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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) due to heart failure, liver disease, or kidney disease. It is also used to treat high blood pressure, alone or in combination with other antihypertensives.
### Primary Indications
* Edema associated with congestive heart failure (CHF)
* Edema associated with liver cirrhosis
* Edema associated with renal disease, including nephrotic syndrome
* Hypertension
### Adult Dosing
* **Edema:**
* Oral: 20 mg to 80 mg once daily. The dose may be repeated every 6 to 8 hours as needed. The maintenance dose is typically 40 mg to 120 mg daily, but may be titrated up to 600 mg daily in severe cases.
* Intravenous (IV)/Intramuscular (IM): 20 mg to 40 mg once daily. The dose may be repeated every 2 hours as needed. The dose can be increased by 20 mg increments every 2 hours. Continuous IV infusion may be used in refractory cases, starting at 4 mg/minute.
* **Hypertension:**
* Oral: 40 mg twice daily. Doses typically range from 40 mg to 120 mg daily.
### Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg to 4 mg/kg per dose, given every 6 to 12 hours. Do not exceed 6 mg/kg per dose.
* IV/IM: 1 mg/kg to 2 mg/kg per dose, given every 6 to 12 hours. Do not exceed 20 mg/dose for neonates or 40 mg/dose for infants and children.
* Continuous IV infusion: 0.1 mg/kg/hour.
### Dose Adjustments
* **Renal Impairment:** Dose reduction may be necessary. For patients with advanced renal disease, particularly those on dialysis, doses may need to be higher, or alternative diuretic strategies considered.
* **Hepatic Impairment:** Caution is advised; dose reduction may be necessary.
### Contraindications
* Anuria
* History of hypersensitivity to furosemide or sulfonamides
### Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia)
* Dehydration
* Hypotension
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperuricemia (can precipitate gout)
* Hyperglycemia
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide.
* **ACE inhibitors/ARBs:** Increased risk of hypotension and renal dysfunction.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increasing the risk of lithium toxicity.
### Monitoring
* Electrolytes (serum potassium, sodium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Fluid intake and output
* Blood pressure
* Hearing (especially with high doses or IV administration)
* Blood glucose levels
### Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* For IV administration, administer slowly to reduce the risk of ototoxicity.
* Monitor for signs and symptoms of dehydration and electrolyte imbalances.
* Patient education on dietary potassium intake may be beneficial.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete details and to ensure patient safety. Dosing may vary based on individual patient factors and local protocols.*
