title: Sublingual administration of furosemide: new application of an old drug.
abstract: BACKGROUND
  In patients with decompensated heart failure, absorption of orally administered furosemide may be delayed, possibly leading to impaired pharmacodynamic effects. Sublingual administration may represent an alternative in such situations.
  
  
  METHODS
  In a crossover study including 11 healthy men, 20 mg furosemide was administered intravenously, orally and sublingually on three different days. Pharmacokinetics and pharmacodynamics were assessed from repeated blood and urine samples.
  
  
  RESULTS
  Compared with oral administration, sublingual administration was associated with 43% higher C(max)[difference 215 ng ml(-1), 95% confidence interval (CI) 37, 392], a higher urinary recovery (8.9 vs. 7.3 mg, difference 1.6 mg, 95% CI 0.3, 2.9), an 28% higher AUC (difference 328 ng h(-1) ml(-1), 95% CI 24, 632) and a higher bioavailability of furosemide (59 vs. 47%, difference 12.0%, 95% CI -1.2, 25.2). Sodium excretion was higher after sublingual compared with oral administration (peak excretion rate 1.8 vs. 1.4 mmol min(-1), P < 0.05), whereas urine volume did not differ significantly between the two application modes. In comparison, intravenous administration showed the expected more rapid and intense response.
  
  
  CONCLUSIONS
  Sublingually administered furosemide tablets differ in certain kinetic and dynamic properties from identical tablets given orally. Sublingual administration of furosemide may offer therapeutic advantages in certain groups of patients.
authors: Department of Cardiology, University Hospital, Basel, Switzerland.
authors: Laurent
authors: L
authors: Haegeli
authors: Hans Peter
authors: HP
authors: Brunner-La Rocca
authors: Markus
authors: M
authors: Wenk
authors: Matthias
authors: M
authors: Pfisterer
authors: Jürgen
authors: J
authors: Drewe
authors: Stephan
authors: S
authors: Krähenbühl
mesh_terms: D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D002626:Chemistry, Pharmaceutical; D018592:Cross-Over Studies; D005665:Furosemide / Q000008:administration & dosage* / Q000737:chemistry / Q000493:pharmacokinetics*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male
chemical_list: D005665:Furosemide