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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome. It is also used to manage hypertension.
## Primary Indications
* Edema (heart failure, cirrhosis, renal disease)
* Hypertension
## Adult Dosing
* **Edema:**
* Oral: 20-80 mg once daily. May increase by 20-40 mg every 6-8 hours as needed.
* IV/IM: 20-40 mg once daily. May increase by 20 mg every 2 hours as needed.
* Maximum daily oral dose: 600 mg.
* Maximum daily IV dose: 200 mg (though higher doses may be used in specific severe cases under close supervision).
* **Hypertension:**
* Oral: 40 mg twice daily. This indication is less common as monotherapy.
## Pediatric Dosing
* **Edema:**
* Oral: 1-2 mg/kg/dose once or twice daily.
* Maximum dose: 6 mg/kg/dose once daily.
* IV/IM: 1 mg/kg/dose once or twice daily.
* Maximum IV/IM dose: 2 mg/kg/dose once daily.
## Dose Adjustments
* **Renal Impairment:** Dose reduction may be necessary. Monitor closely for efficacy and toxicity.
* **Hepatic Impairment:** Dose reduction may be necessary due to altered metabolism and increased sensitivity. Monitor closely for efficacy and toxicity.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Electrolyte Imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration:** Hypotension, dizziness.
* **Ototoxicity:** Tinnitus, hearing loss (especially with rapid IV administration or high doses).
* **Metabolic:** Hyperuricemia (gout), hyperglycemia.
* **Renal:** Increased BUN, azotemia.
* **Dermatologic:** Photosensitivity, rash.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **ACE inhibitors/ARBs:** Increased risk of hypotension and hyperkalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Lithium:** Reduced renal clearance, increased lithium toxicity.
* **Potassium-sparing diuretics/Potassium supplements:** Increased risk of hyperkalemia.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid balance (intake and output)
* Weight
* Hearing (especially with high doses or IV administration)
## Clinical Pearls
* Rapid IV administration can lead to ototoxicity. Administer IV furosemide slowly (e.g., over 30-60 minutes).
* Monitor electrolytes closely, especially potassium. Advise patients on potassium-rich foods if hypokalemia is a concern.
* Furosemide can cause significant volume depletion; monitor for signs of dehydration and hypotension.
* For patients with a history of sulfonamide allergy, cross-reactivity is possible but generally low. Proceed with caution.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the current prescribing information and relevant guidelines for complete and up-to-date details before making any treatment decisions.*
