Because diuresis may be extensive, loop diuretics should be administered initially in small doses; multiple doses, if needed, should be given in early morning and early afternoon. During the remainder of the day, when the drug is not acting, the body can begin to compensate for any derangements in fluid and electrolyte balance that may have occurred as a result of drug therapy. These drugs should be restricted to patients who require greater diuretic potential than can be achieved by other diuretic drugs. In addition to being used in the usual edematous states associated with congestive heart failure, cirrhosis, or renal disease, the loop diuretics can be used in emergencies, such as acute pulmonary edema, when rapid onset of action is essential. They are not recommended for use during pregnancy.
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