Breaking News
April 20, 2018 - College students with autism have high rate of suicidal thoughts
April 20, 2018 - Study sheds light on how the HSC niche is maintained
April 20, 2018 - Drug test spurs frank talk between hypertension patients and doctors
April 19, 2018 - Low-cost deworming drug improves female farmers’ physical fitness
April 19, 2018 - Genome editing identifies neural circuit behind leptin’s anti-obesity and anti-diabetes effects
April 19, 2018 - Many European countries lack comprehensive policy to eliminate viral hepatitis
April 19, 2018 - Young people with ADHD ‘more likely’ to come from deprived neighbourhoods
April 19, 2018 - SLU professor discovers new biomarkers for chlorine gas exposure
April 19, 2018 - Study proposes new mechanism that may contribute to gender differences in weight control
April 19, 2018 - Sleep restriction therapy does not interfere with insomnia patient’s driving ability, research shows
April 19, 2018 - Deep brain stimulation offers relief to UTHealth patient with treatment-resistant depression
April 19, 2018 - Study shows fatty fish and camelina oil boost HDL and IDL cholesterol
April 19, 2018 - FDA Alert: Euphoric Capsules by Epic Products: Recall
April 19, 2018 - Researchers identify peptide produced during cartilage deterioration as a potential source of osteoarthritis pain
April 19, 2018 - New breakthrough may allow scientists to orchestrate tissue regeneration in humans
April 19, 2018 - SYGNIS AG introduces new TruePrime apoptotic cell free DNA amplification kit
April 19, 2018 - Innovative device shows promise in capturing and releasing circulating tumor cells
April 19, 2018 - Researchers shed light on role of striosomal neurons in reinforcement learning
April 19, 2018 - Genetic make-up impacts long-term effectiveness of phobia treatment
April 19, 2018 - Novel biomarker can distinguish malignant lung nodules
April 19, 2018 - Study reports promising novel approach to treat therapy resistant pediatric brain tumors
April 19, 2018 - One-Hour Plasma Glucose Useful Predictor of Diabetic Retinopathy
April 19, 2018 - Hydroxychloroquine no more effective than placebo for relieving osteoarthritis hand pain
April 19, 2018 - Transplanted livers have a protective effect and reduce potential for organ rejection
April 19, 2018 - Researchers develop new method to study activity of inflammatory cells
April 19, 2018 - Researchers discover highly antibiotic resistant superbugs in Gulf States
April 19, 2018 - Interaction between dioxin and HLA gene variant activates events associated with rheumatoid arthritis
April 19, 2018 - Eyes of adolescents could be associated with increased risk of cardiovascular disease in later life
April 19, 2018 - U.S. Women Less Likely Than Men to Get Statins After Heart Attack
April 19, 2018 - Health Canada grants cannabis cultivation license to High Park Farms
April 19, 2018 - Atypical brain development observed in preschoolers with ADHD symptoms
April 19, 2018 - SC Johnson releases annual Sustainability Report
April 19, 2018 - Positive attitudes about aging reduce risk of dementia in older adults
April 19, 2018 - Environmental pollutants found to worsen rheumatoid arthritis
April 19, 2018 - UT Southwestern scientists discover protein linked to metastatic breast cancer
April 19, 2018 - Study highlights need for further evidence to improve symptom management in end of life care
April 19, 2018 - Detecting diminished dopamine-firing cells inside brain could reveal earliest signs of Alzheimer’s
April 19, 2018 - Uniqsis offers high-power LED light unit for scalable flow photochemistry reactions
April 19, 2018 - Case study shows how intravascular ultrasound imaging helps detect acute aortic syndrome
April 19, 2018 - Research reveals new mechanism by which HIV evades the immune system
April 19, 2018 - Nanodisc-delivered cancer treatment helps eliminate tumors
April 19, 2018 - Functional connectivity MRI could help detect brain disorders and diseases
April 19, 2018 - Finding better way to quantify neuropathy symptoms and treatment efficacy
April 19, 2018 - Study examines effectiveness of caregiver education about sickle cell trait
April 19, 2018 - High-resolution images of tumor vasculature using new technology
April 19, 2018 - Lack of sleep may be linked to risk factor for Alzheimer’s disease
April 19, 2018 - Study finds neurotransmitter may play a role in alcohol relapse, addiction
April 19, 2018 - Researchers build molecular networks of calcific aortic valve disease
April 19, 2018 - Researchers develop highly specific apoptosis assay for pharmacodynamic analyses of tumor specimens
April 19, 2018 - Scientists decipher mechanism of chemotherapy induced female infertility
April 19, 2018 - New insight may allow researchers to design drugs that improve immune responses to vaccines
April 19, 2018 - FDA Approves Crysvita (burosumab-twza) for X-Linked Hypophosphatemia
April 19, 2018 - Researchers uncover origin of virus-fighting plasma B cells
April 19, 2018 - Study finds no evidence of lower intelligence in young children who had anesthesia
April 19, 2018 - Baboons break out of research facility briefly
April 19, 2018 - Study shows how deployment time increases risk of suicide attempt in soldiers
April 19, 2018 - Specific odors from malaria infected individuals attract more mosquitoes
April 19, 2018 - FDA Alert: Rhino 69 Extreme 50000 by AMA Wholesale: Recall
April 19, 2018 - Top HIV cure research team refutes major recent results on how to identify HIV persistence
April 19, 2018 - Experts propose new solutions to increase benefit, affordability of targeted cancer medicines
April 19, 2018 - Deficiency of innate immune adaptor TRIF shortens survival time of ALS mice
April 19, 2018 - New machine learning method offers better way to detect heart disease
April 19, 2018 - CNIO researchers determine structure of protein complex related to cell survival
April 19, 2018 - Faith-based diabetes support program launched by UTSA research team
April 19, 2018 - Volumetric Laser Endomicroscopy Helps ID Barrett’s Regions
April 19, 2018 - Engineered cartilage template to heal broken bones
April 19, 2018 - New computational framework accurately predicts drug-drug and drug-food interactions
April 18, 2018 - Some human cancers may be result of evolutionary accidents, research finds
April 18, 2018 - Higher levels of education linked to lower dementia risk in older African Americans
April 18, 2018 - Smoking Puts Blacks at Higher Risk for Heart Failure
April 18, 2018 - Physiotherapist contributes to guidelines for knee cartilage treatment
April 18, 2018 - Researchers use ‘top-down proteomics’ strategy to get new insights into cancer
April 18, 2018 - Physician assistants less likely to accurately diagnose early stage skin cancers
April 18, 2018 - New faster, streamlined method for bowel cancer detection and treatment
April 18, 2018 - Researchers identify new Listeria species in Costa Rica
April 18, 2018 - Novel interactive diagram shows many facets of mild traumatic brain injury
April 18, 2018 - Short sleep linked to obesity in children and adolescents
April 18, 2018 - When weight loss helps with sleep
April 18, 2018 - New mathematical model can predict efficiency of microbiome therapies
April 18, 2018 - People with high LDL cholesterol levels likely to get greater benefits from statins
Study: New Furosemide Formulation Simplifies Administration for HF

