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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to reduce fluid overload.
## Primary Indications
* Edema associated with congestive heart failure (CHF), cirrhosis, and renal disease.
* Hypertension (alone or in combination).
## Adult Dosing
* **Edema:** Typically starts at 20-40 mg orally once or twice daily. Doses can be increased by 20-40 mg every 6-8 hours as needed. Doses can range up to 400 mg/day or higher in severe cases, often with more frequent dosing or continuous infusion.
* **Hypertension:** Typically 40 mg orally twice daily.
## Pediatric Dosing
* **Edema:** 1-2 mg/kg orally once or twice daily. Maximum single dose is 40 mg. For IV administration, 1 mg/kg once or twice daily. Maximum single IV dose is 20 mg. Doses may be adjusted based on response and fluid status.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased due to decreased renal excretion. Careful monitoring of fluid and electrolyte status is crucial.
* **Hepatic Impairment:** May require dose reduction due to altered metabolism and increased sensitivity.
## Contraindications
* Anuria.
* History of hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
Common: Dizziness, lightheadedness, orthostatic hypotension, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, azotemia. Less common: Ototoxicity (especially with rapid IV administration or high doses), hyperglycemia, hyperuricemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (potassium, sodium, chloride).
* Renal function (BUN, creatinine).
* Fluid balance (intake and output, daily weights).
* Blood pressure.
* Auditory function (especially with high doses or IV administration).
## Clinical Pearls
* Administer oral doses with food or milk to minimize GI upset.
* Rapid IV administration can increase the risk of ototoxicity. Infuse IV doses slowly (e.g., over 20-30 minutes).
* Oral administration may be less effective in patients with severe GI edema or malabsorption.
* Monitor for signs of dehydration and electrolyte imbalances closely, especially in elderly patients or those with significant fluid loss.
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*This information is for educational purposes and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition. Please refer to the most current prescribing information and local protocols for complete details.*
