Adult Dosing
Edema
- Usual dose: 50 mg IV single dose
- Alt Dose: 0.5-1 mg/kg IV as a single dose
- Note: may repeat second dose if needed for the patients with CHF, hepatic or renal disease
- Max: 100 mg/dose
Short-term management of ascites
- Usual dose: 50 mg IV single dose
- Alt Dose: 0.5-1 mg/kg IV as a single dose
- Note: May repeat second dose if needed for the patients with malignancy, idiopathic edema or lymphedema
- Max: 100 mg/dose
Note: Dose and dose schedule must be adjusted to the individual patient's needs to prevent a more rapid or substantial loss of fluid or electrolyte than is indicated or necessary
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
- Avoid profound electrolyte and water loss by weighing the patient throughout the treatment period. Reduce dosage or suspend therapy when excessive electrolyte loss occurs
- Administer cautiously in patients with a history of previous episodes of electrolyte imbalance or hepatic encephalopathy to avoid precipitation of hepatic coma and death
- Deaths have been reported in patients with severe myocardial disease who have been receiving digitalis and in patients with severely decompensated hepatic cirrhosis with ascites
- Do not administer lithium with diuretics
- Therapy may cause weakness, muscle cramps, paresthesias, thirst, anorexia, and signs of hyponatremia, hypokalemia, and/or hypochloremic alkalosis following vigorous or excessive diuresis
- In patients receiving other antihypertensive agents orthostatic hypotension may occur
- Hypomagnesemia may occur due to increased urinary excretion of magnesium
- Suspend therapy if a transient increase in serum urea nitrogen
- Increased risk of gastric hemorrhage associated with corticosteroid treatment has been reported with the therapy
- In patients with severe impairment of renal function deafness, tinnitus, and vertigo with a sense of fullness in the ears have occurred most frequently
Cautions: Use cautiously in
- Hepatic impairment
- Advanced cirrhosis of the liver
- History of previous episodes of electrolyte imbalance
- History of hepatic encephalopathy
- Diabetes mellitus
- Increasing azotemia
- Elderly cardiac patients
Pregnancy Category:B
Breastfeeding: Safety unknown, use with caution; an alternate drug may be preferred, especially while nursing a newborn or preterm infant based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 February 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer advises discontinuation of nursing or discontinuation of the drug, taking into account the importance of the drug to the mother.
