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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome. It is also used to manage hypertension, although it is not typically a first-line agent for this indication alone.
### Primary Indications
* Edema due to heart failure
* Edema due to liver cirrhosis
* Edema due to renal disease (including nephrotic syndrome)
* Hypertension (adjunctive therapy)
### Adult Dosing
* **Edema:** Oral: 20 mg to 80 mg once daily. If needed, doses can be increased by 20 mg to 40 mg every 6 to 8 hours or given as a divided dose. The usual maintenance dose is 40 mg to 120 mg per day, but some patients may require up to 600 mg per day.
* **Hypertension:** Oral: 40 mg twice daily.
* **IV/IM:** For acute situations, 20 mg to 40 mg intravenously or intramuscularly. Doses can be repeated every 2 hours as needed. Continuous IV infusion: 4 mg/hour after an initial bolus dose.
### Pediatric Dosing
* **Edema:** Oral: 1 mg/kg/dose to 2 mg/kg/dose once daily. If a larger dose is required, the dose can be increased by 1 mg/kg to 2 mg/kg every 6 to 8 hours. The maximum single dose should not exceed 6 mg/kg.
* **IV/IM:** 1 mg/kg/dose to 2 mg/kg/dose once daily. Maximum dose not to exceed 6 mg/kg/dose.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased due to decreased renal excretion. Monitor for efficacy and adverse effects.
* **Hepatic Impairment:** Dose may need to be adjusted due to altered metabolism and excretion.
### 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
* Rash
### Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Lithium:** Increased risk of lithium toxicity.
* **Antihypertensives (including other diuretics):** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of toxicity in the presence of hypokalemia.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Weight (for fluid status)
* Hearing (especially with high doses or rapid IV administration)
### Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Rapid IV administration can increase the risk of ototoxicity. Administer IV doses slowly over 30 to 60 minutes.
* Monitor for signs and symptoms of electrolyte depletion, particularly hypokalemia (muscle cramps, weakness, arrhythmias).
* Patients with severe edema may require higher doses or more frequent administration.
* Consider alternative diuretics or combination therapy for patients refractory to furosemide.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
