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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) due to heart failure, liver disease, or kidney disease. It is also used to treat high blood pressure.
### Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension.
### Adult Dosing
* **Edema:**
* **Oral:** Starting dose is typically 20-80 mg once or twice daily. The dose may be adjusted based on response. Higher doses may be required for severe edema. The maximum dose is generally 600 mg per day, but may be exceeded under close medical supervision in hospitalized patients.
* **Intravenous (IV) or Intramuscular (IM):** Starting dose is typically 20-40 mg once. If no response, may repeat dose every 2 hours. Higher doses may be required. The maximum IV/IM dose is generally 200 mg per dose, but may be exceeded under close medical supervision in hospitalized patients.
* **Hypertension:**
* **Oral:** Starting dose is typically 20-40 mg once or twice daily. It is usually used in combination with other antihypertensive agents. The maximum dose is generally 120 mg per day.
### Pediatric Dosing
* **Edema:**
* **Oral:** 1-2 mg/kg per dose given once or twice daily. Doses may be increased by 1-2 mg/kg every 6-8 hours to achieve desired diuresis. Maximum daily dose is typically 6 mg/kg.
* **Intravenous (IV) or Intramuscular (IM):** 1 mg/kg per dose. If inadequate response, may increase by 1 mg/kg every 2 hours. Maximum dose is 6 mg/kg.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to reduced renal clearance. However, high doses may also cause ototoxicity.
* **Hepatic Impairment:** Dose may need to be decreased.
### Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
### Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration and hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperglycemia.
* Hyperuricemia.
* Dizziness, lightheadedness.
* Rash.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May decrease furosemide's diuretic and antihypertensive effect.
* **Lithium:** Increased risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity if hypokalemia occurs.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium) at baseline and periodically during treatment, especially with dose changes or in patients at high risk.
* Renal function (BUN, creatinine).
* Blood pressure.
* Fluid balance (intake and output).
* Hearing (especially with high doses or rapid IV administration).
* Blood glucose in diabetic patients.
### Clinical Pearls
* Rapid IV administration (greater than 3-4 minutes) can increase the risk of ototoxicity.
* Oral administration should ideally occur in the morning to minimize nocturia.
* Patients taking furosemide should be advised to maintain adequate fluid intake and monitor for signs of dehydration.
* Potassium supplementation may be necessary, particularly in patients receiving high doses or those with other risk factors for hypokalemia.
Please verify the current prescribing information for detailed guidance.
