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# Furosemide (Lasix)
## 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.
## Primary Indications
* Edema (due to heart failure, liver cirrhosis, renal disease)
* Hypertension
## Adult Dosing
* **Edema:**
* Initial dose: 20-80 mg orally once daily. May be given in divided doses.
* Maximum daily oral dose: 600 mg.
* For patients resistant to smaller doses, higher doses may be administered.
* Intermittent therapy (e.g., every other day, or for 2-4 days a week) may be effective and minimize electrolyte losses.
* **Hypertension:**
* Initial dose: 40 mg orally once daily.
* Subsequent doses adjusted based on response.
* May be used in combination with other antihypertensives.
* Maximum daily oral dose: 600 mg.
* **Intravenous (IV) or Intramuscular (IM):**
* Dose is generally one-half the total daily oral dose.
* Initial dose: 20-40 mg IM or IV.
* If IV, administer slowly (e.g., over 1-2 minutes for doses up to 20 mg). For higher doses, consider continuous infusion.
* Maximum daily IV/IM dose: 600 mg.
## Pediatric Dosing
* **Edema and Hypertension:**
* Initial dose: 1-2 mg/kg orally once daily.
* Maximum daily oral dose: 6 mg/kg, not to exceed 200 mg/day.
* For IV/IM administration: 1 mg/kg, not to exceed 20 mg per dose. Subsequent doses may be increased up to 2 mg/kg.
## Dose Adjustments
* **Renal Impairment:** May require higher doses due to decreased GFR and impaired drug secretion. Monitor response closely.
* **Hepatic Impairment:** Caution, may precipitate hepatic coma. Dose reduction may be necessary.
## Contraindications
* Anuria
* History of hypersensitivity to furosemide or its sulfonamide components.
## Adverse Effects
* **Common:** Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, dizziness, lightheadedness, increased urination, azotemia.
* **Less Common/Serious:** Ototoxicity (especially with rapid IV administration or high doses), hyperglycemia, hyperuricemia (gout), photosensitivity, pancreatitis, Stevens-Johnson syndrome, aplastic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **ACE Inhibitors/ARBs:** Increased risk of hypotension and renal dysfunction.
* **NSAIDs:** May reduce diuretic and antihypertensive effect, and increase risk of renal impairment.
* **Digoxin:** Increased risk of digoxin toxicity due to hypokalemia.
* **Lithium:** Reduced renal clearance, increasing lithium levels and risk of toxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride)
* Renal function (BUN, creatinine)
* Blood pressure
* Urine output
* Blood glucose (in diabetic patients)
* Uric acid levels (in patients with history of gout)
* Hearing function (especially with high doses or IV administration)
## Clinical Pearls
* Oral doses are generally given once daily or in divided doses.
* For severe edema, intermittent dosing (e.g., every other day) may be effective and reduce electrolyte losses.
* Rapid IV administration can lead to ototoxicity.
* Monitor for signs and symptoms of dehydration and electrolyte imbalance.
* Hypokalemia is a significant concern, especially when used with digoxin or corticosteroids.
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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 guidelines before making clinical decisions.*
