective side-effects were fewer than in a comparable group on other drugs.
Mesh-terms: Blood Pressure :: drug effects; Drug Combinations; Female; Follow-Up Studies; Furosemide :: administration & dosage; Furosemide :: therapeutic use; Humans; Hypertension :: drug therapy; Male; Middle Aged; Minoxidil :: administration & dosage; Minoxidil :: adverse effects; Minoxidil :: therapeutic use; Propranolol :: administration & dosage; Propranolol :: therapeutic use;
Virginia Merrill Bloedel Hearing Research Center, Department of Otolaryngology, Head & Neck Surgery, University of Washington, Seattle 98195.
Cochlear function was monitored in adult gerbils using distortion product otoacoustic emissions (DPOAE) during intraperitoneal injection of furosemide. All stimulus parameters were varied independently over a wide range, the stimulus frequencies f1 and f2 from 1 to 16 kHz, and the stimulus levels L1 and L2 from 20 to 80 dB SPL. The observed emissions at 2f1-f2 and 3f1-2f2 could be considered to be made up of two distinct components:(1) an 'active' source which depended in a complex way on the stimulus frequencies and levels, which was dominant at low and moderate stimulus levels, and which, by definition, was eliminated by sufficient furosemide intoxication; and (2) a 'passive' source which was essentially the same at all frequencies, with a level dependence given approximately by a simple power law distribution. The change from the active to the passive source was usually accompanied by an abrupt shift in emission phase angle. A simple summation model was shown to account for the observed form of this transition. The amount of the decrease in 2f1-f2 emission amplitude after furosemide injection was approximately independent of frequency and consistent for the middle frequency ratios and intensity levels (f2/f1 approximately equal to 1.3, L1 x L2 approximately equal to 55 x 50 dB SPL). It was concluded that the combination of DPOAE with furosemide injection can usefully be employed as a probe of active cochlear mechanics.
Mesh-terms: Acoustic Stimulation; Animals; Cochlea :: drug effects; Cochlea :: physiology; Electrophysiology; Furosemide :: administration & dosage; Furosemide :: pharmacology; Gerbillinae; Injections, Intraperitoneal; Models, Biological; Otoacoustic Emissions, Spontaneous :: drug effects; Otoacoustic Emissions, Spontaneous :: physiology; Support, U.S. Gov't, P.H.S. ;
Tel Aviv University, Israel.
OBJECTIVE: Aspirin is known to have a bimodal effect on the renal handling of uric acid (UA). High dosages (>3 gm/day) are uricosuric, while low dosages (1-2 gm/day) cause UA retention. Although very-low-dose (mini-dose) aspirin is used increasingly as a platelet aggregation inhibitor, no studies have been published on whether aspirin's renal effects occur at dosages of < .5 gm/day. The aim of the present study was to evaluate the effects of commonly used mini-dosages of aspirin on renal function and UA handling in elderly patients. METHODS: The study included 49 elderly inpatients (age 61-94). Patients were excluded if they had renal failure, hyperuricemia, gout, or a history of bleeding, or if they were receiving anticoagulants, aspirin, or nonsteroidal antiinflammatory drugs. Previous medications and diet were kept unchanged. Aspirin was administered as follows: 75 mg/day (week 1), 150 mg/day (week 2), 325 mg/day (week 3), and mg/day (week 4). Baseline and weekly samples of blood and urine were evaluated for UA, creatinine, blood urea nitrogen, creatinine clearance, UA excretion, UA clearance, and plasma levels of aspirin. RESULTS: At the lowest dosage, aspirin caused a 15% decrease in the rate of UA excretion (P = .045 by t-test), which was associated with a slight but significant increase in serum levels of UA (P = .009). These effects on UA levels were gradually reduced with increasing dosages of aspirin (multivariate analysis of variance with repeated measures showed no statistically significant difference in the rate of UA excretion between weeks 1-3 and week [baseline], but the difference in serum UA levels for the same comparison was statistically significant [P = .038]). Generally, creatinine and UA clearance rates paralleled each other during aspirin treatment. However, 1 week after aspirin was discontinued, creatinine clearance remained decreased while UA clearance returned to baseline. Plasma aspirin concentrations were low and variable. However, patients with above-median aspirin levels had significantly greater changes in serum creatinine levels, urinary UA excretion rates, and UA clearance rates following the first week of aspirin treatment. Hypoalbuminemia and concomitant treatment with diuretics enhanced the effects of aspirin on renal function and UA retention. CONCLUSION: Mini-dose aspirin, even at a dosage of 75 mg/day, caused significant changes in renal function and UA handling within 1 week in a group of elderly inpatients, mainly in those with preexisting hypoalbuminemia. Given the widespread (and often unmonitored) use of mini-dose aspirin, especially among the elderly, these findings call for clinician alertness as well as for further studies to clarify the mechanisms underlying these phenomena.
