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Table 3 Diuretic Adjustment Algorithm

From: Comparison of a one-time educational intervention to a teach-to-goal educational intervention for self-management of heart failure: design of a randomized controlled trial

Instructed adjustment Instructed adjustment Prescribed loop diuretic dose and frequency Instructed Adjustment Instructed Adjustment
Low Red Zone Low Yellow Zone Green Zone High Yellow Zone High Red Zone
Weight 8# or less than target If Weight is 4–7#
Less than target
Target weight +/- 3 lbs
(Euvolemic)
If Weight 4–7 #
More than target
Weight 8# or more
Above target
nothing nothing 20 mg qd 20 mg bid 20 mg bid
nothing 20 mg qd 20 mg bid 40 mg bid 40 mg bid
nothing 20 mg qd 40 mg qd 40 mg bid 40 mg bid
nothing 40 mg qd 40 mg bid 80 mg bid 80 mg bid
nothing 40 mg qd 80 mg qd 80 mg bid 80 mg bid
nothing half dose qd > 80 mg qd > 80 mg bid > 80 mg bid
nothing 80 mg qd 80 mg or more bid 80 mg bid, thiazide 25 mg qd* 80 mg bid, thiazide 25 mg qd*
nothing 160 mg qd 160 mg bid 160 mg bid, thiazide 25 mg qd* 160 mg bid, thiazide 25 mg qd*
Alternative schedule if Physician prefers diuretic doubled in one does vs. two
Nothing nothing 20 mg qd 40 mg qd 40 mg qd
Nothing 20 mg qd 40 mg qd 80 mg qd 80 mg qd
Nothing 40 mg qd 80 mg qd 160 mg qd 160 mg qd
nothing 80 mg qd 160 mg qd 160 mg bid 160 mg bid