Please check your internet connection and try again.
# Furosemide
## Overview
Furosemide is a potent loop diuretic used to reduce edema.
## Primary Indications
* Pulmonary edema (acute and chronic)
* Peripheral edema associated with heart failure, liver cirrhosis, and renal disease
* Hypertension (adjunctive therapy)
## Adult Dosing
* **Edema:**
* Oral: 20-80 mg once daily. Higher doses may be given, but maximum oral dose is generally 600 mg/day, though doses up to 1g/day have been used in specific situations. Doses can be repeated every 6-8 hours as needed.
* Intravenous (IV)/Intramuscular (IM): 20-40 mg once daily. Doses can be repeated every 2 hours as needed. Higher doses may be necessary; typical IV maximum is 100 mg/dose, but up to 200 mg/dose has been used in severe cases. Continuous IV infusion is also an option.
* **Hypertension:**
* Oral: 40 mg twice daily.
## Pediatric Dosing
* **Edema:**
* Oral: 1-2 mg/kg/dose once or twice daily. Maximum dose: 6 mg/kg/day.
* IV/IM: 1 mg/kg/dose once daily. Maximum dose: 20 mg/dose or 1 mg/kg/dose if higher dose is required. For premature infants, doses should not exceed 1 mg/kg/dose. Higher doses or frequent administration may be necessary in some cases, but this requires careful monitoring and adjustment by a physician.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment may be necessary. In severe renal impairment, response may be diminished, and higher doses may be required.
* **Hepatic Impairment:** Monitor for electrolyte imbalances and hepatic encephalopathy.
## Contraindications
* Anuria
* 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, lightheadedness
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Lithium:** Reduced renal clearance, increased risk of lithium toxicity.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Fluid balance (intake and output)
* Blood pressure
* Hearing (especially with high doses or in patients with risk factors)
* Blood glucose (in diabetic patients)
## Clinical Pearls
* Administer oral furosemide on an empty stomach for maximum absorption, but it can be given with food or milk if gastric irritation occurs.
* Rapid IV administration can cause ototoxicity. Slow IV push (over 1-2 minutes) or continuous infusion is preferred.
* Monitor urine output closely. If urine output does not increase significantly after administration, the dose may need to be increased or the route of administration changed.
* Furosemide is a high-alert medication due to its potential for significant electrolyte disturbances and dehydration.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details.
