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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and renal disease, including the nephrotic syndrome. It is also used to treat hypertension.
### Primary Indications
* Edema (heart failure, liver cirrhosis, renal disease)
* Hypertension
### Adult Dosing
* **Edema:** 20-80 mg orally once daily. May increase by 20-40 mg every 6-8 hours as needed. Maximum oral dose is 600 mg/day (higher doses may be used in rare, refractory cases under close supervision). Intravenous (IV) or intramuscular (IM) doses are typically half the oral dose.
* **Hypertension:** 40 mg orally twice daily. Usually used as an adjunct to other antihypertensives.
### Pediatric Dosing
* **Edema:** 1-2 mg/kg orally once daily. May increase by 1 mg/kg every 6-8 hours as needed. Maximum dose: 6 mg/kg/day.
* **IV/IM:** 1 mg/kg/dose once daily. Maximum dose: 20 mg/dose.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in renal impairment due to reduced bioavailability and increased sensitivity. Close monitoring is required.
### Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides
### Adverse Effects
Common: Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, orthostatic hypotension, hearing impairment, tinnitus.
Serious: Severe electrolyte depletion, hypotension, azotemia, hepatic encephalopathy in patients with severe hepatic disease, Stevens-Johnson syndrome, toxic epidermal necrolysis.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide.
* **Antihypertensives:** Additive hypotensive effects.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increasing the risk of lithium toxicity.
* **Potassium-sparing diuretics/ACE inhibitors/ARBs/Spironolactone/Potassium supplements:** Increased risk of hyperkalemia.
### Monitoring
* Electrolytes (sodium, potassium, chloride)
* BUN, creatinine
* Blood pressure
* Urine output
* Auditory function (especially with high doses or prolonged use)
### Clinical Pearls
* Administer oral furosemide as a single dose in the morning to minimize nocturia. If a second dose is needed, administer it in the early afternoon.
* IV administration may lead to a more rapid onset of diuresis.
* Rate of IV infusion should not exceed 4 mg/minute to minimize risk of ototoxicity.
* Correct electrolyte imbalances and dehydration before initiating or adjusting furosemide therapy.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace clinical judgment. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
