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The Annals of Pharmacotherapy: Vol. 37, No. 5, pp. 695-700. DOI 10.1345/aph.1C320
© 2003 Harvey Whitney Books Company.
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CARDIOLOGY

Combined Furosemide and Human Albumin Treatment for Diuretic-Resistant Edema

Rowland J Elwell, PharmD

Nephrology Fellow, Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY

Ann P Spencer, PharmD

Assistant Professor, Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC

George Eisele, MD

Associate Professor, Division of Nephrology, Department of Medicine, Albany Medical College

Reprints: Rowland J Elwell PharmD, Department of Pharmacy Practice, Albany College of Pharmacy, 106 New Scotland Ave., Albany, NY 12208-3492, FAX 518/445-7302, E-mail elwellr{at}acp.edu

OBJECTIVE: To evaluate the clinical usefulness of combined furosemide and human albumin for the treatment of diuretic-resistant edema in patients with nephrotic syndrome and cirrhosis.

DATA SOURCES: Clinical literature was accessed through MEDLINE (1966–May 2002). Key search terms included furosemide, albumin, human albumin solution, nephrotic syndrome, and cirrhosis.

DATA SYNTHESIS: Hypoalbuminemia, edema, and ascites are often manifestations of nephrotic syndrome and cirrhosis of the liver. Many patients with these conditions are resistant to the effects of diuretics. The combination of furosemide and human albumin solution is occasionally used in these patients. An evaluation of published studies focusing on combined furosemide and albumin in the management of nephrotic syndrome and cirrhosis was conducted.

CONCLUSIONS: Published studies report conflicting results regarding the efficacy of combined furosemide and albumin. Although it is difficult to generate firm conclusions, it appears the combination may provide clinical benefits for select patients. Given these findings, we believe that the addition of albumin to enhance diuretic efficacy should be reserved for patients with recalcitrant edema or ascites in whom diuretic doses have been maximized and those with severe hypoalbuminemia.

Key Words: cirrhosis, furosemide, human albumin solution, nephrotic syndrome

Published Online, March 25, 2003. www.theannals.com, DOI 10.1345/aph.1C320

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-010-H01


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