The Furosemide Myth-Reply

P. G. G. Gerlag, MD; J. J. M. van Meijel, MD; R. W. van Olden, MD
Arch Intern Med. 1988;148(12):2693. doi:10.1001/archinte.1988.00380120125027.
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In Reply.  —The data in our study clearly support the point of view of Dr Rottellar and his colleagues that a maximum orally administered dose of 600 mg/d of furosemide can be exceeded safely.1 Orally administered doses up to 2000 to 2500 mg/d were tolerated well by patients with chronic congestive heart failure, and major side effects did not occur when the drug was administered by those with experience, especially when hypokalemia and volume status was monitored and corrected carefully. Continuous intravenous infusion in these patients was, in our experience, safe up to a dosage of 2000 mg/d, and serum furosemide levels did not exceed 120 μmol/L. Intravenous bolus injection, of course, yields the highest serum furosemide levels and risk of ototoxicity.2 Thus, for this mode of administration, a maximum of 1000 mg/d of furosemide with an infusion time of 30 minutes can be recommended.3 The use


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