Which medications in the drug class Preload Reducers are used in the treatment of Cardiogenic Pulmonary Edema?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Preload Reducers

Reduced pulmonary venous return decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation into the pulmonary interstitium and alveoli. Preload reducers include NTG (eg, Deponit, Minitran, Nitro-Bid IV, Nitro-Bid ointment, Nitrodisc, Nitro-Dur, Nitrogard, Nitroglyn, Nitrol, Nitrolingual, Nitrong, Nitrostat, Transdermal-NTG, Transderm-Nitro, Tridil) and furosemide (eg, Lasix).

Nitroglycerin IV (Nitro-Bid, Minitran, Nitrostat)

NTG is the drug of choice (DOC) for patients who are not hypotensive. It provides excellent and reliable preload reduction, and high dosages provide mild afterload reduction. NTG has rapid onset and offset (both within minutes), allowing for rapid clinical effects and rapid discontinuation of effects in adverse reactions.

Furosemide (Lasix)

Furosemide is the most commonly used loop diuretic. It increases the excretion of water by interfering with the chloride-binding cotransport system, inhibiting sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. Furosemide reduces preload by diuresis in 20-60 minutes. It may contribute to hastened preload reduction with a direct vasoactive mechanism, but this is controversial.

As many as 50% of patients with CPE have total-body euvolemia. Although furosemide is generally administered to all patients with CPE, it is probably most useful in patients with total-body fluid overload.

The oral form of furosemide has a relatively slow onset of action and, therefore, is generally not appropriate in CPE.

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