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# Furosemide (Oral)
## 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 (e.g., congestive heart failure, cirrhosis, renal disease)
* Hypertension (often in combination with other antihypertensives)
## Adult Dosing
* **Edema:** Initial dose is typically 20-80 mg once or twice daily. Doses can be increased by 20-40 mg every 6-8 hours as needed. The usual maintenance dose is 40-80 mg daily. Doses up to 600 mg daily have been used in severe cases.
* **Hypertension:** Initial dose is typically 40 mg twice daily. Adjust based on response.
## Pediatric Dosing
* **Edema:** 1-4 mg/kg/dose orally once or twice daily. Maximum single dose is 40 mg. Maximum daily dose is 6 mg/kg.
## Dose Adjustments
* **Renal Impairment:** Furosemide is renally excreted. Patients with renal impairment may require lower doses or less frequent administration. Higher doses may be needed in some patients with severe renal impairment to achieve diuresis.
* **Hepatic Impairment:** May require dose reduction due to altered drug metabolism and distribution.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
Common: Dizziness, lightheadedness, dehydration, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia), hyperuricemia, hyperglycemia.
Serious: Severe allergic reactions, Stevens-Johnson syndrome, aplastic anemia, ototoxicity (especially with rapid IV administration or in renal impairment).
## Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity.
* **ACE Inhibitors/ARBs, Other Diuretics, Potassium-Sparing Diuretics:** Increased risk of hyperkalemia or hypokalemia, respectively, and hypotension.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effect; increased risk of renal impairment.
* **Corticosteroids:** Increased risk of electrolyte depletion, particularly hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Blood glucose (in diabetic patients)
* Hearing (especially with high doses or concurrent ototoxic agents)
## Clinical Pearls
* Oral furosemide is generally effective for most patients; IV administration is typically reserved for more severe edema or when rapid onset is needed.
* Administering furosemide earlier in the day can help minimize nocturia.
* Electrolyte disturbances are common and require close monitoring and potential supplementation (e.g., potassium).
* Hearing impairment is a potential risk, especially with high doses or in patients with renal impairment.
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*Always verify current prescribing information, including specific dosing and safety guidelines, with the most recent product monograph or reliable drug compendium.*
