Table 27: Diuretic dosing for the treatment of acute heart failure (AHF)

eGFR: >=60 mL/min/1.73m2
Patient: New onset HF or no current diuretic therapy
Initial IV dose*: Furosemide 20-40 mg 2-3 times daily
Maintenance oral dose: Lowest diuretic dose that allows for clinical stability is the ideal dose
Patient: Established HF or chronic oral diuretic therapy
Initial IV dose*: Furosemide dose IV equivalent of oral dose
Maintenance oral dose: Lowest diuretic dose that allows for clinical stability is the ideal dose
eGFR: <60 mL/min/1.73m2
Patient: New onset HF or no current diuretic therapy
Initial IV dose*: Furosemide 20-80 mg 2-3 times daily
Maintenance oral dose: Lowest diuretic dose that allows for clinical stability is the ideal dose
Patient: Established HF or chronic oral diuretic therapy
Initial IV dose*: Furosemide dose IV equivalent of oral dose
Maintenance oral dose: Lowest diuretic dose that allows for clinical stability is the ideal dose

eGFR (estimated glomerular filtration rate) is calculated from the Cockroft-Gault, CKD-EPI or Modification of Diet in Renal Disease formula. See section 7.4.2 for details.

*Intravenous continuous furosemide at doses of 5 to 20mg/h is also an option.

CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration;
eGFR, estimated glomerular filtration rate;
HF, heart failure;
I.V., intravenous.