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# Furosemide (Oral)
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) associated with heart failure, liver disease, and kidney disease. It also treats high blood pressure, alone or in combination with other antihypertensives.
## Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:** 20 mg to 80 mg orally once daily. Higher doses may be given in divided doses. The maintenance dose is typically the smallest dose that will maintain adequate symptom control. Doses can be increased by 20 mg to 40 mg every day or two.
* **Hypertension:** 40 mg orally twice daily. Lower doses (e.g., 20 mg once daily) may be sufficient as adjunctive therapy.
## Pediatric Dosing
* **Edema:** 1 mg/kg/dose orally once daily. Doses can be increased by 1 mg/kg/dose every 6-8 hours as needed, up to a maximum of 6 mg/kg/dose once daily.
* **Hypertension:** The use of furosemide for hypertension in pediatric patients is generally not recommended due to lack of established optimal dosing and potential for excessive diuresis.
## Dose Adjustments
* **Renal Impairment:** In patients with severe renal impairment, the dose may need to be increased, and the route may need to be switched to IV. Dose and frequency should be individualized based on response.
* **Hepatic Impairment:** Caution is advised. Dose reduction may be necessary.
## Contraindications
* Anuria.
* Known 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).
* Hyperuricemia, hyperglycemia.
* Dizziness, lightheadedness.
## Key Drug Interactions
* **Aminoglycosides, other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** Additive hypotensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Increased risk of lithium toxicity.
* **Potassium supplements, potassium-sparing diuretics:** Monitor potassium levels closely.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium), BUN, creatinine, and fluid balance.
* Blood pressure.
* Uric acid and glucose levels.
* Hearing assessment, especially with high doses or prolonged therapy.
## Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* For rapid onset of diuresis, IV administration is preferred. Oral absorption can be variable.
* Monitor for signs and symptoms of dehydration and electrolyte imbalances.
* Patients may require potassium supplementation depending on the dose and duration of therapy.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete and up-to-date details.*
