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# Furosemide Tablets
## Overview
Furosemide is a potent loop diuretic used to manage edema associated with congestive heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also used to treat hypertension, alone or in combination with other antihypertensives.
## Primary Indications
* Edema due to heart failure, liver cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:**
* Initial dose: 20-80 mg orally once daily.
* Dose may be given in divided doses if the initial dose is greater than 80 mg.
* Maximum daily dose: 600 mg.
* Dosing frequency and amount should be adjusted based on patient response. Intermittent dosing (e.g., once daily or every other day) may be effective.
* **Hypertension:**
* Initial dose: 40 mg orally twice daily.
* Dose may be adjusted to 80-120 mg per day in divided doses.
* When used with other antihypertensives, the dose of the other agent should be reduced.
* Maximum daily dose: 600 mg.
## Pediatric Dosing
* **Edema and Hypertension:**
* 20-40 mg orally once daily.
* Dose may be titrated up to 2 mg/kg/day in divided doses.
* Maximum daily dose: 6 mg/kg/day.
* Consider slower titration and careful monitoring of electrolytes and fluid status.
## Dose Adjustments
* **Renal Impairment:** Dose should be adjusted based on the degree of renal impairment and patient response. In patients with severe renal insufficiency, lower doses may be sufficient.
* **Hepatic Impairment:** Caution and careful monitoring are advised.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Dizziness, lightheadedness, muscle cramps, weakness, dehydration, orthostatic hypotension, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), hyperglycemia.
* **Serious:** Severe electrolyte depletion, ototoxicity (especially with rapid IV administration or high doses), severe hypotension, pancreatitis, aplastic anemia, thrombocytopenia, agranulocytosis, rash, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effects of furosemide and increase the risk of renal impairment.
* **Lithium:** Increased risk of lithium toxicity due to decreased renal clearance.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity if hypokalemia occurs.
* **Antihypertensives:** Additive hypotensive effects.
## Monitoring
* Electrolytes (sodium, potassium, chloride) and fluid status.
* Renal function (BUN, creatinine).
* Blood pressure.
* Blood glucose in diabetic patients.
* Auditory function, especially with high doses or in susceptible individuals.
## Clinical Pearls
* Furosemide is a potent diuretic; initiate therapy at the lowest effective dose and titrate as needed.
* Monitor electrolytes closely, particularly potassium, and consider supplementation as needed.
* Educate patients on signs and symptoms of dehydration and electrolyte imbalance.
* Administer oral doses at the same time each day to maintain consistent effects.
* When switching from IV to oral furosemide, the initial oral dose should be approximately equal to the total daily parenteral dose.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current official prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
