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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome. It is also used to manage hypertension, usually in combination with other antihypertensives.
### Primary Indications
* Edema (associated with CHF, liver cirrhosis, renal disease)
* Hypertension
### Adult Dosing
* **Edema:**
* Initial dose: 20-80 mg orally once a day. Doses can be increased by 20-40 mg every 6-8 hours as needed.
* Maintenance dose: Individualize based on response.
* Maximum daily dose: 600 mg orally.
* **Hypertension:**
* Initial dose: 40 mg orally twice a day.
* Maintenance dose: Individualize based on response.
* Maximum daily dose: 400 mg orally.
* **Parenteral Dosing (IV/IM):**
* 20-40 mg IV/IM once a day. Doses can be increased by 20 mg every 2 hours as needed.
* Continuous infusion: 4 mg/hour.
* Maximum daily dose: 600 mg IV/IM.
### Pediatric Dosing
* **Edema:**
* 2 mg/kg/dose orally once a day. Doses can be increased by 1-2 mg/kg/dose every 6-8 hours as needed.
* Maximum daily oral dose: 6 mg/kg/day.
* Parenteral (IV/IM): 1 mg/kg/dose, not to exceed 20 mg/dose. Doses can be repeated every 6-12 hours as needed.
* Maximum daily parenteral dose: 6 mg/kg/day.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to reduced renal clearance. However, caution is advised as high doses can be nephrotoxic. Monitor urine output closely.
* **Hepatic Impairment:** Use with caution. Dose adjustments are generally not required, but monitor for electrolyte imbalances and worsening hepatic encephalopathy.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
### Adverse Effects
* **Common:** Dizziness, lightheadedness, headache, orthostatic hypotension, hyponatremia, hypokalemia, hypochloremia, hyperuricemia, hyperglycemia, dehydration.
* **Less Common:** Photosensitivity, rash, hearing loss (especially with rapid IV administration or in renal impairment), pancreatitis, aplastic anemia, thrombocytopenia, agranulocytosis.
### Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity and nephrotoxicity.
* **ACE Inhibitors, ARBs, Other Antihypertensives:** Additive hypotensive effects. Increased risk of hyponatremia and renal dysfunction.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May decrease furosemide's diuretic and antihypertensive effects.
* **Lithium:** Reduced renal clearance of lithium, increasing lithium toxicity risk.
* **Potassium-Sparing Diuretics (e.g., spironolactone, amiloride):** May offset potassium loss, but monitor potassium closely.
### Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Blood glucose (especially in diabetics)
* Uric acid levels
* Hearing (assess for tinnitus or hearing loss)
### Clinical Pearls
* Administer oral furosemide in the morning to minimize nocturia.
* Rapid IV administration can cause ototoxicity; infuse slowly or use a continuous infusion.
* Furosemide can cause significant electrolyte and fluid losses; monitor closely, especially in elderly patients or those with significant comorbidities.
* Consider oral supplementation of potassium or potassium-sparing diuretics if hypokalemia is persistent or symptomatic.
* Patients with edema due to heart failure may require higher doses than those with edema due to renal disease.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
