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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to manage edema associated with heart failure, liver cirrhosis, and renal disease. It is also used to treat hypertension.
### Primary Indications
* Edema (pulmonary, peripheral) due to heart failure, liver disease, or renal disease.
* Hypertension.
### Adult Dosing
* **Edema:** Oral: 20-80 mg once daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. Maximum oral dose typically 600 mg/day (higher doses may be used under close specialist supervision). Intravenous/Intramuscular: 20-40 mg once daily. Doses may be increased by 20 mg every 2 hours as needed. Maximum IV/IM dose typically 200 mg/dose (higher doses may be used under close specialist supervision).
* **Hypertension:** Oral: 40 mg twice daily.
### Pediatric Dosing
* **Edema:** Oral: 1-2 mg/kg/dose once daily. May increase by 1 mg/kg/dose every 6-8 hours. Maximum dose: 6 mg/kg/day. Intravenous/Intramuscular: 1 mg/kg/dose once daily. May increase by 1 mg/kg/dose every 2 hours. Maximum dose: 6 mg/kg/day.
### Dose Adjustments
* **Renal Impairment:** Reduced doses may be necessary. Patients with severe renal impairment may require higher doses than anticipated due to reduced renal clearance and increased protein binding.
* **Hepatic Impairment:** Reduced doses may be necessary.
### Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
### Adverse Effects
Common: Dizziness, lightheadedness, electrolyte imbalance (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperglycemia.
Serious: Ototoxicity (especially with rapid IV administration or high doses), severe electrolyte disturbances, Stevens-Johnson syndrome.
### Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **ACE inhibitors and ARBs:** Increased risk of hypotension and renal dysfunction.
* **NSAIDs:** May reduce diuretic and antihypertensive effect.
* **Lithium:** Increased risk of lithium toxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
### Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Fluid balance (intake and output)
* Blood pressure
* Hearing (especially with high doses or rapid IV infusion)
### Clinical Pearls
* Administer oral doses with food or milk to minimize gastrointestinal upset.
* Rapid IV administration can cause ototoxicity. Infuse IV furosemide slowly, typically over 30-60 minutes.
* Monitor for signs of dehydration and electrolyte imbalances, particularly hypokalemia, which can increase the risk of cardiac arrhythmias.
* For chronic heart failure, a lower initial dose may be preferred, titrating to effect.
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*This information is intended for clinical professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature before making clinical decisions.*
