Breaking News
September 21, 2018 - 30 Million Americans Now Have Diabetes
September 21, 2018 - Thousands of breast cancer gene variants engineered and analyzed
September 21, 2018 - The current fellowship interview process is cumbersome — Stanford researchers have a better idea
September 21, 2018 - Progenitor cells for human bone and cartilage have been identified
September 21, 2018 - Study reveals new therapeutic target for pediatric tumor-associated intractable epilepsy
September 21, 2018 - SLU’s College professor receives NIH grant to develop I-TEST project
September 21, 2018 - DermTech completes enrollment in clinical study to assess DNA damage and reversal
September 21, 2018 - Grieving patients treated with talk therapy have lower risk of suicide and psychiatric illness
September 21, 2018 - NIH and FDA call for eliminating involvement of RAC in human gene therapy experiments
September 21, 2018 - New system uses algorithm to convert 2D videos into 3D printed ‘motion sculptures’
September 21, 2018 - Sea squirt model reveals key molecules in dopaminergic neuron differentiation
September 21, 2018 - Effective management of neonatal abstinence syndrome requires coordinated ‘cascade of care’
September 21, 2018 - Refugees seek care for wounds of war
September 21, 2018 - Under the sea, in an octopus’ garden on ecstacy
September 21, 2018 - Eating foods with low nutritional quality ratings linked to cancer risk in large European cohort
September 21, 2018 - Giving kids honest information about water consumption may help them make healthy choices
September 21, 2018 - Horwitz Prize Awarded for Work on Hormones
September 21, 2018 - CHMP issues positive opinion supporting use of Trelegy Ellipta in broader group of COPD patients
September 21, 2018 - Scientists discover new molecules that work together to remove unwanted DNA
September 21, 2018 - Dr. Fenella France to deliver 2019 Plenary Lecture
September 21, 2018 - New research finds that MHC-II molecules have more influence on tumors than MHC-I
September 21, 2018 - Researchers study effects of cardiac cycle in simple learning task
September 21, 2018 - FDA takes new steps to address opioid crisis by approving Opioid Analgesic Risk Evaluation and Mitigation Strategy
September 21, 2018 - Positive Barhemsys Phase 3 Treatment Data Published in Anesthesia & Analgesia
September 21, 2018 - Celiac Disease Screening: MedlinePlus Lab Test Information
September 21, 2018 - Autism linked to egg cells’ difficulty creating large proteins
September 21, 2018 - Tweaking nuclear pores could provide new avenue to battle against cancer
September 21, 2018 - Experts warn health care providers to slow down in allowing smart pill in patient care settings
September 21, 2018 - MoreGrasp reports breakthrough development of grasp neuroprosthetics activated by thought control
September 21, 2018 - Study reveals new way to target HER2-negative metastatic breast cancer
September 21, 2018 - CHMP grants positive opinion for VENCLYXTO plus rituximab for treating relapsed/refractory CLL
September 21, 2018 - Study offers solid link between visceral organs and brain’s reward, motivation system
September 21, 2018 - First U.S. patient treated with innovative gene therapy at Bascom Palmer Eye Institute
September 21, 2018 - Choroidal Detachment – The American Society of Retina Specialists
September 21, 2018 - New clinical trial evaluates aesthetic results of conservative surgery in breast cancer
September 21, 2018 - Discovery of a key protein involved in the development of autism
September 21, 2018 - Air pollution appears to be linked to increased risk of developing dementia
September 21, 2018 - Henry Ford Health System receives $600k grant to study genetic makeup of gliomas
September 21, 2018 - Arthritis common in individuals with varying degrees of depression, finds study
September 21, 2018 - Scientist intends to fight pathogenic bacteria with viruses
September 21, 2018 - New research suggests link between PFAS chemicals and hyperthyroidism in pet cats
September 21, 2018 - Multi-year study data shows impact of new soft contact lens to slow myopia progression in children
September 21, 2018 - Neuroscientists identify circuit for brain’s statistical inference about motion
September 21, 2018 - MILabs’ VECTor6 system wins Commercial Innovation Award at WMIC 2018
September 21, 2018 - Scientists find wild African monkeys infected with bacterium that causes syphilis, yaws in humans
September 21, 2018 - 2006 to 2015 Saw Increase in Severe Maternal Morbidity
September 21, 2018 - Similar changes in the brains of patients with ADHD and emotional instability
September 21, 2018 - Cobalt mining in DR Congo takes a high toll on both creuseurs and environment
September 21, 2018 - Eating fatty fish during pregnancy may boost unborn child’s brain development
September 21, 2018 - Study reveals promising new drug candidate to treat acute renal failure
September 21, 2018 - Neural signal that urges to eat overpowers the one that says to stop
September 21, 2018 - Scientists achieve breakthrough in accelerated diagnosis of multi-resistant hospital pathogens
September 21, 2018 - Researchers simulate how different breast tissues respond to heat from MRIs
September 21, 2018 - Despite red flags at surgery centers, overseers award gold seals
September 21, 2018 - Zapping Airway Nerves May Help COPD Patients Breathe
September 21, 2018 - Researchers find answers as to why some people are at risk of gout
September 21, 2018 - Stars of Stanford Medicine: Genetic counseling and compassion
September 21, 2018 - Researchers use reinforcement learning to train gliders to soar like birds
September 21, 2018 - New federally-funded research project could lead to treatments that extend human lifespan
September 21, 2018 - Health insurance ads have shifted over time due to health plans offered via ACA
September 21, 2018 - Use of transcranial electrical stimulation to bolster creativity has far-reaching implications
September 21, 2018 - Scientists find way to boost efficacy of powerful antimalarial drug with anti-cancer medicines
September 21, 2018 - Weighing the risks and benefits of drug tapering—two patients, two perspectives
September 21, 2018 - The “exposome” revealed: a barrage of bacteria, chemicals, microscopic animals and more
September 21, 2018 - Top three immune boosting recommendations to ward off freshers’ flu
September 21, 2018 - Young children’s oral microbiota could serve as early indicator for obesity
September 21, 2018 - Older individuals with multiple sclerosis report higher quality of life than younger counterparts
September 21, 2018 - LineaRx signs agreement with Takis/Evvivax to develop linear-DNA based anti-cancer vaccines
September 21, 2018 - AbbVie Presents Upadacitinib Longer-Term (32-Week) and Patient-Reported Outcomes Data from Phase 2b Atopic Dermatitis Study at 27th European Academy of Dermatology and Venereology (EADV) Congress
September 21, 2018 - Alzheimer’s drug may stop disease if used before symptoms develop
September 21, 2018 - Human skeletal stem cell can generate cartilage, bone
September 21, 2018 - UK and European research collaborations receive vote of confidence by three major cancer charities
September 21, 2018 - Microbiota in the intestines and cell stress cause colon cancer
September 20, 2018 - Arizona EMTs have 39% higher risk for suicide than general public
September 20, 2018 - Driving and older adults: MedlinePlus Medical Encyclopedia
September 20, 2018 - Brain region for stress control is enlarged in people with depression, finds study
September 20, 2018 - Researchers test autobiographical memory for early Alzheimer’s detection
September 20, 2018 - Organizations join forces to help teens with severe mental health challenges | News Center
September 20, 2018 - Neurons in the human brain can encode numerical information
September 20, 2018 - Potential drugs to treat neurodegenerative diseases garner $3 million grant
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