Table 3.

Stepped pharmacologic care algorithm for heart failure

LevelCurrent Daily Furosemide Dosea, mgBolusInfusion Rate, mg/hMetolazone (Oral)
281–16080105 mg daily
3161–24080205 mg twice daily
4≥24080305 mg twice daily
  • a Diuretic equivalents: 40 mg furosemide is considered equivalent to 1 mg bumetanide 20 mg torsemide. Adapted from Grodin et al. (47) and Bart et al. (73). The full algorithm provided in the references includes additional considerations for vasodilator, inotropic, or mechanical therapy for patients who fail to respond within 48 h.