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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) associated with congestive heart failure, liver disease, and kidney disease, as well as hypertension.
## Primary Indications
* Edema due to congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension (often as adjunct therapy).
## Adult Dosing
* **Edema:**
* Oral: Initial dose typically 20-80 mg once or twice daily. May increase by 20-40 mg every 6-8 hours as needed. Maximum daily dose usually 600 mg, but higher doses may be used under close medical supervision.
* Intravenous (IV) or Intramuscular (IM): Initial dose typically 20-40 mg once. May increase by 20 mg every 2 hours as needed. Maximum IV/IM dose usually 200 mg per dose in acute settings, but higher doses may be used in critical care.
* **Hypertension:**
* Oral: Initial dose typically 40 mg twice daily. Adjust based on response. Not typically first-line for hypertension.
## Pediatric Dosing
* **Edema:**
* Oral: 1-2 mg/kg/dose given once or twice daily. Maximum 6 mg/kg/dose per day.
* IV/IM: 1 mg/kg/dose given once. Maximum 20 mg per dose for neonates and infants <2 months. For older infants and children, maximum 40 mg per dose. May be increased by 1 mg/kg/dose every 2 hours as needed.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to decreased renal clearance and increased half-life. However, caution is advised as some patients may require lower doses.
* **Hepatic Impairment:** Dose may need to be reduced in patients with hepatic impairment.
## Contraindications
* Anuria.
* History of hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
Common: Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperglycemia.
Less Common: Ototoxicity (especially with rapid IV administration or high doses), rash, photosensitivity, blood dyscrasias.
## Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May decrease furosemide's diuretic and antihypertensive effects.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and hyperkalemia.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid balance (intake/output, weight).
* Blood pressure.
* Blood glucose in diabetic patients.
* Hearing (especially with high doses or rapid IV administration).
## Clinical Pearls
* Administer IV furosemide slowly (over at least 30-60 minutes for doses >40mg) to reduce the risk of ototoxicity.
* Oral administration is generally preferred for chronic management due to lower risk of ototoxicity and electrolyte disturbances.
* Monitor for signs and symptoms of dehydration and electrolyte depletion.
* Concurrent potassium supplementation may be necessary if hypokalemia develops.
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*This information is for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information with the manufacturer's package insert or other relevant clinical resources.*
