In this pilot study, the treatment in the hospital setting will simulate how the patient would be treated at home in the feasibility study. The results of this pilot will be used to inform the design of the feasibility study. The future feasibility study will test the concept that removing the need for professional care for furosemide administration allows a proportion of these patients to go home and be treated safely at home.
A total of 10 patients will be studied using an open label approach to assess efficacy, tolerability and safety of subcutaneous administration of a novel furosemide regimen, administered subcutaneously.
Patients who are referred to the hospital for treatment of fluid overload will complete screening and treatment phases. Subjects meeting the eligibility criteria will be administered a test dose of 80mg furosemide USP administered by intravenous (IV) bolus over 2 minutes. Fluid intake will be restricted during the 2-hour observation period.
Only patients who respond to the test dose of commercially available 80mg intravenous (IV) furosemide (alternatively, bumetanide 2 mg IV ) by means of diuresis in excess of 400 mL over 2 hours will be eligible to enter the treatment phase of the study with the Investigational Medicinal Product. Patients who have responded to the equivalent dose of furosemide or bumetanide as part of their clinical care for heart failure in the hospital within 24 hours of recruitment will not require this test dose and will be eligible for entry into the study provided they meet all of the entry criteria for the study.
Non-responders will be treated in the hospital with usual care.
Investigational Medicinal Product:
Subjects who are Diuretic Responders will be treated with the Investigational Medicinal Product for a period of 24 hours. Furosemide Injection Solution, 8 mg/mL (80 mg total dose) will be administered subcutaneously by means of the B. Braun Perfusor® Space Infusion Pump System. The pump will be programmed to deliver 80mg of furosemide over 5 hours with 30mg administered during the first hour followed by 12.5mg/hour for 4 hours.
Subjects will be treated with twice daily dosing, by default, but may be reduced to once daily if it is desired to reduce the daily urine response. The duration and frequency of the treatment will be determined by the attending cardiologist.
If the subject requires further diuresis after 24 hours, they will be converted to usual care at that time. If the attending cardiologist makes the determination at any time that the diuresis is not adequate, the subject's participation in the study will be stopped, and the patient will convert over to usual care.
Urine output every 24 hours will be recorded, as will daily weights. Serum potassium, sodium, blood urea nitrogen, creatinine and hemoglobin will be assessed daily. All patients will be monitored for heart rhythm continuously during the hospitalization. Temperature every 8 hours will be recorded, and the injection site will be assessed daily for signs of erythema.
