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# Furosemide Tablets
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease. It is also used to manage hypertension, though not as a first-line agent.
## Primary Indications
* Edema (due to heart failure, liver cirrhosis, renal disease)
* Hypertension (adjunct therapy)
## Adult Dosing
* **Edema:**
* Initial: 20-80 mg orally once daily. Doses can be increased by 20-40 mg every 6-8 hours as needed.
* Maintenance: Adjust to the lowest effective dose. May be given once daily or divided.
* Maximum: 600 mg/day is generally considered the maximum, though higher doses have been used under close supervision in specific situations.
* **Hypertension:**
* Initial: 40 mg orally twice daily.
* Maintenance: Adjust dose as needed.
* Maximum: Generally not recommended above 80 mg/day for hypertension alone.
Dosing for edema is highly individualized and should be adjusted based on patient response and fluid status.
## Pediatric Dosing
* **Edema:**
* Initial: 1-2 mg/kg orally once daily.
* Maximum: 6 mg/kg/day orally. Doses should not exceed adult maximums unless specifically indicated and monitored.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require lower doses due to increased bioavailability and risk of electrolyte imbalances.
* **Renal Impairment:** Patients with significant renal impairment may require higher doses to achieve a diuretic effect, but also have an increased risk of adverse effects. Close monitoring is essential.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Electrolyte Depletion:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration:** Dizziness, orthostatic hypotension.
* **Ototoxicity:** Hearing loss (usually reversible, more common with rapid IV administration or high doses).
* **Metabolic:** Hyperuricemia (can precipitate gout), hyperglycemia.
* **Renal:** Increased BUN and creatinine.
* **Other:** Photosensitivity, rash, gastrointestinal upset.
## Key Drug Interactions
* **Aminoglycosides/Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May decrease diuretic and antihypertensive effect, increase risk of renal impairment.
* **Potassium-Sparing Diuretics:** Risk of hyperkalemia.
* **Thiazide Diuretics:** Additive diuretic effect.
## Monitoring
* Fluid intake and output
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Hearing (especially with high doses or risk factors)
## Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Rapid IV administration can increase the risk of ototoxicity. Infuse slowly.
* Consider potassium supplementation or a potassium-sparing diuretic if hypokalemia is significant and persistent, especially in patients on digoxin.
* Diuresis may be less effective in patients with ascites due to altered drug delivery to the kidneys.
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*Please verify the current prescribing information for complete details before making any clinical decisions.*
