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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to manage fluid overload (edema) and hypertension.
## Primary Indications
* Edema associated with congestive heart failure (CHF), hepatic cirrhosis, and renal disease.
* Hypertension (often in combination with other antihypertensives).
* Acute pulmonary edema.
## Adult Dosing
* **Edema:** Oral: 20-80 mg once daily. May increase by 20-40 mg every 6-8 hours as needed. Usual maintenance dose: 40-120 mg per day in divided doses. IV/IM: 20-40 mg once daily. May increase by 20 mg every 2 hours as needed.
* **Hypertension:** Oral: 40 mg twice daily.
* **Acute Pulmonary Edema:** IV/IM: 40 mg. If inadequate response, may administer another 40 mg after 2 hours.
## Pediatric Dosing
* **Edema:** Oral: 1-2 mg/kg/dose once daily. May increase by 1 mg/kg/dose every 6-8 hours. Maximum dose: 6 mg/kg/day. IV/IM: 1 mg/kg/dose once daily. Maximum dose: 20 mg/dose for neonates and infants under 2 months; 40 mg/dose for older infants and children.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with severe renal impairment due to decreased efficacy, but monitor closely for toxicity.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Anuria.
* Hypersensitivity to furosemide or sulfonamides.
* Hepatic coma or severe electrolyte depletion.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration, hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperglycemia, hyperuricemia.
* Dizziness, headache.
## Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Antihypertensives:** Additive hypotensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
* **Lithium:** Reduced lithium clearance, increasing lithium toxicity risk.
* **Potassium-Sparing Diuretics:** May be used to counteract potassium loss, but monitor electrolytes.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride, magnesium, calcium), BUN, creatinine, and fluid balance.
* Blood pressure.
* Uric acid and glucose levels (if clinically indicated).
* Hearing (especially with high doses or risk factors for ototoxicity).
## Clinical Pearls
* Administer oral furosemide as a single dose in the morning to minimize nocturia.
* Rapid IV administration can increase the risk of ototoxicity. Administer IV doses slowly over at least 30-60 minutes.
* Monitor for signs and symptoms of electrolyte depletion, particularly hypokalemia.
* Furosemide is highly protein-bound; displacement by other drugs can potentiate its effect.
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*This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant literature for complete details.*
