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# Furosemide (Lasix)
## Overview
Furosemide is a 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, alone or in combination with other antihypertensives.
## Primary Indications
* Edema (congestive heart failure, hepatic cirrhosis, renal disease)
* Hypertension
## Adult Dosing
* **Edema:**
* Oral: 20 mg to 80 mg once daily, then may be given as a single dose or in 2 or 3 divided doses. If further diuresis is needed, the dose may be increased by 20 mg to 40 mg every 6 to 8 hours. The usual maintenance dose is 40 mg to 80 mg per day. Doses as high as 600 mg per day have been used in patients with severe edema.
* Intravenous (IV)/Intramuscular (IM): 20 mg to 40 mg once daily. If inadequate response, doses may be increased by 20 mg every 2 hours. Maximum daily dose is typically 200 mg, but higher doses may be used under close medical supervision.
* **Hypertension:**
* Oral: 40 mg twice daily. Doses can be adjusted based on response.
## Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg to 2 mg/kg once daily. The maximum dose is 6 mg/kg/day.
* IV/IM: 1 mg/kg once daily. If inadequate response, doses may be increased by 1 mg/kg every 2 hours.
## Dose Adjustments
* **Renal Impairment:** Patients with severe renal impairment may require lower doses.
* **Hepatic Impairment:** Monitor electrolytes and fluid status closely.
## Contraindications
* Anuria.
* Hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
* Dehydration
* Hypotension
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperuricemia
* Hyperglycemia
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Digoxin:** Increased risk of toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effects and increase risk of renal impairment.
* **Antihypertensives:** Additive hypotensive effect.
* **Lithium:** Reduced renal clearance of lithium, increasing lithium toxicity risk.
## Monitoring
* Blood pressure
* Fluid intake and output
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood glucose levels (in diabetic patients)
* Auditory function (especially with high doses or risk factors)
## Clinical Pearls
* Administer oral furosemide with or without food.
* If administered with food, it may be absorbed more slowly.
* For IV administration, infuse slowly to reduce the risk of ototoxicity.
* Monitor for signs of dehydration and electrolyte disturbances.
* Potassium supplementation may be necessary, especially with prolonged use or higher doses.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and professional resources before making clinical decisions. Dosing may vary based on patient-specific factors and local protocols.*
