SCCM Resource Library-Drug Shortage Alert: Intravenous Loop Diuretics (December 2022))

Pdf Summary

This Drug Shortage Alert addresses the availability and management of intravenous (IV) loop diuretics, last updated in September 2022. It informs healthcare providers about the use, dosing, and equivalency of IV loop diuretics amid a noted shortage. No loop diuretic is superior when used at equipotent doses, and safety as well as prescriber knowledge should guide any substitutions. IV loop diuretics should be reserved for situations such as acute pulmonary congestion, acute decompensated heart failure, and cases where enteral administration is contraindicated or ineffective.<br /><br />Management strategies recommend reserving IV diuretics for urgent cases, using various vial sizes to reduce waste, and ensuring all relevant staff are aware of changes in vial concentration and size to prevent medication errors. Oral loop diuretics like torsemide and bumetanide may serve as alternatives if they're available and the patient can tolerate them. In cases of inadequate response to loop diuretics, thiazide or thiazide-like diuretics can be used as adjuncts. In patients with sulfonamide allergies, ethacrynic acid is recommended due to minimal cross-reactivity.<br /><br />Pharmacotherapeutic considerations include the similar onset and duration of loop diuretics, with variances in bioavailability, metabolism, and impact of food on absorption. In patients with gastrointestinal complications, IV routes or adjusted oral dosing are recommended. Initial loading doses for IV loop diuretics depend on the patient's renal function and response history. <br /><br />Safety concerns raised include potential hypovolemia, electrolyte imbalances, and ototoxicity, with ethacrynic acid posing a higher ototoxic risk and cost. Costs of these medications vary significantly, with ethacrynic acid being notably expensive. Healthcare providers are advised to be familiar with dosing differences and potential errors during this shortage.

Asset Subtitle

Pharmacology, Crisis Management, 2022, 0:05:26

Asset Caption

This alert provides information about dosing and equivalency of loop diuretics. This summary provides information regarding the event of a shortage and its impact on adult patients by providing potential management strategies, pharmacotherapeutic considerations, and safety implications. The recommendations provided in this document are based on current evidence, including a review of available literature by the SCCM Drug Shortages and Medication Safety Committee, and the need for conservation during this shortage.

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Pharmacology

Tag Resource Allocation

Year 2021

Keywords

IV loop diuretics

drug shortage

acute pulmonary congestion

heart failure

medication errors

oral alternatives

ethacrynic acid

thiazide diuretics

renal function

ototoxicity

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