Study: New Furosemide Formulation Simplifies Administration for HF

image_pdfDownload PDFimage_print

Action Points

  • A pH-neutral formulation of furosemide (Lasix) may be safe and effective for subcutaneous administration to patients with acute decompensated heart failure.
  • Note that neither the subcutaneous nor the intravenous formulation was associated with worsening renal function, ototoxicity, or skin irritation. In addition, patients shared similar rates of 30-day hospitalization.

A pH-neutral formulation of furosemide (Lasix) may be safe and effective for subcutaneous administration to patients with acute decompensated heart failure, according to the results of a phase II trial.

The 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).

Nisha Gilotra, MD, of Johns Hopkins School of Medicine in Baltimore, and colleagues, in a study online in JACC: Heart Failure, found that 6-hour urine output was statistically no different between groups (median 1,425 mL for IV versus 1,350 mL for subcutaneous, P=0.84). Natriuresis, however, was higher in the subcutaneous furosemide group (32.8 mEq/l versus 7.3 mEq/l for the IV group, P=0.05).

Patients lost a similar amount of weight in 6 hours — an average of -1.5 kg for both groups (P=0.95).

As for safety, neither formulation was associated with worsening renal function, ototoxicity, or skin irritation. In addition, patients shared similar rates of 30-day hospitalization (52% for subcutaneous versus 42% for IV groups, P=0.55).

“There have been limited advancements in diuretic therapy in decompensated heart failure, despite diuretics serving as the mainstay for relief of congestion for several decades,” the team wrote. “This is the first study to examine the efficacy of a novel subcutaneous formulation of the loop diuretic furosemide administered by 5-hour fixed-dose infusion in patients presenting with worsening heart failure in the outpatient setting.”

“This method of decongestion may allow treatment at home and reduced heart failure resources and warrants further investigation.”

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.

“In an attempt to address some of these hurdles to subcutaneous administration of furosemide, the scFurosemide used in this study was developed with a physiologic pH of 7.4 and the ability to administer it through an infusion pump,” the team said.

Based on the results, the 80 mg dose is “clearly an efficacious dose” for heart failure patients with acute volume overload, the researchers wrote.

In an accompanying editorial comment, Gary Francis, MD, and Tamas Alexy, MD, PhD, both of the University of Minnesota in Minneapolis, said: “If there were a simple pathway to manage the thousands of patients with acutely decompensated heart failure by using an effective and safe diuretic regimen, particularly if the treatment protocol reduced the need for prolonged, expensive hospitalizations and readmissions, it could be transformative in our current clinical practice.”

“It is conceivable that buffered subcutaneous furosemide formulation may eventually be self-administered by select patients at home, using a small patch pump. This strategy may reduce heart failure symptoms to the point that a trip to the emergency department or clinic would not be necessary. One may imagine that, in the future, the delivery system may even be made responsive to the individual’s volume status as measured by an internal pressure monitoring device.”

The study was conducted in subjects who were on average 57 years old. A total of 55% of the group were women, and there were no baseline differences between the groups.

Gilotra and colleagues acknowledged that the 5-hour administration required of the new formulation may be a barrier to wider use, although they reasoned that this length of time maximizes diuretic efficiency, allowing for a more steady-state concentration and prolonged diuresis.

Indeed, hourly urine output was greater in the IV group at hour 2 (425 mL versus 250 mL, P=0.02) and greater in the subcutaneous group at hour 6 (325 mL versus 125 mL, P=0.005), the investigators showed.

Francis and Alexy said that further studies will be required to evaluate how patients tolerate the repeated subcutaneous administration of furosemide and to better understand the optimal dose. In addition, “whether patients could readily self-administer the medication is open to question.”

The study was funded by scPharmaceuticals.

Gilotra and co-authors have no relationships listed and no conflicts of interest.

Francis disclosed financial relationships with Amgen, Cytokinetics, and Capricor Therapeutics.

Alexy reported having no relationships relevant to the paper.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-12-12T00:00:00-0500

last updated

Tagged with:

About author

Related Articles