Please check your internet connection and try again.
# Furosemide
## Overview
Furosemide is a potent loop diuretic used to manage fluid overload and edema.
## Primary Indications
* Edema associated with congestive heart failure (CHF), cirrhosis, and renal disease (including nephrotic syndrome).
* Hypertension (less commonly as monotherapy).
* Acute pulmonary edema.
## Adult Dosing
* **Edema:**
* Oral: Start with 20-80 mg once daily. The dose may be increased by 20-40 mg every 6-8 hours or as needed.
* Intravenous (IV) or Intramuscular (IM): Start with 20-40 mg once daily. If no adequate response, the dose can be increased by 20 mg every 2 hours.
* Maximum oral dose: Generally 600 mg daily, but higher doses may be used in refractory cases under close monitoring.
* Maximum IV/IM dose: Typically 40-80 mg per dose, but higher doses may be administered in urgent situations or with continuous infusion.
* **Hypertension:**
* Oral: Start with 40 mg twice daily. Dose may be adjusted based on response. Not typically a first-line agent.
* **Acute Pulmonary Edema:**
* IV/IM: 20-40 mg. If response is inadequate after 2 hours, consider increasing the dose to 40 mg. Doses can be repeated every 4-6 hours or a continuous infusion may be used.
## Pediatric Dosing
Dosing is highly individualized based on indication and patient response. Consult specific pediatric guidelines or a pediatric specialist.
* **Edema:**
* Oral: 1-2 mg/kg/dose once or twice daily. Maximum dose: 6 mg/kg/dose once or twice daily.
* IV/IM: 1 mg/kg/dose once or twice daily. Maximum dose: 6 mg/kg/dose once or twice daily.
* **Neonatal Hyperbilirubinemia:**
* Oral: 0.5-1 mg/kg/dose every 6-12 hours.
## Dose Adjustments
* **Renal Impairment:** May require higher doses due to decreased renal excretion. Monitor for efficacy and toxicity closely.
* **Hepatic Impairment:** Reduced protein binding may increase free drug concentration. Monitor for electrolyte imbalances and volume status.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration, hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperuricemia, hyperglycemia.
* Dizziness, headache, weakness.
* Rash, photosensitivity.
## Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and renal dysfunction.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Lithium:** Reduced lithium clearance, increasing risk of lithium toxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity if hypokalemia occurs.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid balance (intake/output, weight).
* Blood pressure.
* Hearing (especially with high doses or IV administration).
* Blood glucose and uric acid (in susceptible patients).
## Clinical Pearls
* Oral furosemide may have variable absorption.
* IV administration is typically 1.5-2 times the oral dose.
* For continuous IV infusion, the total daily oral dose can be divided by 24.
* Monitor for signs of dehydration and electrolyte depletion.
* Hypokalemia is common and may necessitate potassium supplementation or potassium-sparing diuretics.
* Ototoxicity is often reversible but can be permanent.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.*
