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# Furosemide (Tab 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 treat hypertension.
## Primary Indications
* Edema (congestive heart failure, liver cirrhosis, renal disease)
* Hypertension (adjunctive therapy)
## Adult Dosing
* **Edema:**
* **Initial:** 20 mg to 80 mg orally once daily.
* **Maintenance:** Dosage is individualized based on response. May be given as a single dose or divided doses.
* **Maximum:** Up to 600 mg orally per day in severe cases, but doses exceeding 80 mg orally daily are generally reserved for hospitalized patients or those with severe edema.
* **Hypertension:**
* **Initial:** 40 mg orally twice daily.
* **Maintenance:** Doses are adjusted based on response. Typically used in combination with other antihypertensives.
* **Maximum:** Not well established for hypertension monotherapy, but generally used in lower doses for this indication.
## Pediatric Dosing
* **Edema:**
* **Initial:** 1 mg/kg/dose orally once daily.
* **Maximum initial dose:** 40 mg per dose.
* **Subsequent doses:** May be increased by 1 mg/kg/dose every 6-8 hours as needed, not to exceed 6 mg/kg/dose per day. Doses may be given once or twice daily.
* **Premature infants:** Lower doses may be required.
## Dose Adjustments
* **Renal Impairment:** Dosage reduction is typically necessary. Monitor electrolytes and renal function closely. In patients with significant renal impairment, higher doses may be required to achieve a diuretic effect, but caution is advised.
* **Hepatic Impairment:** Use with caution. Edema in cirrhosis patients may require careful titration due to electrolyte disturbances and potential for hepatic encephalopathy.
## Contraindications
* Anuria
* History of hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalance (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, headache, increased urination.
* **Serious:** Severe electrolyte depletion, ototoxicity (especially with rapid IV administration or high doses), hyperglycemia, hyperuricemia, pancreatitis, aplastic anemia, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide and increase the risk of renal impairment.
* **Lithium:** Furosemide can decrease renal clearance of lithium, leading to increased serum lithium levels and risk of toxicity.
* **Potassium-sparing diuretics (e.g., spironolactone, amiloride):** May counteract potassium loss but can lead to hyperkalemia.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Serum glucose and uric acid (especially in patients with diabetes or gout)
* Hearing (if ototoxicity is suspected)
## Clinical Pearls
* Furosemide's onset of action is approximately 30-60 minutes orally and peak effect is within 1-2 hours. Duration of action is 6-8 hours.
* Administer oral doses in the morning to minimize nocturia, unless once-daily dosing is necessary for edema control.
* Rapid intravenous administration can cause ototoxicity. Infuse slowly, typically over 30-60 minutes.
* Fluid and electrolyte replacement may be necessary to prevent dehydration and imbalances.
* Patients with severe edema may require higher doses, but monitor closely for electrolyte abnormalities and dehydration.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and institutional protocols for definitive guidance. Dosing may vary based on individual patient factors and clinical context.*
