Lasix As Needed – The Importance of Recognizing Diagnosis

An 81 year old female is taking Lasix as needed.  The reason for taking the Lasix as needed may surprise you!

Medication List:

  • Advair 250/50 BID
  • Simvastatin 20 mg HS
  • Furosemide 40 mg once daily as needed for blood pressure
  • Duonebs QID prn
  • Flonase 1 spray into each nostril daily
  • Toprol XL 12.5 mg once daily
  • Norvasc 5 mg daily
  • FeSO4 325 mg BID
  • Senna-S 3 tabs BID
  1. The first thing I notice is the furosemide as needed for blood pressure!  A pretty unique order for sure.  I have seen prn orders quite a bit with loop diuretics in relation to CHF/edema, but it is pretty unusual for hypertension.  I would investigate this further.
    1. Another question to ask here; Is the patient actually doing daily blood pressures and what blood pressure would they take the furosemide for?
    2. It appears there would be plenty of room to increase other blood pressure medications as well.
  2. I would investigate the iron supplement.  Do they need it long term as well as the possibility to contribute to constipation and the pretty substantial dose of Senna-S
    1. Hemoglobin and ferritin would be a good assessment here to get a sense for the necessity of long term iron.
    2. This patient looks like a potential aspirin candidate.  The hemoglobin and past history may give us some guidance here as to why this patient isn’t on aspirin.
  3. Assessing the use and frequency of use of Duonebs is always something I try to look into.  We obviously don’t have a diagnosis here, but this will help give us a sense of the respiratory control.

What else would you like to investigate?

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  1. catherine

    I don’t see PRN lasix. I see Furosemide 40 mg QD. And I agree that a reassessment of BPs is called for. Why so many HTN meds?

    • Eric Christianson

      Thanks for catching that Catherine, an oversight on my part 🙂

  2. ethel

    Isnt as needed means prn?

  3. Dee

    Have you considered that the “prn for blood pressure” was a typo/picking error by the physician?
    Since the patient is taking Toprol XL- which is pretty much only used in heart failure.
    Stage C heart failure

  4. Jen

    She has advair but no albuterol prn. Another is, depending on pt history and labs, why not switch the zocor to Lipitor or crestor

  5. Jessica Boh

    Would you still consider this patient for aspirin even though she is 81 years old? The ASPREE study and several similar suggest aspirin is associated with higher risk of bleed and no prolongation of disability or death. Just a thought!

  6. Teresita

    I’m glad I read your blog re: Lasix can be taken PRN for CHF/ edema because my Dr.reduced my Lasix to 20mg.daily but after 6 days I started filling up, congested and coughing like crazy.Since it was late to call the office I took (1)20 mg.yesterday pm and it helped me a lot.But I have to call my doc and ask for PRN extra dose for CHF.Thank you for sharing.


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Written By Eric Christianson

July 19, 2017

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