Mesh-terms: Age Factors; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal :: administration & dosage; Anti-Inflammatory Agents, Non-Steroidal :: blood; Aspirin :: administration & dosage; Aspirin :: blood; Blood Urea Nitrogen; Creatinine :: blood; Creatinine :: urine; Diuretics, Sulfamyl :: administration & dosage; Female; Furosemide :: administration & dosage; Human; Hydrogen-Ion Concentration; Kidney :: drug effects; Kidney :: physiology; Kidney Function Tests; Male; Middle Aged; Prospective Studies; Serum Albumin; Uric Acid :: blood; Uric Acid :: urine;
Furosemide 40 mg was administered to 8 healthy subjects as an i.v. bolus dose, as 1 tablet in the fasting state, and as 1 tablet and a solution after food intake. The i.v. data gave a total body clearance of 162 +/- 10.8 ml/min and a renal clearance of 117 +/- 11.3 ml/min; the volume of distribution at steady state was 8.3 +/- .61. Oral administration gave a bio-availability of the tablet (fasting) of 51%. Food intake slightly reduced the bioavailability, but not to a significant extent. There was no significant difference in availability between the tablet and the solution. Moment analysis gave a mean residence time after the i.v. dose, MRTi .v., of 51 +/- 1.5 min. The mean absorption times (MAT) for all oral doses were significantly longer than the MRTi .v., indicating absorption rate-limited kinetics of furosemide. On average, food delayed the absorption by 60 min. The MAT for the tablet in the postprandial state was significantly longer than for the solution, indicating dissolution rate-limited absorption of the tablet.
Neurophysiologic and behavioral assessments of auditory function were performed on 224 very low birth weight (less than or equal to 1500 gm) infants requiring intensive care in the nursery. The subjects were studied prospectively from 36 weeks to 4 years of age, as available for follow-up. To classify them according to their neonatal status, we applied a principal components analysis to a number of variables representative of the extent of illness and of patient care in early postnatal life. The subjects were then divided into neonatal status quartiles and evaluated for hearing outcome. All those with sensorineural hearing loss fell exclusively into the lowest neonatal status quartile. Sensorineural hearing loss was statistically associated (1) with greater amounts of furosemide administration for longer durations and in combination with aminoglycoside antibiotics and (2) with more episodes of low pH, hypoxemia, or both, higher total bilirubin levels, and substantially lower neonatal status scores. Birth weight, gestational age, highest creatinine level, Apgar score, and aminoglycosides alone were not systematically related to hearing capacity. Subjects in the lowest neonatal status quartile also had a considerably higher incidence of middle ear disorders, characterized by elevated thresholds and prolonged auditory brain stem-response latencies reflective of conductive hearing loss. We conclude that protracted illness and its associated treatment, independently of specific diagnostic categories, constitute important risk factors for permanent hearing loss and for transient hearing loss in early life.
Mesh-terms: Aminoglycosides; Anoxemia :: complications; Anti-Bacterial Agents :: administration & dosage; Audiometry, Evoked Response; Bilirubin :: blood; Furosemide :: administration & dosage; Hearing Loss, Sensorineural :: etiology; Human; Infant, Low Birth Weight :: physiology; Infant, Newborn; Prospective Studies; Reaction Time; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ; Water-Electrolyte Imbalance :: complications;
