TABLE 2

Recommended dosing of diuretics in renal insufficiency

Loop diuretics: maximum intravenous bolus dose
Drug	Creatinine clearance < 25 mL/min	Creatinine clearance 25–75 mL/min	Creatinine clearance > 75 mL/min
Furosemide	160–200 mg^a	80–160 mg^a	40–80 mg^a
Bumetanide	8–10 mg^a	4–8 mg^a	1–2 mg^a
Torsemide	50–100 mg^a	20–50 mg^a	10–20 mg^a
Loop diuretics: continuous infusion
Drug	Creatinine clearance < 25 mL/min	Creatinine clearance 25–75 mL/min	Creatinine clearance > 75 mL/min

Furosemide	40-mg loading dose, then 20 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 40 mg/hour	40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour	40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour
Bumetanide	1-mg loading dose, then 1 mg/hour × 1 hour; if response is inadequate, increase infusion to 2 mg/hour	1-mg loading dose, then 0.5 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 1 mg/hour	1-mg loading dose, then 0.5 mg/hour
Torsemide	20-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, increase infusion to 20 mg/hour	20-mg loading dose, then 5 mg/hour × 1 hour; if response is inadequate, increase infusion to 10 mg/hour	20-mg loading dose, then 5 mg/hour
Thiazide diuretics
Drug	Creatinine clearance < 20 mL/min	Creatinine clearance 20–50 mL/min	Creatinine clearance > 50 mL/min

Hydrochlorothiazide	100–200 mg/day	50–100 mg/day	25–50 mg/day
Chlorothiazide	Usual dosage range: 500–2,000 mg/day in 1 or 2 divided doses^b
Metolazone	Usual dosage range: 2.5–20 mg once daily^b
Carbonic anhydrase inhibitor
Acetazolamide	Usual dosage range: 250–1,000 mg/day in 1 or 2 divided doses

↵a These doses may have to be repeated several times a day to achieve a sustained response.
↵b Dose recommendations are not available for these diuretics, but the higher end of the usual dose range should be used in patients with renal failure.