Clinical Conundrum: In ADHF cases of acute pulmonary edema, what are the venodilatory effects of furosemide that improve dyspnea? What is the cause? and what is the onset of this effect?
Background:
Besides furosemide's diuretic effect, it has additional venodilatory effects.
Furosemide's venodilatory effect helps treat pulmonary congestion and decreases the pulmonary capillary wedge pressure.
Answer:
A study in 2000 supported that the onset of action where both venous capacitance and blood flow had increased within 5 -15 minutes following the IV administration of furosemide whereas peak urine flow did not occur until 30 - 60 minutes after patients had been given the medication.
In 1997 a study showed that furosemide's venodilatory effect appears to be mediated by local vascular prostaglandin synthesis causing a reduction in right atrial pressure and pulmonary capillary wedge pressure.
In addition, a 2017 study found that expeditious initiation of an effective IV loop diuretic regimen is important in controlling dyspnea and other symptoms related to fluid overload and improves in-hospital outcomes.
Bottom line:
In patients presenting with dyspnea related to pulmonary edema, furosemide provides venodilatory effects that are beneficial in patients with acute pulmonary edema by providing pulmonary symptom relief prior to diuresis.
Written by:
Ngoc Vo, PharmD
Pharmacy Resident, PGY-1
Reviewed By:
Joanne C. Routsolias, PharmD, RN, BCPS
Clinical PharmD Specialist - Emergency Medicine/Toxicology
Reference:
Berrazueta, J., González, J., & de Mier, I. (2007). Vasodilatory Action of Loop Diuretics: A Plethysmography Study of Endothelial Function in Forearm Arteries and Dorsal Hand Veins in Hypertensive Patients and Controls. Journal Of Cardiovascular Pharmacology, 49(2), 90-95. doi: 10.1097/fjc.0b013e31802e3c39Br
Jhund, P., McMurray, J., & Davie, A. (2000). The acute vascular effects of frusemide in heart failure. British Journal Of Clinical Pharmacology, 50(1), 9-13. doi: 10.1046/j.1365-2125.2000.00219.x
Pickkers P, et al. Direct vascular effects of furosemide in humans. Circulation. 1997 Sep 16;96(6):1847-52. doi: 10.1161/01.cir.96.6.1847. PMID: 9323071.
Dikshit, K., Vyden, J., & Forrester, J. (1973). Renal and Extrarenal Hemodynamic Effects of Furosemide in Congestive Heart Failure after Acute Myocardial Infarction. New England Journal Of Medicine, 288(21), 1087-1090. doi: 10.1056/nejm197305242882102
Matsue Y, Voors AA, Kagiyama N, et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. Am Coll Cardiol. 2017;69(25):3042.