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# Furosemide (Tab lasix furosemide)
## Overview
Furosemide is a loop diuretic used to treat edema associated with heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also used to treat hypertension, alone or in combination with other antihypertensive agents.
## Primary Indications
* Edema (congestive heart failure, liver cirrhosis, renal disease, nephrotic syndrome)
* Hypertension
## Adult Dosing
* **Edema:**
* Oral: 20 mg to 80 mg once daily. Doses may be increased by 20 mg to 40 mg every 6 to 8 hours until desired response is achieved. Doses greater than 80 mg should be administered in divided doses.
* Maximum oral dose: 600 mg daily.
* IV/IM: 20 mg to 40 mg once daily. If insufficient response, the dose may be increased by 20 mg every 2 hours, or the dose may be doubled every 2 hours.
* Maximum IV/IM dose: 200 mg in a single dose (higher doses may be required in severe cases under close monitoring).
* **Hypertension:**
* Oral: 40 mg twice daily.
* Combination therapy: May be used in combination with other antihypertensives.
* Maximum oral dose: 400 mg daily (though higher doses are generally not recommended for chronic hypertension management).
## Pediatric Dosing
* **Edema:**
* Oral: 1 mg/kg to 4 mg/kg per day divided into one or more doses.
* Maximum oral dose: 6 mg/kg per day.
* IV/IM: 1 mg/kg per dose.
* Maximum IV/IM dose: 2 mg/kg per dose.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in renal impairment due to decreased protein binding and impaired tubular secretion. However, monitor closely for increased diuresis and electrolyte imbalances.
* **Hepatic Impairment:** Caution is advised; dose reduction may be necessary.
## Contraindications
* Anuria
* Known hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Common:** Dizziness, lightheadedness, headache, weakness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia), dehydration, hypotension, hyperglycemia.
* **Serious:** Severe electrolyte disturbances, ototoxicity (hearing loss, tinnitus, especially with rapid IV administration or high doses), acute kidney injury, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May decrease furosemide's diuretic and antihypertensive effects.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Antihypertensives (including other diuretics, ACE inhibitors, ARBs):** Additive hypotensive effect.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
## Monitoring
* Electrolytes (serum potassium, sodium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Fluid balance (intake and output)
* Hearing (especially with high doses or prolonged use)
* Blood glucose (in diabetic patients)
## Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Rapid IV administration can lead to ototoxicity. Infuse slowly, typically over 30-60 minutes.
* Electrolyte imbalances, particularly hypokalemia, are common and can increase the risk of cardiac arrhythmias and digoxin toxicity. Consider potassium supplementation or potassium-sparing diuretics if indicated.
* Monitor for signs of dehydration and hypotension.
* Response to furosemide can vary significantly; titrate dose based on patient response and tolerance.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the current official prescribing information and relevant clinical guidelines for complete and up-to-date details before making any therapeutic decisions.
