Table 4

Oral Diuretics Recommended for Use in the Treatment of Chronic Heart Failure

DrugInitial Daily Dose(s)Maximum Total Daily DoseDuration of Action
Loop Diuretics
 Bumetanide0.5 to 1.0 mg once or twice10 mg4 to 6 hours
 Furosemide20 to 40 mg once or twice600 mg6 to 8 hours
 Torsemide10 to 20 mg once200 mg12 to 16 hours
Thiazide Diuretics
 Chlorothiazide250 to 500 mg once or twice1000 mg6 to 12 hours
 Chlorthalidone12.5 to 25 mg once100 mg24 to 72 hours
 Hydrochlorothiazide25 mg once or twice200 mg6 to 12 hours
 Indapamide2.5 mg once5 mg36 hours
 Metolazone2.5 mg once20 mg12 to 24 hours
Potassium-Sparing Diuretics*
 Amiloride5 mg once20 mg24 hours
 Spironolactone12.5 to 25 mg once50 mg2 to 3 days
 Triamterene50 to 75 mg twice200 mg7 to 9 hours
Sequential Nephron Blockade
 Metolazone2.5 to 10 mg once plus loop diuretic
 Hydrochlorothiazide25 to 100 mg once or twice plus loop diuretic
 Chlorothiazide (IV)500 to 1000 mg once plus loop diuretic

IV indicates intravenous; and mg, milligrams.

  • * Eplerenone, although also a diuretic, is primarily used in chronic heart failure as a suppressor of the rennin-angiotensin-aldosterone system.

  • Higher doses may occasionally be used with close monitoring.