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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and renal disease, including nephrotic syndrome. It is also used to treat hypertension.
### Primary Indications
* Edema (congestive heart failure, cirrhosis, renal disease)
* Hypertension (adjunct therapy)
### Adult Dosing
* **Edema:** 20-80 mg orally once daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. Doses up to 200 mg orally once daily or in divided doses have been used in severe cases.
* **Hypertension:** 40 mg orally twice daily. Not typically used as a first-line agent for hypertension unless edema is also present.
### Pediatric Dosing
* **Edema:**
* **Neonates:** 1-4 mg/kg/dose orally every 12-24 hours.
* **Infants and Children:** 2 mg/kg/dose orally once daily. If response is inadequate, increase to 3 mg/kg/dose once daily, then 4 mg/kg/dose once daily. Doses greater than 6 mg/kg/dose are not recommended. Maximum dose is 6 mg/kg/dose.
* **Hypertension:** Not recommended for primary treatment of hypertension in pediatric patients.
### Dose Adjustments
* **Renal Impairment:** Dosing may need to be adjusted based on the degree of renal impairment. Patients with renal insufficiency may require higher doses due to impaired drug excretion.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides (potential cross-sensitivity)
* Hepatic coma or severe electrolyte depletion
### Adverse Effects
* **Electrolyte Imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration:** Especially in elderly patients.
* **Ototoxicity:** Transient or permanent hearing loss, usually associated with rapid IV administration or high doses.
* **Dizziness, lightheadedness, hypotension.**
* **Hyperuricemia, hyperglycemia.**
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and natriuretic effect of furosemide.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and renal impairment.
* **Lithium:** Reduced renal clearance of lithium, leading to lithium toxicity.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
### Monitoring
* Serum electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Hearing (especially with high doses or IV administration)
### Clinical Pearls
* Furosemide's onset of action is approximately 30-60 minutes orally, with peak diuresis occurring within 1-2 hours.
* For more rapid diuresis, intravenous or intramuscular administration may be used. IV onset is within 5 minutes, with peak effect in 30 minutes.
* Monitor fluid balance and electrolytes closely, especially during initiation of therapy and with dose changes.
* Oral potassium supplements may be required to correct hypokalemia.
* Advise patients to rise slowly from a sitting or lying position to minimize orthostatic hypotension.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details and to ensure patient-specific care.*
