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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to reduce excess fluid in the body (edema) and treat high blood pressure (hypertension).
## Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:**
* Oral: 20 mg to 80 mg once daily. Doses may be increased by 20 mg to 40 mg every 6 to 8 hours. Maximum recommended daily dose is 600 mg. Doses greater than 80 mg should be given in divided doses.
* Intravenous (IV) or Intramuscular (IM): 20 mg to 40 mg once daily. Doses may be increased by 20 mg every 2 hours. In patients with severe renal impairment, doses may need to be higher.
* **Hypertension:**
* Oral: 40 mg twice daily. May be used in combination with other antihypertensives.
## Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg to 2 mg/kg once daily. Maximum dose is 6 mg/kg/day.
* IV or IM: 1 mg/kg once daily. Maximum dose is 6 mg/kg/day.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with severe renal impairment. Continuous infusion may be more effective than bolus doses in some patients.
* **Hepatic Impairment:** Use with caution; monitor for electrolyte and fluid balance.
## Contraindications
* Anuria.
* History of hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte imbalance (hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia).
* Dehydration.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hypotension.
* Hyperuricemia.
* Hyperglycemia.
* Photosensitivity.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May decrease diuretic and antihypertensive effects.
* **Lithium:** Increased risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid balance (intake and output).
* Blood pressure.
* Blood glucose and uric acid levels (periodic assessment).
* Hearing function (especially with high doses or IV administration).
## Clinical Pearls
* Administer oral furosemide on an empty stomach if possible, but it can be taken with food or milk if gastric irritation occurs.
* For edema, doses are often given daily or every other day, depending on the patient's response and renal function.
* Rapid IV administration can increase the risk of ototoxicity. Infuse IV doses slowly.
* Hypokalemia is a common and significant side effect; consider potassium supplementation or a potassium-sparing diuretic if necessary.
* Monitor for signs of dehydration and electrolyte imbalance, especially in elderly patients or those with impaired renal function.
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*Please verify current prescribing information and consult with a healthcare professional for specific patient management.*
