Agents used to augment diuresis in adult patients with heart failure refractory to high-dose loop diuretics*

In patients who undergo concurrent therapy with a loop diuretic plus an agent listed in this table (ie, combination diuretic therapy), frequent monitoring (eg, vital signs, electrolyte levels) in the inpatient setting is typically required. After initiation of combination therapy, the approach to subsequent therapy is based on clinical response (eg, resolution of symptoms, decrease in weight) and tolerability (eg, complications such as hypokalemia). For more information on choice of agent, dosing, and monitoring of combination diuretic therapy, refer to UpToDate content on management of patients refractory to diuretics and content on advanced heart failure.