lasix injection over oral

[pwnttothemax]

I work at a veteran's hospital, and I've noticed a lot of patients are on lasix injectable as opposed to lasix oral. At first I thought it justifiable; maybe they all have GI problems or something and can't absorb well. But I don't mean just a few, I mean a significant portion of patients on a scheduled dose of injectable so I don't think that's why.

I asked the pharmacists I work with and got a seeming cop-out answer, "it works faster." But if the dose is scheduled BID, I think the end result would be the same without the inherent risk of having to stick a patient.

Anyone know for if there's a specific indication or reasoning behind mass use of scheduled injectable diuretics?

Thanks all! It's been a while since I've posted, but these forums are always full of answers!

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[pwnttothemax]

nobody knows?? weekly bump

 

[rxlea]

Well what's the bioavailability of oral? Time to peak effect?

What if your patient has severe edema?

Also, where does it exert its effects? How much of the oral gets there? What about IV?

 

[rxlea]

FYI I'm learning too but those are questions that I would need to figure out myself before discussing it with my preceptor

 

[naseuy]

Are the patient clinically stable? Are they NPO/able to tolerate oral formulations? Also, if a patient is a candidate to IV to PO, what's the conversion factor?

 

[Garfield3d]

The two concerns that I think of with oral furosemide are 1.) Gut edema, and 2.) Variable oral absorption of furosemide (not just lower bioavailability, but unpredictable bioavailability). However, I don't think of either of those as being imminent concerns with most patients. Are your patients particularly ill or having consistent problems with volume overload?

I can't imagine faster onset as being the reason for IV vs. PO either, so I agree with you on that one.

--Garfield3d

 

[Frozen]

The typical patient needing IV Lasix is an acute heart failure pt. Oral diuretics do not seem to absorb well when patients are in acute HF, the thought is as mentioned before, their GI tract becomes too swollen from the backup of the portal circulation and they no longer effectively absorb oral diuretics.

 

[pwnttothemax]

The typical patient needing IV Lasix is an acute heart failure pt. Oral diuretics do not seem to absorb well when patients are in acute HF, the thought is as mentioned before, their GI tract becomes too swollen from the backup of the portal circulation and they no longer effectively absorb oral diuretics.

That would be the reason and indication, I expect, variable PO absorption due to heart failure. Though to confuse matters even more, the patients all have other oral meds as well, but I'm guessing in acute HF diuresis is important enough to specifically go IV. My assumption was that since we don't do TPN or anything that their guts absorb fine, but I suppose that doesn't include meds. Man I need to study disease states. Thanks you guys for pointing this out!