Please check your internet connection and try again.
## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and renal disease, including nephrotic syndrome. It is also used to manage hypertension, alone or in combination with other antihypertensives.
### Primary Indications
* Edema (heart failure, cirrhosis, renal disease)
* Hypertension
### Adult Dosing
* **Edema:**
* Oral: The usual starting dose is 20 mg to 80 mg once daily. Doses may be adjusted based on response. Doses higher than 80 mg should be given in divided doses. Doses up to 600 mg daily have been used in severe cases, but typically the lowest effective dose is preferred.
* Intravenous (IV) or Intramuscular (IM): The usual starting dose is 20 mg to 40 mg once daily. Doses may be adjusted. Higher doses may be administered as a continuous infusion.
* **Hypertension:**
* Oral: The usual starting dose is 40 mg twice daily. The dose may be adjusted. As monotherapy, it is generally used in patients with normal renal function.
### Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg to 2 mg/kg once daily, not to exceed 6 mg/kg/day.
* IV or IM: 1 mg/kg once daily, not to exceed 6 mg/kg/day. If needed, doses can be increased every 2 hours.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to reduced renal clearance and protein binding. Careful titration is required.
* **Hepatic Impairment:** Caution is advised. Dose adjustments may be necessary.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
### Adverse Effects
* Electrolyte disturbances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
* Dehydration
* Hypotension
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperuricemia and gout
* Hyperglycemia
* Photosensitivity
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Potassium-sparing diuretics:** Monitor for hyperkalemia.
* **Lithium:** Increased risk of lithium toxicity due to reduced renal clearance.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Blood glucose (in diabetic patients)
* Uric acid levels
### Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Intravenous furosemide should be administered slowly (e.g., over 30-60 minutes) to reduce the risk of ototoxicity. Rapid IV push administration is generally discouraged.
* Monitor for signs and symptoms of electrolyte imbalance, particularly hypokalemia. Potassium supplementation may be necessary.
* Patients with edema may require daily dosing, while those with hypertension may benefit from intermittent dosing.
* Effectiveness can be reduced by concomitant administration of NSAIDs.
***
*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.*
