24
Treatment
7.2. Diuretics and Decongestion Strategies in Patients With
HF
COR LOE
Recommendations
1 B-NR 1. In patients with HF who have fluid retention, diuretics are
recommended to relieve congestion, improve symptoms, and
prevent worsening HF.
1 B-NR 2. For patients with HF and congestive symptoms, addition
of a thiazide (e.g., metolazone) to treatment with a loop
diuretic should be reserved for patients who do not respond to
moderate- or high-dose loop diuretics to minimize electrolyte
abnormalities.
Table 12. Commonly Used Oral Diuretics in Treatment of
Congestion for Chronic HF
Drug Initial Daily Dose
Maximum Total
Daily Dose Duration of Action
Loop diuretics
Bumetanide 0.5–1.0 mg once or
twice
10 mg 4–6 h
Furosemide 20–40 mg once or
twice
600 mg 6–8 h
Torsemide 10–20 mg once 200 mg 12–16 h
iazide diuretics
Chlorthiazide 250–500 mg once
or twice
1000 mg 6–12 h
Chlorthalidone 12.5–25 mg once 100 mg 24–72 h
Hydrochlorothiazide 25 mg once or
twice
200 mg 6–12 h
Indapamide 2.5 mg once 5 mg 36 h
Metolazone 2.5 mg once 20 mg 12–24 h
