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# Furosemide (Oral)
## Overview
Furosemide is a potent loop diuretic used to treat edema associated with congestive heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome. It is also used to treat hypertension, usually in combination with other antihypertensives.
## Primary Indications
* Edema due to heart failure, liver cirrhosis, or renal disease.
* Hypertension.
## Adult Dosing
* **Edema:** The usual starting dose is 20-80 mg orally once a day. Doses can be increased by 20-40 mg every 6-8 hours as needed. The maximum daily dose is typically 600 mg, but higher doses may be used in resistant cases under close medical supervision. Doses are often given once or twice daily.
* **Hypertension:** The usual starting dose is 40 mg orally twice a day. Doses may be adjusted based on response. Furosemide is generally not recommended as a first-line agent for hypertension unless edema is also present.
## Pediatric Dosing
* **Edema:** Dosing in neonates, infants, and children is highly individualized. A common starting dose is 1-2 mg/kg orally once a day. Doses can be increased by 1-2 mg/kg every 6-8 hours as needed. The maximum daily dose is generally 6 mg/kg, or 200 mg per day, whichever is less.
## Dose Adjustments
* **Renal Impairment:** Patients with renal impairment may require lower doses or less frequent administration due to a prolonged half-life and increased sensitivity.
* **Hepatic Impairment:** Caution is advised.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Dizziness, lightheadedness, orthostatic hypotension, hypokalemia, hyponatremia, hypochloremia, dehydration, increased urination, hyperuricemia.
* **Less Common:** Hearing impairment (especially with rapid IV administration, ototoxicity is a risk with high doses or prolonged therapy), hyperglycemia, blood dyscrasias, pancreatitis, rash.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Antihypertensives:** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Lithium:** Increased risk of lithium toxicity due to reduced renal clearance.
## Monitoring
* Electrolytes (sodium, potassium, chloride), BUN, creatinine, and fluid balance, especially with higher doses or prolonged therapy.
* Blood pressure.
* Uric acid and glucose levels.
* Hearing assessment if ototoxicity is suspected.
## Clinical Pearls
* Oral furosemide onset of action is typically within 1 hour, with peak effects at 1-2 hours and duration of action up to 6-8 hours.
* Electrolyte imbalances, particularly hypokalemia, are common and can lead to arrhythmias, especially in patients taking digoxin.
* Advise patients to rise slowly to minimize orthostatic hypotension.
* If a dose is missed, take it as soon as remembered unless it is close to the time for the next dose. Do not double doses.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition. Please refer to the official prescribing information for complete details and warnings.*
