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2.8 Oedema

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Diuretics

 

National Guidance

NICE TA127: Hypertension: clinical management of primary hypertension in adults (August 2011) 

 

 

Loop Diuretics

 

Bumetanide

  • Tablets 1mg, 5mg
  • Oral liquid 1mg/5mL
  • Injection 500micrograms/mL (2mg/4mL)

 

Co-amilofruse

  • Tablets 2.5mg/20mg, 5mg/40mg  (amiloride/furosemide)

Note:

  • Although it is generally considered preferable to prescribe diuretics separately, the use of fixed combinations may be justified if compliance is a problem.

 

Furosemide

  • Tablets 20mg, 40mg, 500mg
  • Oral solution - Sugar free 20mg/5mL, 40mg/5mL, 50mg/5mL
  • Injection 20mg/2mL, 50mg/5mL, 250mg/25mL (Hospital only) 

Note: 

  • Furosemide is the first line choice. Bumetanide may be better absorbed than furosemide in patients with severe CCF. 

 

 

Osmotic Diuretics 

Mannitol

  • Intravenous Infusion 10% - 500mL in viaflo bag (PVC and latex free)
  • Intravenous Infusion 20% - 500mL in viaflex bag

Note:

  • These are rarely used in heart failure as they may actually expand the blood volume. Mannitol is used in cerebral oedema.  

 

 

Potassium-sparing diuretics

Amiloride hydrochloride

  • Tablets 5mg
  • Oral Solution - Sugar free 5mg/5mL  

 

Thiazides and related diuretics

Thiazide diuretics can cause a fall in serum potassium in the first weeks of therapy, with higher doses causing a greater fall. However, clinically significant hypokalaemia does not generally occur therefore routine potassium supplementation is not generally recommended.

If hypokalaemia becomes a problem with maintenance therapy then potassium sparing diuretics are preferable to potassium supplements. 

 

Chlortalidone

  • Tablets 50mg

 

Metolazone (Amber 1)

  • Tablets 5mg

Notes:

  • Metolazone is a powerful diuretic, start with a dose of 2.5mg-5mg and monitor response closely.
  • Metolazone is included as an adjunct to loop diuretics in severe CCF and oliguria.  

 

 

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 

Return to Chapter: 2. Cardiovascular system

Last updated by: Dupe Fagbenro on 14-11-2018 15:23