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# Furosemide (Oral)
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also used to treat hypertension, although it is not a first-line agent.
## Primary Indications
* Edema associated with congestive heart failure (CHF)
* Edema associated with liver cirrhosis
* Edema associated with renal disease or the nephrotic syndrome
* Hypertension (adjunct therapy)
## Adult Dosing
* **Edema:** 20-80 mg orally once daily. Doses can be increased by 20-40 mg every 6-8 hours until the desired response is achieved. The usual maintenance dose is 40-80 mg orally once daily. Doses higher than 80 mg daily are generally not recommended due to lack of increased efficacy and potential for increased adverse effects.
* **Hypertension:** 40 mg orally twice daily. This is generally not a first-line agent for hypertension.
## Pediatric Dosing
* **Edema:** 1-2 mg/kg orally once daily. Maximum dose: 6 mg/kg/day. Doses can be increased every 2 days if needed.
## Dose Adjustments
* **Renal Impairment:** For patients with moderate to severe renal impairment, initial doses should be lower and increased cautiously. The dose may need to be higher in patients with renal impairment compared to those with normal renal function.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
Common adverse effects include dizziness, lightheadedness, headache, orthostatic hypotension, rash, pruritus, and gastrointestinal upset. Serious adverse effects include electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, ototoxicity (especially with rapid IV administration or in patients with renal impairment), hyperglycemia, and hyperuricemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of toxicity due to hypokalemia.
* **Lithium:** Increased risk of lithium toxicity due to decreased renal clearance.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide.
* **Potassium supplements/Potassium-sparing diuretics:** Monitor potassium levels closely.
## Monitoring
* Electrolytes (sodium, potassium, chloride)
* BUN and creatinine
* Blood pressure
* Urine output
* Hearing (especially with high doses or prolonged therapy)
## Clinical Pearls
* Furosemide is a potent diuretic and can cause rapid fluid and electrolyte loss.
* Oral administration is generally preferred over intravenous unless rapid diuresis is required.
* Patients with significant edema may require higher doses.
* Dosing frequency should be adjusted based on patient response and renal function.
* Monitor for signs and symptoms of hypokalemia (muscle cramps, weakness, arrhythmias).
* Consider potassium supplementation or potassium-sparing diuretics if hypokalemia is significant or persistent.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
