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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 the nephrotic syndrome).
* Hypertension.
### Adult Dosing
* **Edema:**
* Initial: 20-80 mg orally once daily.
* Further doses: May be given in two or three doses daily.
* Maximum: 600 mg/day orally (higher doses may be used under close medical supervision).
* **Hypertension:**
* Initial: 40 mg orally twice daily.
* Maintenance: Adjust dose based on response.
* Maximum: Generally not recommended as monotherapy for hypertension; typically used in combination.
### Pediatric Dosing
* **Edema:**
* Initial: 1-2 mg/kg orally once daily.
* Maximum initial dose: 40 mg/day.
* Further doses: Adjust based on response. May be given in two or three divided doses.
* Maximum: 6 mg/kg/day orally.
### Dose Adjustments
* **Renal Impairment:** Higher doses may be required due to impaired excretion. Dose escalation should be guided by response and monitoring.
* **Hepatic Impairment:** Dose may need to be reduced, particularly in patients with ascites and electrolyte abnormalities.
### Contraindications
* Anuria.
* Hypersensitivity to furosemide or sulfonamides.
### Adverse Effects
Common: Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia), dehydration, hypotension, increased urination, gastrointestinal upset.
Serious: Ototoxicity (especially with rapid IV administration or high doses), severe allergic reactions, blood dyscrasias, hyperglycemia.
### Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **Antihypertensives/Diuretics:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May decrease diuretic and antihypertensive effects, and increase risk of renal impairment.
* **Lithium:** Decreased lithium clearance, increased risk of lithium toxicity.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Blood pressure.
* Fluid balance (intake/output, weight).
* Hearing (especially with high doses or in sensitive individuals).
### Clinical Pearls
* Administer oral furosemide in the morning to minimize nocturia.
* Rapid IV administration can cause ototoxicity and hypotension. Administer IV doses slowly (e.g., 20 mg over 1-2 minutes).
* Electrolyte replacement, particularly potassium, is often necessary.
* Monitor for signs of dehydration and hypotension.
* Individualize dosing based on patient response and renal function.
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*This information is intended as a concise reference. Always consult the most current prescribing information and institutional protocols for complete details.*
