A Comprehensive Review of the Loop Diuretics: Should Furosemide Be First Line?

Abstract

Growing evidence demonstrates more favorable pharmacokinetic profiles of torsemide and bumetanide compared with furosemide. Furthermore, torsemide may be more efficacious and safer than furosemide in patients with HF. A trial comparing all 3 drugs would be required to confirm torsemide as the primary loop diuretic in patients with HF, but based upon limited current evidence, we recommend torsemide over furosemide. Currently, little evidence exists to support either torsemide or bumetanide as first-line treatment over furosemide in patients with other edematous disease states.

Mortal Furosemide-Hypokalemia-Disturbances in Rats NO-System Related Shorten Survival by L-NAME. Therapy Benefit with BPC 157 Peptide More Than With L-Arginine

“…Diuretic-hypokalemia is an increasingly common cause of arrhythmias [3]. Therefore, we attempted to define hypokalemia and/or hypokalemia disturbances as particular disturbances related to NO-system and possible therapeutic value of NOsystem-related agents: NO-synthase (NOS)-blocker, L-NAME, NOSsubstrate, L-arginine, and, particularly, stable gastric pentadecapeptide BPC 157 [4][5][6].…”

Overview of Diuretic Strategies in Edematous States

“…In heart failure patients, toresemide has been shown to decrease left-ventricular remodeling, rates of hospitalization, and mortality over furosemide. 6 When compared to furosemide, bumetanide was more effective in reducing edema in patients with nephrotic syndrome and dyspnea in heart failure. 6 Certain localized edematous states secondary to venous insufficiency, moderate-severe lymphedema, or malignant ascites require caution against depleting plasma volume when using diuretics.…”

“…6 When compared to furosemide, bumetanide was more effective in reducing edema in patients with nephrotic syndrome and dyspnea in heart failure. 6 Certain localized edematous states secondary to venous insufficiency, moderate-severe lymphedema, or malignant ascites require caution against depleting plasma volume when using diuretics. 14 Given the multifactorial causes of diuresis failure, exploring the nature of the edema state, utilizing a different diuretic agent or considering an additional agent, changing the route, frequency (Table 1), or the dose, can be attempted.…”

“…5 The superior pharmacodynamic profile of toresemide (see Table 1) and its anti-aldosterone and vasorelaxation effect likely contributes to its better performance in improving left ventricular function, reduction of mortality, frequency/duration of heart-failure related hospitalization, quality of life, exercise tolerance and New York Heart Association functional class compared with furosemide. 6,7 Synergy of loop-diuretics with potassium sparing or thiazide diuretics is efficacious in persistent edematous states. 8 Additionally, inadequate tissue perfusion, signaled by increasing blood urea nitrogen or serum creatinine, can be addressed during diuresis in heart failure with inotropes or vasodilators.…”

Bruk av diuretika ved nyresykdom

“…Wargo & Banta publiserte i 2009 en oversiktsartikkel med spørsmål om furosemid fortsatt skal vaere førstevalget blant slyngediuretika (25). De konkluderer med at torsemid, et slyngediuretikum med halveringstid 3 -4 timer, har fordeler ved hjertesvikt.…”