Please check your internet connection and try again.
# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic that inhibits the reabsorption of sodium and chloride in the ascending limb of the loop of Henle, leading to increased excretion of water, sodium, chloride, potassium, calcium, and magnesium.
## Primary Indications
* Edema associated with congestive heart failure (CHF)
* Edema associated with hepatic cirrhosis
* Edema associated with renal disease (including the nephrotic syndrome)
* Hypertension (may be used alone or in combination with other antihypertensives)
## Adult Dosing
* **Edema:** 20 mg to 80 mg orally once daily. If inadequate response, increase dose by 20 mg to 40 mg every 6 to 8 hours or consider administering the total daily dose in 2 or 3 divided doses. Doses may be increased to 600 mg orally per day in severe cases.
* **Hypertension:** 40 mg orally once daily. Doses higher than 80 mg may not be effective and may increase serum electrolyte losses.
## Pediatric Dosing
* **Edema/Hypertension:** 1 mg/kg to 2 mg/kg orally once daily, not to exceed 6 mg/kg/day. The dose can be divided and given every 6 to 12 hours.
* *Note: Dosing varies and should be guided by patient response and clinical judgment.*
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in renal impairment due to reduced excretion. Monitor electrolytes and fluid status closely.
* **Hepatic Impairment:** Furosemide can accumulate in hepatic impairment. Use with caution and monitor for electrolyte imbalances.
## Contraindications
* Anuria
* History of hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Electrolyte Imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration and Hypotension:** Due to excessive diuresis.
* **Ototoxicity:** Particularly with rapid IV administration or in patients with severe renal impairment.
* **Hyperuricemia and Gout:**
* **Hyperglycemia:**
* **Rash:**
* **Aplastic anemia, Thrombocytopenia, Agranulocytosis:** Rare but serious hematologic effects.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce natriuretic and antihypertensive effects.
* **Lithium:** Furosemide can decrease lithium clearance, increasing lithium levels and toxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Digoxin:** Hypokalemia induced by furosemide increases the risk of digoxin toxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid status (weight, intake/output)
* Blood glucose (in diabetic patients)
* Uric acid levels
## Clinical Pearls
* Oral administration is generally preferred for chronic use.
* IV administration is more potent and has a faster onset of action.
* Rapid IV administration can increase the risk of ototoxicity.
* Administer potassium supplements if hypokalemia develops and is clinically significant.
* Monitor for signs and symptoms of dehydration.
* Consider the timing of doses to minimize nocturia.
***
*Disclaimer: This information is intended for clinical decision support and does not replace independent judgment. Always refer to the most current prescribing information and consult relevant literature for complete and up-to-date drug information.*
