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# Furosemide
## Overview
Furosemide is a loop diuretic used to treat fluid overload (edema) associated with heart failure, liver disease, and kidney disease, as well as hypertension.
## Primary Indications
* Edema due to congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension (often as add-on therapy).
## Adult Dosing
* **Edema:** 20 mg to 80 mg orally once daily. Higher doses may be needed in severe cases, administered as a single dose or divided doses. Maximum recommended daily oral dose is 600 mg. For rapid diuresis, IV doses are typically 20 mg to 40 mg, with subsequent doses adjusted based on response.
* **Hypertension:** 40 mg orally twice daily. Lower doses are generally preferred for hypertension alone.
* Dosing frequency and amount are highly individualized based on patient response and clinical status.
## Pediatric Dosing
* **Edema:** 1 mg/kg to 2 mg/kg orally once daily, not to exceed 6 mg/kg/day. IV doses: 1 mg/kg per dose, not to exceed 20 mg per dose in neonates and infants up to 2 months of age. For older children, IV doses may be up to 6 mg/kg/day divided in 1-4 doses.
* **Neonatal doses:** Specific protocols often dictate precise dosing due to variability in renal function.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be adjusted. In severe renal impairment, oral absorption may be reduced, and IV administration may be more effective.
* **Hepatic Impairment:** Monitor electrolytes and fluid status closely.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Common:** Dizziness, lightheadedness, electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia), dehydration, hypotension, polyuria.
* **Serious:** Ototoxicity (especially with rapid IV administration or high doses), severe electrolyte depletion, hyperuricemia, hyperglycemia.
## Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce natriuretic and diuretic effect, and increase risk of renal impairment.
* **Lithium:** Reduced renal clearance of lithium, leading to lithium toxicity.
* **Antihypertensives:** Additive hypotensive effect.
* **Potassium-depleting agents:** Increased risk of hypokalemia.
## Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid balance (intake and output, daily weights).
* Blood pressure.
* Hearing (especially with high doses or prolonged use).
## Clinical Pearls
* Administer oral furosemide with food or milk to minimize gastrointestinal upset.
* Rapid IV administration can increase the risk of ototoxicity. Slow IV infusion is generally preferred.
* Monitor for signs and symptoms of dehydration and electrolyte imbalance.
* Educate patients on the importance of regular monitoring and adherence to prescribed doses.
**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for definitive guidance.
