How to prescribe loop diuretics in oedema

### What you need to know Loop diuretics are commonly prescribed to manage oedema symptoms such as swollen legs or breathlessness and to relieve fluid overload. They are widely recommended by guidelines and organisations such as the National Institute for Health and Care Excellence (NICE) in the UK. The loop diuretics available in the UK are furosemide, bumetanide, and torasemide. But which option is best? The pharmacokinetics of loop diuretics are well characterised. Studies and trials on humans and animals describe pharmacodynamic differences between loop diuretics. However, there is limited evidence directly comparing them. In particular, there is little and low quality information comparing the clinical outcomes of furosemide with the less commonly chosen alternatives torsemide and bumetanide. This article (box 1) outlines some pharmacokinetic differences between available loop diuretics that may influence loop selection in practice and advises how to dose them effectively. Box 1 ### How this article was created We initially wrote this article in response to questions primary care clinicians frequently posed when seeking assistance in managing oedema in patients with heart failure. Evidence was gathered over a 15 year period in response to patient and physician queries regarding the management of oedema and the use of loop diuretics. We …