Please check your internet connection and try again.
# Furosemide
## Overview
Furosemide is a loop diuretic used to treat edema associated with congestive heart failure, liver cirrhosis, and renal disease, including the nephrotic syndrome. It is also used to treat hypertension, either alone or in combination with other antihypertensives.
## Primary Indications
* Edema due to heart failure, liver disease, or renal disease
* Hypertension
## Adult Dosing
* **Edema:** The usual initial dose is 20 mg to 80 mg orally once a day. If needed, the dose can be increased by 20 mg to 40 mg every 6 to 8 hours. The maximum daily dose is 600 mg. For patients requiring higher doses, consider intravenous administration.
* **Hypertension:** The usual initial dose is 40 mg orally once a day. If needed, the dose can be adjusted by increasing it by 20 mg every 4 to 5 days. The maximum daily dose is 120 mg.
* **Acute Pulmonary Edema:** 40 mg to 80 mg intravenously. Subsequent doses may be 20 mg to 40 mg intravenously.
## Pediatric Dosing
* **Edema:**
* **Oral:** 1 mg/kg to 2 mg/kg once daily. Maximum: 6 mg/kg/day.
* **Intravenous/Intramuscular:** 1 mg/kg once daily. Maximum: 20 mg/dose. If response is inadequate, increase to 2 mg/kg/dose every 6 hours.
## Dose Adjustments
* **Renal Impairment:** Lower initial doses may be necessary. Dosing is highly individualized and requires close monitoring of fluid and electrolyte balance.
* **Hepatic Impairment:** Use with caution due to increased risk of electrolyte imbalance. Dosing adjustments may be needed.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Electrolyte abnormalities:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia, hyperuricemia.
* **Dehydration:** Especially in the elderly.
* **Ototoxicity:** Particularly with rapid IV administration or high doses.
* **Hypotension:** Especially with rapid IV administration.
* **Hyperglycemia:**
* **Photosensitivity:**
* **Aplastic anemia, agranulocytosis, thrombocytopenia:** Rare but serious hematologic effects.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other ototoxic drugs:** Increased risk of ototoxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effects.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Potassium supplements/Potassium-sparing diuretics:** May counteract furosemide-induced hypokalemia, but risk of hyperkalemia if not carefully managed.
## Monitoring
* Fluid intake and output
* Electrolytes (sodium, potassium, chloride, magnesium, calcium)
* Renal function (BUN, creatinine)
* Blood pressure
* Auditory function (especially with high doses or IV administration)
* Blood glucose in diabetic patients
* Uric acid levels in patients with a history of gout
## Clinical Pearls
* Oral furosemide may be taken with or without food.
* Administer intravenous furosemide slowly to minimize the risk of ototoxicity.
* Monitor for signs and symptoms of electrolyte imbalance, particularly hypokalemia (e.g., muscle cramps, weakness, palpitations).
* Due to the risk of hypokalemia, concomitant use of potassium supplements or potassium-sparing diuretics should be carefully considered and monitored.
* When used for hypertension, once-daily dosing is typically sufficient.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete and up-to-date details before prescribing or administering any medication.*
