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## Furosemide (Lasix) ### Overview Furosemide is a potent loop diuretic used to treat fluid overload (edema) and high blood pressure. It works by inhibiting the reabsorption of sodium and chloride in the kidneys, leading to increased urine output. ### Primary Indications * Edema associated with congestive heart failure (CHF), liver cirrhosis, and renal disease (including the nephrotic syndrome). * Hypertension, usually in combination with other antihypertensives. * Acute pulmonary edema. ### Adult Dosing * **Edema:** * Initial dose: 20-80 mg orally once daily. * Subsequent doses: May be increased by 20-40 mg every 6-8 hours as needed. * Maintenance dose: Typically 40-80 mg orally once or twice daily. * Maximum oral dose: 600 mg daily (though higher doses may be used under strict medical supervision for refractory edema). * **Hypertension:** * Initial dose: 40 mg orally twice daily. * Maintenance dose: Adjust as needed, usually 40-80 mg orally twice daily. * Maximum oral dose: 600 mg daily. * **Acute Pulmonary Edema:** * Initial dose: 20-40 mg intravenously (IV) or intramuscularly (IM). * Subsequent doses: 20-40 mg IV or IM every 2 hours as needed, or continuous infusion at 10 mg/hour. * Maximum IV/IM dose: 600 mg daily (though higher doses may be used under strict medical supervision). *Dosing for all indications should be individualized based on response and fluid/electrolyte status.* ### Pediatric Dosing * **Edema:** * Infants and children: 1-2 mg/kg orally once daily. * Subsequent doses: May be increased by 1-2 mg/kg every 6-8 hours as needed. * Maximum oral dose: 6 mg/kg/day. * **Neonates:** * 2 mg/kg orally or IV/IM once daily. * Subsequent doses: May be increased by 1 mg/kg every 12-24 hours. * Maximum dose: 6 mg/kg/day. *Parenteral dosing in neonates may require lower initial doses due to increased sensitivity.* ### Dose Adjustments * **Renal Impairment:** Higher doses may be required due to reduced renal clearance. However, monitor closely for ototoxicity. * **Hepatic Impairment:** Use with caution; dose may need to be reduced. Monitor for electrolyte imbalances and hepatic encephalopathy. ### Contraindications * Anuria. * Hypersensitivity to furosemide or sulfonamides (potential cross-sensitivity). * Severe electrolyte depletion (e.g., hypokalemia, hyponatremia) prior to correction. ### Adverse Effects * **Common:** Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia), dehydration, azotemia, hyperuricemia, hyperglycemia. * **Less Common/Serious:** Hypotension, ototoxicity (hearing loss, tinnitus, usually reversible), rash, Stevens-Johnson syndrome, aplastic anemia, pancreatitis, photosensitivity. ### Key Drug Interactions * **Aminoglycosides, other ototoxic drugs:** Increased risk of ototoxicity. * **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide. * **Lithium:** Furosemide can decrease lithium clearance, increasing the risk of lithium toxicity. * **Potassium-sparing diuretics (e.g., spironolactone):** May be used to counteract potassium loss, but monitor electrolytes carefully. * **Antihypertensives:** Additive hypotensive effect. * **Corticosteroids:** Increased risk of hypokalemia. ### Monitoring * **Fluid status:** Daily weights, intake/output. * **Electrolytes:** Sodium, potassium, chloride, magnesium, calcium (especially with long-term use or high doses). * **Renal function:** BUN, creatinine. * **Blood pressure:** Especially when used for hypertension or in patients with edema. * **Hearing:** Monitor for signs of ototoxicity. * **Blood glucose:** In diabetic patients. * **Uric acid:** In patients prone to gout. ### Clinical Pearls * Furosemide is a potent diuretic; administer doses slowly, especially IV, to avoid hypotension and ototoxicity. * Oral administration is generally preferred unless the patient cannot take oral medications or requires rapid diuresis. * Due to its short half-life, frequent dosing or continuous infusion may be necessary for sustained diuresis. * Patients on furosemide may require potassium or magnesium supplementation, depending on their electrolyte levels and clinical status. --- *This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information and a healthcare professional for any questions regarding medication use.*