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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and kidney disease, including nephrotic syndrome. It is also used to treat hypertension, either alone or in combination with other antihypertensives.
## Primary Indications
* Edema (congestive heart failure, cirrhosis, renal disease)
* Hypertension
## Adult Dosing
* **Edema:**
* Oral: Typically starts at 20-80 mg once or twice daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. The maximum daily oral dose is typically 600 mg, but higher doses have been used under close medical supervision.
* Intravenous (IV)/Intramuscular (IM): Typically starts at 20-40 mg once. If inadequate response, doses may be increased by 20 mg every 2 hours. The maximum daily IV/IM dose is typically 200 mg, but higher doses may be required in severe cases.
* **Hypertension:**
* Oral: Typically starts at 40 mg twice daily. May be adjusted to 20-120 mg daily given in one or two divided doses.
## Pediatric Dosing
* **Edema:**
* Oral: 1-2 mg/kg/dose once or twice daily. Doses may be increased by 1-2 mg/kg/dose every 6-8 hours. Maximum dose is 6 mg/kg/day.
* IV/IM: 1 mg/kg/dose once. If inadequate response, doses may be increased by 1 mg/kg/dose every 2 hours. Maximum dose is 6 mg/kg/day.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is often necessary due to decreased renal excretion. Close monitoring of fluid and electrolyte status is crucial.
* **Hepatic Impairment:** Dose adjustments may be needed due to altered metabolism and increased sensitivity.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, dizziness, lightheadedness, orthostatic hypotension, increased urination.
* **Serious:** Ototoxicity (especially with rapid IV administration or high doses), hyperuricemia, hyperglycemia, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other Diuretics:** Additive diuretic effect, increased risk of dehydration and electrolyte depletion.
* **NSAIDs:** May decrease the natriuretic and antihypertensive effects of furosemide.
* **Lithium:** Reduced renal clearance, increasing the risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Fluid balance (intake/output, daily weights)
* Blood pressure
* Hearing (especially with high doses or IV administration)
* Blood glucose and uric acid levels
## Clinical Pearls
* Furosemide is a high-ceiling diuretic; its diuretic effect is dose-dependent.
* Administer oral furosemide at least 6 hours before bedtime to minimize nocturia.
* Rapid IV administration can increase the risk of ototoxicity. Infuse slowly, typically over 30-60 minutes.
* Patients with sulfonamide allergies may have a cross-reactivity, though this is uncommon.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and current guidelines before making any clinical decisions.*
