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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used to treat fluid overload (edema) associated with heart failure, liver disease, and kidney disease, including nephrotic syndrome. It is also used to treat high blood pressure, alone or in combination with other antihypertensives.
## Primary Indications
* Edema due to heart failure, liver cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:**
* Oral: Initial dose is typically 20-80 mg once daily. May be increased by 20-40 mg every 6-8 hours as needed. Maintenance doses vary widely based on patient response.
* Intravenous (IV) or Intramuscular (IM): Initial dose is typically 20-40 mg once daily. If response is insufficient, doses can be increased by 20 mg every 2 hours, or given as a continuous infusion.
* Maximum daily oral dose is generally 600 mg, but higher doses may be used in rare cases under close supervision.
* Maximum IV/IM dose is generally 200 mg per dose, but higher doses may be used in refractory cases.
* **Hypertension:**
* Oral: Initial dose is typically 40 mg twice daily. Dose may be adjusted based on blood pressure response. Doses higher than 40 mg twice daily are not usually effective for blood pressure control.
## Pediatric Dosing
* **Edema:**
* Oral: 1-4 mg/kg/dose once or twice daily. Maximum: 6 mg/kg/day.
* IV/IM: 1 mg/kg/dose once. If response is insufficient, doses can be increased by 1 mg/kg every 2 hours, or given as a continuous infusion (0.1 mg/kg/hour). Maximum: 6 mg/kg/dose.
* Dosing should be individualized and titrated to the lowest effective dose.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to decreased renal excretion, but monitor closely for electrolyte imbalances.
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
* Severe electrolyte depletion (e.g., hypokalemia, hyponatremia).
## Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalance (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, fatigue, headache.
* **Serious:** Severe electrolyte depletion, ototoxicity (especially with rapid IV administration or high doses), hyperuricemia/gout, hyperglycemia, pancreatitis, rash, Stevens-Johnson syndrome, aplastic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Increased risk of lithium toxicity due to decreased renal clearance.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride) and bicarbonate.
* Renal function (BUN, creatinine).
* Fluid balance (intake and output, weight).
* Blood pressure.
* Hearing assessment in patients receiving high doses or with risk factors for ototoxicity.
## Clinical Pearls
* Administer oral furosemide as early in the day as possible to minimize nocturia.
* Rapid IV administration may cause ototoxicity. Infuse slowly, typically over 30-60 minutes, or as a continuous infusion for higher doses.
* Monitor electrolytes closely, especially potassium. Potassium supplements or potassium-sparing diuretics may be necessary.
* Educate patients about signs and symptoms of dehydration and electrolyte imbalance.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant clinical guidelines for complete details. Dosing may vary based on individual patient factors and local protocols.*
