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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used for the management of edema associated with congestive heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also indicated for the treatment of hypertension, alone or in combination with other antihypertensive agents.
## Primary Indications
* Edema (congestive heart failure, liver cirrhosis, renal disease, nephrotic syndrome)
* Hypertension
## Adult Dosing
### Edema
* **Oral:**
* Initial dose: 20-80 mg once daily.
* Higher doses may be needed for severe edema. Doses can be given once daily or divided every 6-12 hours.
* Maximum daily dose: 600 mg.
* **Intravenous (IV) / Intramuscular (IM):**
* Initial dose: 20-40 mg once daily.
* If inadequate response, subsequent doses can be increased by 20 mg every 2 hours, or the dose can be repeated every 6-8 hours.
* For severe cases, continuous infusion may be considered: 10 mg/hour.
* Maximum daily dose: 600 mg.
### Hypertension
* **Oral:**
* Initial dose: 40 mg twice daily.
* Subsequent doses adjusted based on response.
* When used with other antihypertensives, the dose of the other agent may need to be reduced.
* Maximum daily dose: 120 mg.
## Pediatric Dosing
### Edema
* **Oral:**
* 1-2 mg/kg/dose once daily.
* If inadequate response, increase dose by 1 mg/kg/dose every 6-8 hours.
* Maximum daily dose: 6 mg/kg.
* **Intravenous (IV) / Intramuscular (IM):**
* 1 mg/kg/dose once daily.
* If inadequate response, increase dose by 1 mg/kg/dose every 2 hours.
* Maximum dose: 6 mg/kg/dose.
*Note: Dosing in neonates can be complex and may require specific protocols.*
## Dose Adjustments
* **Renal Impairment:** Higher doses may be required to achieve diuresis. Monitor for electrolyte imbalances.
* **Hepatic Impairment:** Dose may need to be reduced. Monitor for hepatic encephalopathy.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Electrolyte imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration:** Especially in the elderly.
* **Ototoxicity:** Usually reversible, more common with rapid IV administration or high doses.
* **Hypotension.**
* **Hyperuricemia, hyperglycemia.**
* **Aplastic anemia, agranulocytosis, thrombocytopenia** (rare).
* **Photosensitivity.**
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect, increase risk of renal impairment.
* **Lithium:** Reduced renal clearance, increased 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
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Blood pressure.
* Fluid balance (intake and output).
* Hearing (if symptoms of ototoxicity arise).
* Blood glucose and uric acid levels.
## Clinical Pearls
* Administer oral furosemide on an empty stomach for maximum absorption; however, administer with food or milk if gastric irritation occurs.
* Rapid IV administration can increase the risk of ototoxicity. Administer IV infusions slowly (e.g., over 30-60 minutes).
* Patients receiving chronic furosemide therapy are at risk for hypokalemia, which can predispose them to digoxin toxicity and arrhythmias. Consider potassium supplementation or potassium-sparing diuretics if clinically indicated.
* Monitor for signs of dehydration, especially in elderly patients.
* Furosemide is a potent diuretic; educate patients on potential for increased urination and need for adequate hydration.
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*This information is intended for healthcare professionals. Always consult the official prescribing information or a trusted drug reference for the most current and complete details before making any treatment decisions.*
