Advertisement

Subcutaneous furosemide for the treatment of heart failure: a state-of-the art review

  • Maxwell Eyram Afari
  • Joe Aoun
  • Sarthak Khare
  • Lana Tsao
Article

Abstract

The prevalence of heart failure (HF) is on the rise. By 2030, over eight million Americans (46% increase from current prevalence) will have heart failure. In the USA, approximately 30 billion dollars is spent annually on heart failure and this number will likely double in 2030. Thus, HF represents a significant economic burden. Acute decompensated heart failure (ADHF) is a clinical spectrum, which refers to increasing symptoms and signs of heart failure prompting an emergency room visit or hospitalization. In ADHF, inpatient administration of intravenous diuretic is the standard of care due to the variability in the absorption of oral diuretics. Within 30 days, 25–30% of these patients are readmitted with recurrent ADHF. Recent efforts have focused in reducing HF readmission, and thereby decreasing costs; hence, innovative outpatient treatment options have emerged. Subcutaneous furosemide use will potentially overcome the need to place intravenous lines, reduce associated expenses, and enable management of ADHF at home. This review presents data on the pharmacodynamics and pharmacokinetics of subcutaneous furosemide, scientific evidence on the use of this therapy in the palliative and hospice population, and its experimental use as an outpatient therapy and/or as a bridge from inpatient to home.

Keywords

Subcutaneous Furosemide Heart failure At-home treatment Palliative care 

Notes

Compliance with ethical standards

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

None of the authors has any conflict of interest related to the contents of this manuscript. Lana Tsao has received research grant from SC Pharmaceuticals Inc. (developers of the proprietary furosemide infusor) for an ongoing clinical trial. None of the coauthors have any disclosures to make.

References

  1. 1.
    Mozaffarian D, Benjamin EJ, Go AS et al (2015) Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 131:e29–e322Google Scholar
  2. 2.
    Vidic A, Chibnall JT, Hauptman PJ (2015) Heart failure is a major contributor to hospital readmission penalties. J Card Fail 21:134–137CrossRefGoogle Scholar
  3. 3.
    Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC (1985) Furosemide absorption altered in decompensated congestive heart failure. Ann Intern Med 102:314–318CrossRefGoogle Scholar
  4. 4.
    Gottlieb SS, Khatta M, Wentworth D, Roffman D, Fisher ML, Kramer WG (1998) The effects of diuresis on the pharmacokinetics of the loop diuretics furosemide and torsemide in patients with heart failure. Am J Med 104:533–538CrossRefGoogle Scholar
  5. 5.
    Harada K, Tamura M, Yasuoka K, Toyono M (2001) A comparison of tissue Doppler imaging and velocities of transmitral flow in children with elevated left ventricular preload. Cardiol Young 11:261–268CrossRefGoogle Scholar
  6. 6.
    Verma AK, da Silva JH, Kuhl DR (2004) Diuretic effects of subcutaneous furosemide in human volunteers: a randomized pilot study. Ann Pharmacother 38:544–549CrossRefGoogle Scholar
  7. 7.
    Galindo-Ocana J, Romero-Mena J, Castillo-Ferrando JR et al. (2013) Subcutaneous furosemide as palliative treatment in patients with advanced and terminal-phase heart failure. BMJ Support Palliat Care 3:7–9Google Scholar
  8. 8.
    Austin J, Hockey D, Williams WR et al. (2013) Assessing parenteral diuretic treatment of decompensated heart failure in the community. Br J Community Nurs 18:528, 530-4Google Scholar
  9. 9.
    Sica DMP, Myers R, Ter Maaten JM, Sale M, DeBoer R, Pitt B (2018) Subcutaneous furosemide in heart failure:pharmacokinetic characteristics of a newly buffered solution. JACC Basic Transl Sci 3:25–34CrossRefGoogle Scholar
  10. 10.
    Goenaga MA, Millet M, Sanchez E, Garde C, Carrera JA, Arzellus E (2004) Subcutaneous furosemide. Ann Pharmacother 38:1751CrossRefGoogle Scholar
  11. 11.
    Farless LB, Steil N, Williams BR, Bailey FA (2013) Intermittent subcutaneous furosemide: parenteral diuretic rescue for hospice patients with congestive heart failure resistant to oral diuretic. Am J Hosp Palliat Care 30:791–792CrossRefGoogle Scholar
  12. 12.
    Zacharias H, Raw J, Nunn A, Parsons S, Johnson M (2011) Is there a role for subcutaneous furosemide in the community and hospice management of end-stage heart failure? Palliat Med 25:658–663CrossRefGoogle Scholar
  13. 13.
    Galindo-Ocana J, Romero-Mena J, Castillo-Ferrando JR, Aguilera-Gonzalez C, Bernabeu-Wittel M, Ollero-Baturone M (2013) Subcutaneous furosemide as palliative treatment in patients with advanced and terminal-phase heart failure. BMJ Support Palliat Care 3:7–9CrossRefGoogle Scholar
  14. 14.
    Picazo Sanchez M, Castillo Lorenzo MN, Cuxart Perez M, Sans Lorman R (2018) Palliative use of furosemide in continuous subcutaneous infusion in a renal transplant patient with heart failure. Nefrologia 38:438–439Google Scholar
  15. 15.
    Buckley LF, Carter DM, Matta L, Cheng JW, Stevens C, Belenkiy RM, Burpee LJ, Young MA, Weiffenbach CS, Smallwood JA, Stevenson LW, Desai AS (2016) Intravenous diuretic therapy for the Management of Heart Failure and Volume Overload in a multidisciplinary outpatient unit. JACC Heart Fail 4:1–8CrossRefGoogle Scholar
  16. 16.
    Zatarain-Nicolas E, Lopez-Diaz J, de la Fuente-Galan L, Garcia-Pardo H, Recio-Platero A (2013) San Roman-Calvar JA. Subcutaneous infusion of furosemide administered by elastomeric pumps for decompensated heart failure treatment: initial experience. Rev Esp Cardiol (Engl Ed) 66:1002–1004CrossRefGoogle Scholar
  17. 17.
    Gilotra NA, Princewill O, Marino B, Okwuosa IS, Chasler J, Almansa J, Cummings A, Rhodes P, Chambers J, Cuomo K, Russell SD (2018) Efficacy of intravenous furosemide versus a novel, pH-neutral furosemide formulation administered subcutaneously in outpatients with worsening heart failure. JACC Heart Fail 6:65–70CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineSt. Elizabeth’s Medical Center/ Tufts University School of MedicineBrightonUSA
  2. 2.Department of MedicineSt Elizabeth’s Medical Center/ Tufts University School of MedicineBrightonUSA

Personalised recommendations