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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with congestive heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome. It is also used to treat hypertension, either alone or in combination with other antihypertensives.
## Primary Indications
* Edema (congestive heart failure, liver cirrhosis, renal disease, nephrotic syndrome)
* Hypertension
## Adult Dosing
* **Edema:**
* **Oral:** 20-80 mg once daily. If response is inadequate, may be given as a single dose every morning. If even larger doses are required, they may be administered in two divided doses. Doses greater than 80 mg once daily are not recommended.
* **Intravenous/Intramuscular:** 20-40 mg once daily. If response is inadequate, may be increased by 20 mg increments and administered no frequently than every 2 hours. The maximum dose is 200 mg in a single dose for patients with severe renal disease, or in cases of rapid or excessive diuresis.
* **Hypertension:**
* **Oral:** 40 mg twice daily. The dose may be adjusted based on response.
## Pediatric Dosing
* **Edema:**
* **Oral:** 1-2 mg/kg/day in single or divided doses. Maximum dose: 6 mg/kg/day.
* **Intravenous/Intramuscular:** 1 mg/kg/dose. If response is inadequate, may be increased by 1 mg/kg/dose and administered no more frequently than every 2 hours. Maximum dose: 6 mg/kg/dose.
## Dose Adjustments
* **Renal Impairment:** Furosemide is primarily eliminated by the kidneys. Dose adjustments may be necessary in patients with significant renal impairment. Higher doses may be required to achieve diuresis, and continuous infusions may be considered.
* **Hepatic Impairment:** Caution is advised. Patients with hepatic cirrhosis may be more sensitive to the effects of furosemide, and fluid and electrolyte balance should be closely monitored.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Common:** Dizziness, lightheadedness, dehydration, hypotension, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia), hyperglycemia, hyperuricemia.
* **Less Common:** Ototoxicity (especially with rapid IV administration or high doses), rash, photosensitivity, gastrointestinal upset.
## Key Drug Interactions
* **Aminoglycosides, other ototoxic drugs:** Increased risk of ototoxicity.
* **Corticosteroids, ACTH:** Increased risk of electrolyte depletion.
* **Digoxin:** Risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced lithium clearance and increased risk of lithium toxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide and may potentiate renal damage.
* **Antihypertensives:** Additive hypotensive effects.
## Monitoring
* **Fluid and Electrolyte Balance:** Monitor serum electrolytes (sodium, potassium, chloride, magnesium, calcium), BUN, and creatinine regularly, especially in patients with significant renal impairment or those receiving high doses.
* **Blood Pressure:** Monitor blood pressure regularly.
* **Urine Output:** Monitor urine output.
* **Blood Glucose:** Monitor in diabetic patients.
* **Uric Acid:** Monitor in patients with a history of gout.
* **Hearing:** Assess for auditory changes.
## Clinical Pearls
* Furosemide is a potent diuretic and can cause rapid and significant fluid and electrolyte loss. Closely monitor patients for signs of dehydration and electrolyte imbalances.
* Hypokalemia is a common and significant adverse effect. Consider potassium supplementation or potassium-sparing diuretics if hypokalemia is severe or symptomatic.
* Intravenous administration should be performed slowly (e.g., over 30-60 minutes) to reduce the risk of ototoxicity. Avoid rapid bolus injections.
* In patients with edema and renal impairment, higher doses or continuous infusions may be necessary to achieve adequate diuresis.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
