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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) and high blood pressure.
## Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease (including nephrotic syndrome).
* Hypertension, usually in combination with other antihypertensives.
* Acute pulmonary edema.
## Adult Dosing
* **Edema:** 20-80 mg orally once daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. Maximum daily dose generally 600 mg, though higher doses have been used under close supervision.
* **Hypertension:** 40 mg orally twice daily.
* **Acute Pulmonary Edema:** 20-40 mg intravenously. May repeat every 2 hours as needed.
* **IV/IM Dosing:** Generally 1-2 times the oral dose.
## Pediatric Dosing
* **Edema/Hypertension:** 1-2 mg/kg/dose orally every 6-12 hours. Maximum dose: 6 mg/kg/day.
* **Neonates:** Dosing is highly variable and depends on clinical status. Initial doses of 0.5-1 mg/kg/dose IV or PO every 12-24 hours are common. Some protocols use continuous infusion.
## Dose Adjustments
* **Renal Impairment:** Increased doses may be required due to decreased renal excretion. Monitor for efficacy and toxicity.
* **Hepatic Impairment:** May require lower doses due to altered metabolism and increased sensitivity.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides (cross-sensitivity possible).
* Hepatic coma or severe electrolyte depletion.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration, hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperuricemia (can precipitate gout).
* Hyperglycemia.
* Dizziness, headache, weakness.
* Rash, photosensitivity.
## Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity.
* **NSAIDs:** May decrease diuretic and antihypertensive effects; increased risk of nephrotoxicity.
* **Lithium:** Decreased renal clearance of lithium, increasing risk of lithium toxicity.
* **Antihypertensives (including other diuretics, ACE inhibitors, ARBs):** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium) at baseline and regularly during therapy.
* Renal function (BUN, creatinine).
* Fluid status (weight, intake/output, edema assessment).
* Blood pressure.
* Blood glucose.
* Uric acid.
* Hearing assessment, especially with high doses or in patients with risk factors for ototoxicity.
## Clinical Pearls
* Administer oral furosemide in the morning to minimize nocturia.
* Rapid IV administration (e.g., > 4 mg/min) can increase the risk of ototoxicity. Infuse slowly or dilute.
* Monitor for signs of dehydration and electrolyte disturbances. Potassium supplementation is often necessary.
* Patients with severe edema may require higher doses or more frequent administration, adjusted based on response and tolerance.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature for complete details. Dosing recommendations may vary based on specific clinical scenarios and local protocols.*
