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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) from conditions such as heart failure, liver disease, and kidney disease. It also treats high blood pressure.
## Primary Indications
* Edema associated with congestive heart failure, cirrhosis, and renal disease.
* Hypertension (often used in combination with other antihypertensives).
## Adult Dosing
* **Edema:** 20 mg to 80 mg orally once daily. Higher doses may be given, and the dose can be divided. The usual maintenance dose is 40 mg to 80 mg daily.
* **Hypertension:** 40 mg orally twice daily.
* **Intravenous (IV) or Intramuscular (IM):** 20 mg to 40 mg once daily. Dose may be increased by 20 mg every 2 hours until desired response is achieved. The total daily dose should not exceed 200 mg in patients with edema unless otherwise directed by protocol.
## Pediatric Dosing
* **Oral:** 1 mg/kg to 4 mg/kg once daily, not to exceed 40 mg per dose. Doses can be given once or twice daily.
* **IV/IM:** 1 mg/kg per dose, not to exceed 40 mg per dose. Doses can be given once or twice daily.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are highly individualized and depend on the degree of renal impairment and patient response. Continuous monitoring is crucial.
* **Hepatic Impairment:** Use with caution; patients may be more sensitive to the effects of furosemide, particularly electrolyte and volume depletion.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides (cross-sensitivity may occur).
## Adverse Effects
Common: Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperglycemia, hyperuricemia.
Less Common: Ototoxicity (especially with rapid IV administration or high doses), rash, Stevens-Johnson syndrome, blood dyscrasias.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide and increase the risk of nephrotoxicity.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Antihypertensives:** Additive hypotensive effect.
* **Lithium:** Increased risk of lithium toxicity due to decreased renal clearance.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid status (weight, intake/output).
* Blood pressure.
* Blood glucose (especially in diabetics).
* Uric acid.
* Hearing (especially with high doses or rapid IV infusion).
## Clinical Pearls
* Furosemide is a potent diuretic; administer in the morning to minimize nocturia.
* Rapid IV administration can cause ototoxicity; infuse slowly (e.g., over 30-60 minutes) or as an infusion.
* Electrolyte monitoring is critical, particularly for potassium. Consider potassium supplementation or a potassium-sparing diuretic if hypokalemia is significant or if the patient is on digoxin.
* Monitor for signs of dehydration and hypotension.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete details and to confirm the most current recommendations before making any clinical decisions.*
