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# Furosemide
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with heart failure, liver disease, and kidney disease, as well as hypertension.
## Primary Indications
* Edema (congestive heart failure, cirrhosis, renal disease)
* Hypertension (adjunct therapy)
## Adult Dosing
* **Edema:**
* Oral: 20 mg to 80 mg once daily. The dose may be increased by 20 mg to 40 mg every 6 to 8 hours as needed. Doses greater than 80 mg should be given in divided doses. The maximum recommended oral dose is 600 mg daily, although higher doses have been used in severe cases under close supervision.
* Intravenous/Intramuscular: 20 mg to 40 mg once daily. If inadequate response, the dose may be increased by 20 mg every 2 hours. The maximum recommended IV/IM dose is 600 mg daily, although higher doses have been used in severe cases under close supervision.
* **Hypertension:**
* Oral: 40 mg twice daily. Not typically used as first-line therapy.
## Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg/dose to 2 mg/kg/dose every 6 to 12 hours. Maximum dose: 6 mg/kg/day.
* Intravenous/Intramuscular: 1 mg/kg/dose every 6 to 12 hours. Maximum dose: 6 mg/kg/day.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with severe renal impairment due to decreased renal excretion. However, close monitoring for ototoxicity and increased diuretic effect is crucial.
* **Hepatic Impairment:** Use with caution due to potential for electrolyte imbalances and hepatic encephalopathy.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalance (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, hyperuricemia.
* **Serious:** Ototoxicity (especially with rapid IV administration or high doses), severe electrolyte depletion, azotemia, hyperglycemia, pancreatitis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides, Cisplatin:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide.
* **Potassium-depleting agents (e.g., corticosteroids):** Increased risk of hypokalemia.
* **Lithium:** Increased risk of lithium toxicity due to reduced renal clearance.
* **Antihypertensives:** Additive hypotensive effect.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Fluid balance (intake and output)
* Blood pressure
* Blood glucose (in diabetic patients)
* Auditory function (especially with high doses or prolonged use)
## Clinical Pearls
* Administer IV furosemide slowly (over at least 30-60 minutes) to reduce the risk of ototoxicity. Rapid IV injection can cause sudden hearing loss.
* Monitor for signs of dehydration and electrolyte depletion, particularly hypokalemia, which can increase the risk of cardiac arrhythmias.
* Oral administration is generally preferred unless immediate diuresis is required or the patient cannot take oral medications.
* For heart failure patients, consider administering on an intermittent schedule (e.g., every other day) to avoid chronic volume depletion and electrolyte disturbances, if clinically appropriate.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.*
