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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) due to conditions like heart failure, liver disease, and kidney disease, as well as hypertension.
### Primary Indications
* Edema associated with congestive heart failure, cirrhosis, and renal disease.
* Hypertension (usually in combination with other antihypertensives).
### Adult Dosing
* **Edema:** Initial dose is typically 20-80 mg orally once daily. Doses can be increased by 20-40 mg every 6-8 hours as needed. The usual maintenance dose ranges from 20-80 mg orally daily. Doses up to 600 mg daily have been used in severe cases, but higher doses increase the risk of adverse effects.
* **Hypertension:** Initial dose is typically 40 mg orally twice daily. It is rarely used as a sole agent for hypertension.
* **Intravenous/Intramuscular:** For rapid diuresis, 20-40 mg IV/IM can be administered. Higher doses may be necessary, administered slowly to avoid ototoxicity. Dosing should be individualized based on response.
### Pediatric Dosing
* **Edema/Hypertension:** Doses are typically 1-2 mg/kg orally once daily. Maximum single dose is 40 mg. For IV/IM administration, 1 mg/kg/dose is recommended, not to exceed 20 mg/dose. Higher doses may be required in specific situations and should be determined by a specialist.
### Dose Adjustments
* **Renal Impairment:** Patients with severe renal impairment may require lower doses or less frequent administration due to prolonged half-life. However, some patients may require higher doses to achieve diuresis. Careful titration is essential.
* **Hepatic Impairment:** Dose may need to be adjusted. Monitor electrolytes closely.
### Contraindications
* Anuria.
* History of hypersensitivity to furosemide or sulfonamides.
* Severe electrolyte depletion (e.g., hypokalemia, hyponatremia).
### Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperglycemia, hyperuricemia.
* **Serious:** Ototoxicity (especially with rapid IV administration or high doses), severe skin reactions (e.g., Stevens-Johnson syndrome), aplastic anemia, pancreatitis, cholestatic jaundice.
### Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects.
* **Lithium:** Furosemide can decrease lithium clearance, increasing the risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Hypokalemia induced by furosemide can increase the risk of digoxin toxicity.
### Monitoring
* Fluid status and weight.
* Electrolytes (sodium, potassium, chloride) and bicarbonate.
* Renal function (BUN, creatinine).
* Blood pressure.
* Blood glucose and uric acid levels.
* Hearing (especially with high doses or prolonged therapy).
### Clinical Pearls
* Furosemide is a potent diuretic; start with the lowest effective dose and titrate based on clinical response and electrolyte status.
* Oral administration is generally preferred; if IV administration is necessary, give slowly to minimize ototoxicity.
* Advise patients to take furosemide early in the day to avoid nocturia.
* Educate patients about signs and symptoms of dehydration and electrolyte imbalance.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
