Which medications in the drug class Diuretics, Loop are used in the treatment of Dilated Cardiomyopathy?

Updated: Nov 28, 2018
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Diuretics, Loop

Diuretics are reserved for congestive states. They are not indicated for patients with functional restriction in the absence of edema/congestion.

Patients can effectively adjust their diuretic use by weighing themselves at home. If patients have a 3- to 5-lb weight gain in 1-7 days, they should be advised to double their diuretic dose and potassium supplement for 1 day. Additional treatment should be based on the effectiveness of this increased dose to reduce weight or symptoms. Agents such as metolazone, hydrochlorothiazide, and acetazolamide may be used to augment effects of loop diuretics.

Furosemide (Lasix)

Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. The bioavailability of oral furosemide is 50%. If a switch is made from IV to oral administration, an equivalent oral dose should be used. Doses vary depending on the patient's clinical condition.

Bumetanide

Bumetanide increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle. This agent does not appear to act in the distal renal tubule.

Torsemide (Demadex)

Torsemide is well-absorbed, with a peak plasma concentration within 1 hour. Oral bioavailability does not differ between patients with CHF and normal patients (80-90%).

The bioavailability of furosemide is aoout 50%, but it is highly variable (10-90%). In patients with severe edema that may impair absorption, the furosemide effect may be limited, and therapy should be switched to torsemide.

Bumetanide has an oral bioavailability of 80-100%. Torsemide is considered superior to furosemide and bumetanide: Its bioavailability is superior to that of furosemide, and it has a longer half-life than bumetanide.

Ethacrynic acid (Edecrin)

Ethacrynic acid increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. This agent is used only in refractory cases. Continuous IV infusion is preferable in many cases. It is indicated for temporary treatment of edema associated with heart failure when greater diuretic potential is needed. It is useful for patients who have a true sulfonamide allergy. 


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