Diuretics for Edema
| Drug | Usual Dose | Comments |
|---|---|---|
| Loop (May be administered PO or IV) | ||
| Furosemide | 20-120 mg qd or bid | Short acting; potent; effective with low GFR |
| Bumetanide | 0.5-2 mg qd or bid | Better oral absorption than furosemide, but shorter duration of action |
| Torsemide | 20-200 mg qd | Better oral absorption than furosemide, longer duration of action |
| Distal, K-Losing | ||
| Hydrochlorothiazide | 12.5-25 mg qd | Causes hypokalemia; need GFR >25 mL/min |
| Chlorthalidone | 12.5-25 mg qd | Long acting (up to 72 h); hypokalemia |
| Metolazone | 1-5 mg qd | Long acting; hypokalemia; effective with low GFR, especially when combined with a loop diuretic |
| Distal, K-Sparing | ||
| Spironolactone | 12.5-100 mg qd | Hyperkalemia; acidosis; blocks aldosterone; gynecomastia, impotence, amenorrhea; onset takes 2-3 days; avoid use in renal failure or in combination with ACE inhibitors or potassium supplement |
25-50 mg qd | Similar side effects to spironolactone, but more specific for mineralocorticoid receptor; lower incidence of gynecomastia and amenorrhea | |
5-10 mg qd or bid | Hyperkalemia; once daily; less potent than spironolactone | |
| Triamterene | 100 mg bid | Hyperkalemia; less potent than spironolactone; renal stones |
Abbreviations: ACE, angiotensin-converting enzyme; GFR, glomerular filtration rate.
Source: From Chap. 42. Jaundice and Evaluation of Liver Function, HMOM-18.