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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with congestive heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also used to manage hypertension, alone or in combination with other antihypertensives.
### Primary Indications
* Edema (CHF, hepatic cirrhosis, renal disease)
* Hypertension
### Adult Dosing
* **Edema:**
* Initial: 20-80 mg orally once daily.
* Subsequent: Dose adjusted based on response. Doses may be given once or twice daily.
* Maximum oral dose: 600 mg/day (higher doses may be used in severe cases under close medical supervision).
* **Hypertension:**
* Initial: 40 mg orally twice daily.
* Maintenance: 20-120 mg/day divided into two doses.
* Maximum oral dose: 600 mg/day.
* **Parenteral Dosing:**
* *Edema:* Initial 20-40 mg IV or IM once. Subsequent doses 20-40 mg IV or IM every 6-8 hours as needed. May be given as a continuous infusion in refractory edema.
* *Hypertension:* Typically not first-line for hypertension management via parenteral route.
### Pediatric Dosing
* **Edema:**
* Oral: 2 mg/kg/dose orally once or twice daily. Maximum 6 mg/kg/dose.
* IV/IM: 1 mg/kg/dose IV or IM once. Subsequent doses 1 mg/kg/dose IV or IM every 6-8 hours as needed. Maximum 6 mg/kg/dose.
* *Note:* Dosing for neonates and premature infants is highly individualized due to immature renal function.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in renal insufficiency, but caution is advised as it may worsen renal function. Monitor closely.
* **Hepatic Impairment:** Dose reduction may be necessary.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides.
### Adverse Effects
Common: Dizziness, lightheadedness, muscle cramps, weakness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperuricemia, hyperglycemia.
Serious: Ototoxicity (especially with rapid IV administration or high doses), severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).
### Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and renal dysfunction.
* **NSAIDs:** May reduce diuretic and antihypertensive effects.
* **Lithium:** Increased risk of lithium toxicity.
* **Potassium-Sparing Diuretics/Potassium Supplements:** Monitor potassium levels closely to avoid hyperkalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
### Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Hearing (especially with high doses or prolonged therapy)
* Blood glucose (in diabetics)
* Uric acid
### Clinical Pearls
* Administer IV furosemide slowly (e.g., over 30-60 minutes) to minimize ototoxicity. Rapid IV push can increase risk.
* Monitor fluid balance and electrolytes closely, as rapid diuresis can lead to dehydration and severe electrolyte depletion.
* Edematous patients may require higher doses due to impaired absorption or increased volume of distribution.
* Furosemide can cause or exacerbate gout due to hyperuricemia.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making any clinical decisions.*
