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## Furosemide
### Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and renal disease, as well as hypertension.
### Primary Indications
* Edema (pulmonary, peripheral)
* Hypertension
### Adult Dosing
* **Edema:** Initial dose is typically 20-80 mg orally once or twice daily. Doses can be increased by 20-40 mg every 6-8 hours as needed. The maximum daily dose for edema is generally 600 mg, but higher doses may be used under close medical supervision in specific situations. For intravenous administration, the initial dose is usually 20-40 mg, and subsequent doses can be increased by 20 mg at a time.
* **Hypertension:** Initial dose is typically 40 mg orally twice daily. Furosemide is generally not the first-line agent for hypertension unless edema is also present.
### Pediatric Dosing
* **Edema:** 1-2 mg/kg/dose orally every 6-12 hours. Doses can be increased by 1-2 mg/kg/dose every 6-8 hours. Maximum dose is generally 6 mg/kg/day. For intravenous administration, 1 mg/kg/dose every 6-12 hours. Maximum dose is generally 6 mg/kg/day. Specific dosing may vary based on institutional protocols.
### Dose Adjustments
* **Renal Impairment:** Furosemide may require dose adjustments in renal impairment. Higher doses may be needed due to decreased protein binding and reduced tubular secretion. However, caution is advised due to potential ototoxicity and nephrotoxicity.
* **Hepatic Impairment:** Dose reduction may be necessary.
### Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
### Adverse Effects
* **Electrolyte disturbances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration:** Hypotension, dizziness.
* **Ototoxicity:** Hearing impairment, tinnitus (especially with rapid IV administration or high doses).
* **Metabolic:** Hyperuricemia, hyperglycemia.
* **Renal:** Increased BUN and creatinine.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce furosemide's diuretic and antihypertensive effects.
* **Lithium:** Increased risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
### Monitoring
* Electrolytes (serum potassium, sodium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Auditory function (especially with high doses or prolonged therapy)
### Clinical Pearls
* Furosemide is a high-ceiling diuretic; effectiveness increases with dose.
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Rapid intravenous administration can increase the risk of ototoxicity. Inject slowly over at least 30-60 minutes for doses > 40 mg, or as a continuous infusion.
* Monitor for signs of dehydration and electrolyte imbalance, particularly hypokalemia, which can increase the risk of cardiac arrhythmias.
* Consider potassium supplementation or potassium-sparing diuretics if hypokalemia is significant or difficult to manage.
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*Disclaimer: This information is intended for clinical professionals. Always consult the official prescribing information and local protocols for complete and up-to-date guidance.*
