Please check your internet connection and try again.
# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) and high blood pressure.
## Primary Indications
* Edema associated with congestive heart failure, cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:** 20-80 mg orally once daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. Usual maintenance dose: 40-80 mg orally daily. Maximum dose: 600 mg orally daily (higher doses may be used under specialist supervision).
* **Hypertension:** 40 mg orally twice daily.
* **IV/IM:** Equivalent to oral dosing. Titrate based on response.
## Pediatric Dosing
* **Edema:** 1-2 mg/kg orally or IV/IM once daily. Maximum dose: 6 mg/kg/day. Doses are typically given once daily or divided into two doses.
* **Neonates:** Lower doses may be required due to immature renal function.
## Dose Adjustments
* **Renal Impairment:** Furosemide is renally eliminated. Higher doses may be required in patients with renal insufficiency. Monitor for efficacy and toxicity.
* **Hepatic Impairment:** Caution advised. Dose reduction may be necessary.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte abnormalities (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hypotension.
* Hyperuricemia, hyperglycemia.
* Dizziness, lightheadedness.
## Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effects.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increasing risk of lithium toxicity.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium), renal function (BUN, creatinine), and fluid status (weight, edema).
* Blood pressure.
* Blood glucose and uric acid levels (periodically).
* Hearing (especially with high doses or risk factors).
## Clinical Pearls
* Administer oral furosemide to ensure absorption; food may decrease absorption.
* For IV administration, use a slow infusion rate (e.g., over 1-2 minutes) to minimize ototoxicity. Continuous infusion may be preferred for higher doses.
* Dosing for diuretic effect is often more effective when administered once daily due to a long duration of action.
* Patients taking furosemide for heart failure may require potassium supplementation.
* Monitor for signs of dehydration, particularly in elderly patients or those on concomitant diuretics.
***
*This information is intended for healthcare professionals and should not replace clinical judgment. Always consult the most current prescribing information for definitive guidance.*
