Pediatric Nephrology

, Volume 12, Issue 7, pp 603–616

The clinical pharmacology of loop diuretics in the pediatric patient

  • Shannan K. Eades
  • Michael L. Christensen
Pharmacology review

DOI: 10.1007/s004670050514

Cite this article as:
Eades, S. & Christensen, M. Pediatr Nephrol (1998) 12: 603. doi:10.1007/s004670050514

Abstract.

The loop diuretics furosemide and bumetanide are frequently employed in the pediatric population for the management of fluid overload in both acute and chronic disease states. They act mainly by inhibiting sodium reabsorption in the nephron at the thick ascending limb of Henle’s loop. Important pharmacokinetic differences between adults and infants include a reduced clearance and prolonged half-life, that may cause accumulation of these agents to potentially toxic levels if dosing intervals are not adjusted. Unfortunately, little is known about the time required for maturation of loop diuretic elimination in older infants, children, and adolescents. Similar to adults, limited pharmacodynamic evidence in neonates suggests that a maximally efficient diuretic dose exists. Increasing the diuretic dose beyond this maximum does not offer further benefit, but may increase the risk of toxicity. Common problems encountered in the pediatric patient as well as in adults are loop diuretic tolerance and resistance. Loop diuretic dosing strategies aimed at overcoming these phenomena include administration by continuous infusion, coadministration with albumin, and coadministration with metolazone or thiazides. This article reviews the pharmacology, pharmacokinetics, and pharmacodynamics of furosemide and bumetanide in pediatric patients. A better understanding of the clinical pharmacology of the loop diuretics should aid clinicians in the development of dosing regimens aimed at producing adequate diuresis without promoting excessive diuretic tolerance.

Key words: Loop diureticsFurosemideBumetanideTolerance

Copyright information

© IPNA - International Pediatric Nephrology Association New York, USA 1998

Authors and Affiliations

  • Shannan K. Eades
    • 1
  • Michael L. Christensen
    • 1
  1. 1.Department of Clinical Pharmacy, Pediatric Pharmacology Research Unit, Crippled Children’s Foundation Research Center, University of Tennessee, Memphis, Tennessee, USAUS