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New Furosemide Formulation for managing Heart Failure at home


New Furosemide Formulation for managing Heart Failure at home

In acute medical care,  HF patients presenting with congestion require intravenous (IV) administration of a diuretic agent is a must.There have been limited advancements in diuretic therapy in decompensated heart failure, despite diuretics serving as the mainstay for the relief of congestion for several decades.

According to the results of a phase II trial, a new formulation of furosemide (Lasix) has been developed which is pH-neutral and may be safe and effective for subcutaneous administration to patients with acutely decompensated heart failure.The study has been published in JACC Heart Failure. 

Dr. Nisha A. Gilotra and associates  sought to determine the efficacy and safety of a novel, pH-neutral formulation of furosemide administered subcutaneously (SC) for treatment of acute decompensated heart failure (HF) The researchers in a single-center study had 41 patients randomized to a single dose of subcutaneous furosemide (at a fixed 80 mg over 5 hours) or IV furosemide (123 mg on average).The primary outcome was 6-h urine output, and secondary outcomes were weight change, natriuresis, and adverse events.

Out of total patients, 19 were treated with IV (mean dose: 123 ± 47 mg) and 21 with SC furosemide (fixed dose of 80 mg over 5 h). It was found that  6-h urine output in the IV group was not significantly different from that in the SC furosemide group (median IV: 1,425 ml; interquartile range [IQR]: 1,075 to 1,950 ml; vs. median SC: 1,350 ml; IQR: 900 to 1,900 ml; p = 0.84). Additionally, mean weight loss was not significantly different (−1.5 ± 1.1 kg in the IV group vs. −1.5 ± 1.2 kg in the SC group; p = 0.95). There was no worsening renal function, ototoxicity, or skin irritation with either formulation. Thirty-day hospitalization rates were similar.

 The researchers concluded that  In this phase II trial, they did not identify significant differences between urine output obtained with pH-neutral furosemide administered SC and that obtained by IV. This method of decongestion may allow treatment at home and reduced HF resources and warrants further investigation. (Sub-Q Versus IV Furosemide in Acute Heart Failure; NCT02579057)

Prior formulations of subcutaneous furosemide were too alkaline, forcing it to be injected at low volumes at a time and causing frequent skin burns and stings, the authors noted. In addition, the attempted use of an elastomeric pump required catheter placement and continuous infusion and was associated with complications such as abscess formation.

For further reference log on to :

http://heartfailure.onlinejacc.org/content/early/2017/11/27/j.jchf.2017.10.001?sso=1&sso_redirect_count=2&access_token=

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Dr. Kamal Kant Kohli

Dr. Kamal Kant Kohli

A Medical practitioner with a flair for writing medical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues. Before Joining Medical Dialogues, he has served as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils of India. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751
Source: JACC

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  1. user
    dr dharmendra kumar dewan December 16, 2017, 8:50 pm

    useful information …

  2. Good article