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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) due to heart failure, liver disease, or kidney disease, and to treat high blood pressure.
## Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension (often as adjunct therapy).
## Adult Dosing
* **Edema:** Oral: Initial dose 20-80 mg once daily. May increase by 20-40 mg every 6-8 hours as needed. Usual maintenance dose 20-80 mg daily. Maximum daily oral dose typically 600 mg, but higher doses may be used in severe cases under close supervision. IV/IM: Initial dose 20-40 mg once daily. May increase by 20 mg every 2 hours as needed. Maximum IV dose typically 200 mg in a single dose, though higher doses may be used in specific situations.
* **Hypertension:** Oral: 40 mg twice daily.
## Pediatric Dosing
* **Edema:** Oral: 1-2 mg/kg/dose once daily. May increase by 1 mg/kg/dose every 6-8 hours as needed. Maximum daily dose 6 mg/kg. IV/IM: 1 mg/kg/dose once daily. May increase by 1 mg/kg/dose every 2 hours as needed. Maximum single dose 20 mg. Higher doses may be required in premature infants.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to decreased excretion. However, monitor closely for increased toxicity.
* **Hepatic Impairment:** Monitor for electrolyte imbalances and hepatic encephalopathy.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, increased urination.
* **Serious:** Ototoxicity (especially with rapid IV administration or high doses), severe electrolyte depletion, hyperglycemia, hyperuricemia, rash.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effects.
* **Lithium:** Increased risk of lithium toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Fluid status (weight, intake/output)
* Blood pressure
* Blood glucose (in diabetics)
* Uric acid
## Clinical Pearls
* Administer oral furosemide on an empty stomach if possible to enhance absorption; however, if gastric irritation occurs, take with food or milk.
* Rapid IV administration (e.g., > 4 mg/minute) can lead to ototoxicity. Administer IV doses slowly, especially at higher concentrations or doses.
* Hypokalemia is a significant concern and may necessitate potassium supplementation or potassium-sparing diuretics.
* Monitor patients closely for signs of dehydration and electrolyte imbalance.
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**Disclaimer:** This information is intended for clinical use and does not replace professional judgment. Always verify current prescribing information, guidelines, and individual patient factors before making clinical decisions.
