To the Editor.
—In patients with acute renal failure, it is common to administer furosemide in dosages as high as 4 g/day to induce diuresis.1 In patients with chronic renal failure, dosages of 1 to 2 g/day are commonly administered.2 In patients with cardiac failure, however, furosemide is rarely given in doses over 250 mg.3 The use of higher doses is discouraged because of the risk of ototoxicity and hepatic toxicity.4The difference in the recommended dosage of furosemide in renal failure and cardiac failure is surprising, especially in view of the fact that the drug is largely excreted by the kidneys, so that higher blood levels are more likely to be attained in patients with renal, rather than cardiac, failure. One would thus expect toxic reactions to be more common in patients with renal failure than in those with cardiac failure who take the same
O'Rourke MF, Sammel NL, Kuchar D. High-Dose Furosemide in Cardiac Failure. Arch Intern Med. 1984;144(12):2429. doi:10.1001/archinte.1984.00350220165037
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