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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used for the management of fluid overload due to heart failure, liver cirrhosis, and renal disease. It is also used to manage hypertension, although less commonly as a primary agent.
## Primary Indications
* Edema associated with congestive heart failure, cirrhosis, and renal disease.
* Hypertension (adjunctive therapy).
## Adult Dosing
* **Edema:**
* Initial: 20-80 mg orally once daily. Doses may be given every day, every other day, or for limited periods.
* Further doses: 20-40 mg orally every 6-8 hours as needed.
* Maximum daily oral dose: 600 mg.
* **Hypertension:**
* Initial: 40 mg orally twice daily.
* Maintenance: Adjust based on response.
* Maximum daily oral dose: 400 mg.
## Pediatric Dosing
* **Edema/Hypertension:**
* Initial: 1-2 mg/kg orally once daily.
* Further doses: Increase by 1-2 mg/kg every 6-8 hours as needed.
* Maximum daily oral dose: 6 mg/kg.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased due to impaired excretion. However, close monitoring for ototoxicity and reduced efficacy is necessary. In patients with severe renal impairment, the maximum dose should not exceed 200 mg per day unless specifically indicated and closely monitored.
* **Hepatic Impairment:** Dose reduction may be necessary due to increased bioavailability.
## Contraindications
* Anuria.
* Hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Dizziness, lightheadedness, orthostatic hypotension, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hyperglycemia, hyperuricemia.
* **Less Common/Serious:** Ototoxicity (especially with rapid IV administration or high doses), Stevens-Johnson syndrome, aplastic anemia, severe skin reactions.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effects; increased risk of renal impairment.
* **Lithium:** Reduced renal clearance of lithium, increasing risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride).
* BUN and creatinine.
* Blood pressure.
* Urine output.
* Hearing (especially with high doses or rapid IV administration).
* Blood glucose and uric acid levels.
## Clinical Pearls
* Furosemide is a potent diuretic; monitor fluid balance closely to avoid dehydration and electrolyte disturbances.
* Oral administration is preferred when possible. Intravenous administration should be given slowly to minimize ototoxicity.
* Electrolyte supplementation (especially potassium) may be necessary.
* Monitor patients closely for signs of ototoxicity, such as tinnitus or hearing loss.
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*Please verify the current prescribing information for the most up-to-date recommendations.*
