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# Furosemide (Oral)
## Overview
Furosemide is a loop diuretic used to treat fluid overload (edema) and high blood pressure.
## Primary Indications
* Edema associated with heart failure, liver disease, or kidney disease.
* Hypertension (often used in combination with other antihypertensives).
## Adult Dosing
* **Edema:**
* Initial: 20-80 mg once daily.
* Maintenance: 20-80 mg once daily, or may be divided into two doses.
* Higher doses (e.g., 100-200 mg/day) may be required in severe cases.
* **Hypertension:**
* Initial: 40 mg twice daily.
* Maintenance: Adjust dose based on response. Doses higher than 80 mg/day are generally not recommended for hypertension alone.
## Pediatric Dosing
* **Edema:**
* Oral: 1-4 mg/kg/day in one or two divided doses.
* Maximum dose: 6 mg/kg/day.
* *Note: Dosing is highly individualized and requires careful titration.*
## Dose Adjustments
* **Renal Impairment:** Lower starting doses and slower titration may be necessary. Higher doses may be required in some cases of severe renal impairment to achieve a diuretic response, but careful monitoring is crucial.
* **Hepatic Impairment:** Patients with cirrhosis may be more sensitive to the effects and require dose reduction.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Electrolyte Imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration and Hypotension.**
* **Ototoxicity** (especially with rapid IV administration or high doses).
* **Hyperuricemia** (can precipitate gout).
* **Hyperglycemia.**
* **Photosensitivity.**
* **Rash.**
## Key Drug Interactions
* **Aminoglycosides and other Ototoxic drugs:** Increased risk of ototoxicity.
* **Antihypertensives (including other diuretics):** Additive hypotensive effects.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May reduce the diuretic and natriuretic effects of furosemide.
* **Lithium:** Reduced renal clearance and increased risk of lithium toxicity.
* **Potassium-Sparing Diuretics (e.g., spironolactone):** May be used to counteract hypokalemia, but requires careful monitoring.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Blood pressure.
* Fluid status (weight, edema, urine output).
* Blood glucose (in diabetic patients).
* Uric acid levels (in patients prone to gout).
## Clinical Pearls
* Administer in the morning to minimize nocturia.
* Rapid IV administration can increase the risk of ototoxicity.
* Monitor electrolytes closely, especially in patients taking digoxin or with significant fluid loss.
* Supplementation with potassium may be necessary if hypokalemia develops and is clinically significant.
**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult current prescribing information and your healthcare provider for any questions regarding medication use.
