In congestive hea failure patients
Diuretics are given orally in hypeension, given slow iv in CCF for rapid onset of action. Diuretics although donot treat the pathologic changes in HF they are used as main stay for symptomatic treatment to remove excess fluid.Switching to iv or infusion bypasses the GI tract and helps in over coming diuretic resistance. Ref: Goodman and Gillman 13th ed. kidney.
Volume of distribution is increased
Hepatic clearance of drugs is not changed
Orally administered diuretics may not be effective, may work parenterally
Inotropic action of digoxin is attenuated
Cardiovascular system