Version July 2025
| Starting dose (oral or intravenous*) | Maximum effective dose¶ (higher individual doses or more frequent dosing intervals are unlikely to produce substantial additional diuresis)Δ | Maximal recommended daily dose¶ (greater daily total doses are associated with a risk for toxicity) | |||||||
| Furosemide | Bumetanide | Torsemide | Furosemide | Bumetanide | Torsemide | Furosemide | Bumetanide | Torsemide | |
| Heart failure◊ | 20 mg once or twice daily | 0.5 mg once or twice daily | 10 mg once daily | 80 mg 3 times daily | 3 mg 3 times daily | 50 mg twice daily | 600 mg | 10 mg | 200 mg |
| Cirrhotic ascites§ | 40 mg once or twice daily | 1 mg once or twice daily | 10 mg once daily | 40 mg 3 times daily | 1 mg 3 times daily | 20 mg twice daily | 160 mg | 4 mg | 40 mg |
| Nephrotic syndrome | 40 mg once or twice daily | 1 mg once or twice daily | 10 mg once daily | 120 mg 3 times daily | 3 mg 3 times daily | 50 mg twice daily | 600 mg | 10 mg | 200 mg |
| Chronic kidney disease¥ | ‡ | ‡ | ‡ | 200 mg 3 times daily | 10 mg 3 times daily | 100 mg twice daily | 600 mg | 10 mg | 200 mg |
| Acute kidney injury | 80 mg once or twice daily | 2 mg once or twice daily | 20 mg once daily | 500† mg once | Not reported | Not reported | 600 mg | Not reported | Not reported |
* Refer to UpToDate topics on the maximum effective dose and major side effects of loop diuretics for details.
¶ Dose is delivered intravenously.
Δ More aggressive regimens have been shown to be safe and effective for acute decompensated heart failure. Refer to UpToDate topics on the use of diuretics in patients with heart failure for details.
◊ Guidelines from American College of Cardiology/American Heart Association[1] recommend furosemide and bumetanide starting daily or twice daily and torsemide starting daily. Similar guidelines are available from the European Society of Cardiology[2]. Note that higher doses may be useful in acute decompensated heart failure.
§ In most patients with cirrhosis, furosemide (or equivalent) should be combined with spironolactone at a ratio of 40 mg furosemide to 100 mg of spironolactone; the dosing ratio should be adjusted based upon the plasma potassium concentration. Refer to UpToDate topics on initial therapy of ascites for details.
¥ Chronic kidney disease alone typically does not cause edema but complicates the treatment of other edematous syndromes. In this situation, the presence of chronic kidney disease should guide dosing. Refer to UpToDate topics on the maximum effective dose and major side effects of loop diuretics for details.
‡ Initial diuretic doses for patients with chronic kidney disease depend on its stage but are generally higher than those given for patients with heart failure or cirrhosis.
† High doses of furosemide (500 mg) may be effective, but most authorities now avoid such high doses and, instead, recommend a single trial with a lower starting dose.
Courtesy of David H Ellison, MD, FASN, FAHA.
