Subcutaneous furosemide therapy for chronic management of refractory congestive heart failure in dogs and cats
Open access
In our edition of: Apr 2025
In our categories of: small animals
our summary:
Lombardo, S.F., Ferasin, H. and Ferasin, L. (2025) Subcutaneous furosemide therapy for chronic management of refractory congestive heart failure in dogs and cats. Animals, 15 (3), 358.
The aim of this retrospective study was to determine the effectiveness of subcutaneous (SC) administration of furosemide in controlling the signs of congestive heart failure (CHF) in dogs and cats with refractory heart failure. Secondary aims were to describe any side effects and to assess the feasibility of owners administering SC furosemide therapy at home.
Clinical records of dogs and cats treated with SC furosemide at a referral centre in the UK between 2020-2024 were reviewed. SC furosemide was offered off-label to owners when treatment with oral diuretics had not resulted in a satisfactory clinical response and owners were considering euthanasia. Extracted data included patient details and clinical information including signs at presentation, diagnosis, sleeping respiratory rate at home and the number of relapses of CHF episodes. Owners received instruction on how to correctly administer SC injections and were also assessed for their ability to perform SC injections twice daily to their pets. Additionally, owners assessed their pet’s quality of life (QoL) based on their appetite, exercise, grooming activity, and general interaction.
The study looked at three timepoints: first (T1) was related to the initial onset of CHF; second (T2) corresponded to the start of SC furosemide as rescue therapy; and third (T3) related to the patient’s death, or the end of data collection for those still alive. The dose of SC furosemide was decided by the attending clinician based on the current oral dose of furosemide or the equivalent dose of torasemide
Records of 30 client-owned animals (13 dogs and 17 cats) were eligible for analysis. Myxomatous mitral valve disease was the most common diagnosis in dogs (10/13 dogs) and hypertrophic cardiomyopathy in cats (6/17). At T2 nine dogs were receiving treatment with oral furosemide therapy and four dogs oral torasemide. At the same timepoint 12 cats were receiving treatment with oral furosemide therapy and five were receiving oral torasemide. All the study animals were given SC furosemide at a median dose of 5.5 mg/Kg/day in dogs and 4.0 mg/Kg/day in cats, administered as two equal injections at 12-hour intervals.
In all cases there was a good clinical response with satisfactory control of the animal’s breathing rate and effort. Owners reported a noticeable improvement in their pet’s QoL. The median survival time following administration of SC furosemide was 106 days in dogs and 89 days in cats. Six dogs and ten cats were euthanised due to a relapse of the signs of CHF and negative impact on their quality of life. SC injections were well tolerated in most animals however, mild to moderate skin irritation was observed in two dogs and three cats.
All owners in this study were able to continue the therapy at home and regularly administered SC furosemide without any concerns about the pet’s QoL.
Limitations of the study include the small sample population, the patients were affected by different cardiovascular conditions with differing disease progression, the treatment dose of SC furosemide was not standardised, and the assessment of QoL was based on owner report rather than a standardised measure.
This study provides some evidence that treatment with subcutaneous administration of furosemide, may be successful in relieving the signs of congestive heart failure in dogs and cats. This could provide an alternative treatment option for effective care at home for those animals experiencing poor clinical response from oral diuresis.
The following may also be of interest:
Besche, B. et al. (2020) Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study. Journal of Veterinary Internal Medicine, 34 (5), pp. 1746– 1758. https://doi.org/10.1111/jvim.15864
An inFOCUS summary is available
Packham, L. (2020) In dogs with congestive heart failure, is torasemide superior to furosemide as a first line diuretic treatment? Veterinary Evidence, 5 (4) https://doi.org/10.18849/ve.v5i4.300
Luis Fuentes, V. et al. (2020) ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. Journal of Veterinary Internal Medicine, 34 (3), pp.1062-1077. https://doi.org/10.1111/jvim.15745
Keene, B.W. et al. (2019) ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. Journal of Veterinary Internal Medicine, 33 (3), pp. 1127-1140. https://doi.org/10.1111/jvim.15488
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