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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, including nephrotic syndrome. It is also used to manage hypertension, alone or in combination with other antihypertensives.
## Primary Indications
* Edema (associated with CHF, cirrhosis, renal disease)
* Hypertension
## Adult Dosing
* **Edema:**
* Initial: 20-80 mg orally once daily.
* May increase by 20-40 mg every 6-8 hours as needed.
* Usual maintenance: 40 mg orally once or twice daily.
* Maximum daily dose: 600 mg (higher doses may be used in severe cases under close supervision).
* **Hypertension:**
* Initial: 40 mg orally twice daily.
* Maintenance: 20-120 mg orally per day in two divided doses.
* Maximum daily dose: 120 mg (unless more is required for edema).
## Pediatric Dosing
* **Edema:**
* 2 mg/kg orally once daily.
* If inadequate response, increase by 1-2 mg/kg every 6-8 hours.
* Do not exceed 6 mg/kg/dose.
* Maximum daily dose: 40 mg (unless higher dose is required for edema).
* **Neonates:**
* 1 mg/kg orally every 24 hours.
* May be increased by 1 mg/kg every 24 hours if needed.
* Do not exceed 3 mg/kg/dose.
## Dose Adjustments
* **Renal Impairment:** Lower doses may be necessary; monitor response closely. In severe renal impairment, doses may need to be significantly higher to achieve diuresis.
* **Hepatic Impairment:** Use with caution; monitor for electrolyte imbalances and hepatic encephalopathy.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia)
* Dehydration
* Hypotension
* Dizziness, lightheadedness
* Ototoxicity (especially with rapid IV administration or high doses)
* Hyperuricemia (can precipitate gout)
* Hyperglycemia
* Photosensitivity
* Aplastic anemia, agranulocytosis, thrombocytopenia (rare)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and renal dysfunction.
* **Corticosteroids:** Increased risk of hypokalemia.
* **NSAIDs:** May decrease furosemide's diuretic and antihypertensive effects and increase risk of renal impairment.
* **Lithium:** Furosemide can decrease lithium clearance, increasing lithium toxicity risk.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Antidiabetic agents:** Furosemide may impair glucose tolerance, requiring dose adjustments.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid balance (intake and output, daily weight)
* Signs of dehydration
* Blood glucose (in diabetic patients)
* Hearing (especially with high doses or IV administration)
## Clinical Pearls
* Oral furosemide is generally less potent than IV furosemide.
* The diuretic effect of furosemide may be diminished by concurrent administration of NSAIDs.
* Monitor potassium closely, especially in patients taking digoxin or other potassium-wasting medications.
* Rapid IV administration can increase the risk of ototoxicity.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
