Furosemide (Ascites / Cirrhosis)

How it works

Furosemide inhibits the sodium-potassium-chloride co-transporter in the thick ascending limb of the loop of Henle, producing a potent diuresis that helps mobilise ascitic and oedema fluid.

Prescribing in practice

• In cirrhotic ascites furosemide is usually combined with spironolactone rather than used alone, and overly rapid diuresis must be avoided as it can precipitate hypovolaemia, renal impairment and hepatic encephalopathy.
• It can cause hypokalaemia, hyponatraemia and metabolic alkalosis, which are particularly hazardous in liver disease and warrant close electrolyte surveillance.
• Diuretics should be withheld if there is hyponatraemia, worsening renal function, tense or refractory ascites needing paracentesis, or clinical encephalopathy.

Monitoring

Monitor body weight, renal function and electrolytes regularly, titrating the diuretic to a controlled rate of weight loss rather than aggressive fluid removal.

Counselling the patient

• You will be weighed regularly so the dose can be adjusted to remove fluid gradually and safely.
• Report increasing confusion, drowsiness, severe thirst or cramps, as these may mean the dose needs changing.

Evidence & guidelines

Combined spironolactone and furosemide diuretic therapy is the established standard for managing cirrhotic ascites in national and international guidance.