Diuretics for Edema | ||
| DRUG | USUAL DOSE | COMMENTS |
|---|---|---|
| Loop (may be administered PO or IV) | ||
| Furosemide | 20-200 mg qd or bid | Short acting; potent; effective with low GFR |
| Bumetanide | 0.5-5 mg qd or bid | Better oral absorption than furosemide, but shorter duration of action; enhanced metabolism in CKD |
| Torsemide | 20-100 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 |
| 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, use with caution in combination with ACE inhibitors or angiotensin receptor blockers |
| Eplerenone | 25-50 mg qd | Similar side effects to spironolactone, but more specific for mineralocorticoid receptor; lower incidence of gynecomastia and amenorrhea |
| Amiloride | 5-10 mg qd or bid | Hyperkalemia; once daily; less potent than spironolactone |