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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to manage edema associated with heart failure, liver cirrhosis, and renal disease. It is also used to treat hypertension, though less commonly as a first-line agent.
### Primary Indications
* Edema due to heart failure, liver disease, or renal disease
* Hypertension (adjunctive therapy)
### Adult Dosing
* **Edema:** Oral: 20 mg to 80 mg once daily. Doses can be increased by 20 mg to 40 mg every 6-8 hours as needed. The usual dose is 40 mg to 120 mg per day in divided doses. Some patients may require up to 600 mg per day, particularly those with severe edema.
* **Hypertension:** Oral: 40 mg twice daily.
* **Intravenous (IV) / Intramuscular (IM):** 20 mg to 40 mg once daily. If inadequate response, dose can be increased by 20 mg every 2 hours. May require doses up to 200 mg in refractory cases.
### Pediatric Dosing
* **Edema:** Oral: 1 mg/kg to 2 mg/kg once daily, not to exceed 6 mg/kg/day.
* **IV/IM:** 1 mg/kg once daily, not to exceed 4 mg/kg/dose.
### Dose Adjustments
* **Renal Impairment:** Dose reduction may be necessary. IV administration may be more effective than oral in severe renal impairment.
* **Hepatic Impairment:** Use with caution; monitor for electrolyte imbalances and hepatic encephalopathy.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
### Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
* Dehydration
* Hypotension
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperglycemia
* Hyperuricemia (can precipitate gout)
* Dizziness, lightheadedness
* Rash
### Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **Antihypertensives/Diuretics:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effects.
* **Lithium:** Increased risk of lithium toxicity.
* **Warfarin:** May potentiate the anticoagulant effect.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid status (weight, intake/output)
* Blood glucose and uric acid levels (periodically)
* Auditory function (especially with high doses or risk factors)
### Clinical Pearls
* Rapid IV administration can lead to ototoxicity. Administer IV furosemide slowly, typically over 30-60 minutes, or as a continuous infusion.
* To minimize nocturia, administer the last dose of the day early in the evening.
* Concurrent potassium supplementation may be necessary, especially with prolonged use or higher doses.
* Monitor for signs of dehydration and electrolyte abnormalities.
* Consider continuous infusion for patients with refractory edema or severe renal impairment.
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*This information is intended for healthcare professionals. Always verify the most current prescribing information with official drug reference materials before administering or dispensing any medication.*
