Furosemide

Diuretic · Loop diuretic

Indications

Cardiac, pulmonary, cerebral and peripheral oedema, hypertension.

Dosage

ORAL: Oedema: Adults: Treatment is usually begun with 20-80 mg as single dose daily or on alternate days. Children: Usual: 2mg/kg as single dose, may increase by 1-2 mg/kg after 6-8 hr. Max: 6 mg/kg. Heart Failure: Adults: Usual: 20-80 mg as single dose, may repeat or increase by 20-40 mg after 6-8 hr. Max: 600 mg/day. Hypertension: Adults: Initial: 40 mg twice daily. Maintenance: Adjust according to response. INJECTION: Oedema: Adults: Initially 20-40 mg as single dose IM or slow IV. Children: 1 mg/kg single dose. May increase by 1 mg/kg after 2 hr. Max: 6 mg/kg. Heart Failure: Adults: IV/IM: 20-40 mg. May repeat or increase by 20 mg after 2 hr.

Administration

IV: IV injections should be given slowly over 1-2 min; maximum rate of administration for IVPB or infusion: 4 mg/min; replace parenteral therapy with oral therapy as soon as possible. Oedema: Initial dose: 20-40 mg IM or IV. Give the IV injection slowly (1 to 2 min); ordinary, prompt diuretics ensure. If needed, another dose may be given in the same manner 2 hours later. The dose may be raised by 20 mg and given no sooner than 2 hours after previous dose, until desired diuretic effect is obtained. This dose should then be given once or twice daily. Administer high dose parenteral therapy as a controlled infusion at a rate = 4 mg/min. Acute pulmonary oedema: The usual initial dose is 40 mg IV (over 1 to 2 min). If response is not satisfactory within 1 hour, increase to 80 mg IV (over 1 to 2 min). Additional therapy (e.g. digitalis, oxygen) may be given concomitantly. CHF and chronic…

Adverse Effects

Disorders of electrolyte balance, dehydration, allergic reactions, GI upset, hypotension, rash, hyperuricaemia, hyperglycaemia, raised serum creatinine.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Renal failure with anuria, hypokalaemia, hyponatraemia, hypotension, hypersensitivity to sulphonamides, in pregnancy for short time and if strictly indicated. Comatose or precomatose states associated with liver cirrhosis or encephalopathy, hypovolaemia, dehydration. Addison's disease. Precautions: Furosemide may pass into breast milk and inhibit lactation, stop breast feeding. Prostatic hypertrophy or impaired micturition. Monitor fluid and electrolyte balance, renal function, and blood counts. Diabetes, gout, renal or hepatic impairment, hepatorenal syndrome, hypotension, adrenal disease. Elderly.

Interactions

Digitalis, lithium, aminoglycosides, cephalosporins, antihypertensives, NSAIDs, digoxin, vancomycin, carbamazepine, phenytoin, corticosteroids, theophylline, risperidone, K+ - sparing diuretics, K+ suppl.

Advice to Patient

Take with meals or milk as directed. Take medication at the same time each day. Take the last dose of furosemide several hours before bedtime to avoid sleep disturbance. For single daily dose, take medication in morning. Contact prescriber if there is unusual weight gain or loss; swollen ankles, feet or hands; trembling; numbness; fatigue; muscle cramps; muscle weakness; palpitations; constant nausea or vomiting; diarrhoea or hearing changes. Include potassium-rich foods in diet such as bananas and orange juice. Do not take potassium supplements without consulting prescriber. Avoid alcohol, standing for long time and exercising in hot weather. Avoid foods containing high amount of sodium. Check blood glucose level regularly and inform prescriber about changes. Weigh yourself in same dress at the same time of day when therapy is started and weekly if therapy is continued for…

Pharmacokinetics

Onset of action: Diuresis: Oral, sublingual: 30-60 mins. IM: 30 mins. IV: Approx. 5 min. Symptomatic treatment with acute pulmonary oedema: Within 15-20 mins, occurs prior to diuretic effect. Peak effect: Oral, sublingual: 1-2 hrs. Duration: Oral, sublingual: 6-8 hrs. IV: 2 hrs. Metabolism: Minimally hepatic. Bioavailability: Oral Tab: 47%-64%. Oral soln: 50%. Sublingual adm of oral tab: Approx. 60%. Half-life elimination: Normal renal func: 0.5-2 hrs. End-stage renal disease: 9 hrs. Excretion: Urine (Oral: 50%, IV: 80%). Faeces.

Brands with this active ingredient

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