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# Furosemide (Oral)
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) associated with conditions such as heart failure, liver disease, and kidney disease. It also treats high blood pressure, often in combination with other antihypertensives.
## Primary Indications
* Edema due to heart failure, liver cirrhosis, or renal disease
* Hypertension
## Adult Dosing
* **Edema:** Typically 20 mg to 80 mg once daily. Doses may be increased by 20 mg to 40 mg every 6 to 8 hours as needed. The maximum daily dose is usually 600 mg, but doses up to 2000 mg/day have been used in severe cases under close medical supervision. Doses above 80 mg may be given divided.
* **Hypertension:** Typically 40 mg twice daily. Not usually recommended as a first-line agent for hypertension.
## Pediatric Dosing
* **Edema:** 1 mg/kg to 2 mg/kg per dose given once or twice daily. The maximum single dose is 40 mg. The maximum daily dose is typically 6 mg/kg/day. Dosing may be adjusted based on response and tolerability.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with severe renal impairment due to decreased oral absorption and increased clearance. However, caution is advised.
* **Hepatic Impairment:** Monitor for electrolyte imbalances and fluid status closely.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides (potential for cross-sensitivity)
* Hepatic coma or severe electrolyte depletion
## Adverse Effects
* Electrolyte abnormalities (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
* Dehydration
* Hypotension
* Dizziness, lightheadedness
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperglycemia
* Increased uric acid levels (gout)
* Rash
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increasing lithium levels and risk of toxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid status (weight, edema, urine output)
* Glucose (in diabetic patients)
* Uric acid levels
## Clinical Pearls
* Oral absorption is variable; patients with significant edema may have reduced absorption.
* Administer oral doses at least 4-6 hours before bedtime to minimize nocturia.
* Rapid IV administration can increase the risk of ototoxicity.
* Hypokalemia is a common and important adverse effect; consider potassium supplementation or potassium-sparing diuretics if necessary.
* Tolerance to diuretic effects may develop with chronic use.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical judgment. Always verify current prescribing information with the official drug product labeling or a reliable drug information resource before making clinical decisions.*
