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# Furosemide (Oral)
## 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, although it is not typically a first-line agent for this indication.
## Primary Indications
* Edema (associated with CHF, cirrhosis, renal disease)
* Hypertension (adjunctive therapy)
## Adult Dosing
* **Edema:** Initial dose: 20-80 mg orally once daily. Doses can be increased by 20-40 mg every 6-8 hours as needed. Usual maintenance dose: 40-80 mg orally once or twice daily. Maximum daily dose: 600 mg.
* **Hypertension:** Initial dose: 40 mg orally twice daily. This is not a preferred agent for routine hypertension management.
## Pediatric Dosing
* **Edema:** 1-2 mg/kg/dose orally once or twice daily. Maximum dose: 6 mg/kg/day.
## Dose Adjustments
* **Renal Impairment:** Patients with severe renal impairment may require lower doses or less frequent administration. Dose adjustments are highly individualized based on response and electrolyte status.
* **Hepatic Impairment:** Dose reduction may be necessary due to increased bioavailability.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Common:** Dizziness, lightheadedness, orthostatic hypotension, hyponatremia, hypochloremia, hypokalemia, hyperuricemia, hyperglycemia, azotemia.
* **Serious:** Severe electrolyte depletion, dehydration, ototoxicity (especially with rapid IV administration or in severe renal impairment, less common with oral), Stevens-Johnson syndrome, aplastic anemia.
## Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity.
* **ACE Inhibitors, ARBs, Other Antihypertensives:** Additive hypotensive effect.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increased risk of lithium toxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide.
* **Potassium-Sparing Diuretics, Potassium Supplements:** Counteract hypokalemia, but monitor potassium levels closely.
* **Thiazide Diuretics:** Additive diuresis and electrolyte depletion.
## Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Blood pressure (including orthostatic measurements)
* Fluid balance (intake and output, weight)
* Blood glucose
* Uric acid
## Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Advise patients to rise slowly from a sitting or lying position to minimize orthostatic hypotension.
* Emphasize the importance of regular monitoring of electrolytes and renal function.
* Dosing for edema is highly individualized and should be titrated to the lowest effective dose to achieve desired diuresis while minimizing electrolyte disturbances.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
