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# Furosemide (Lasix)
## Overview
Furosemide is a potent 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, alone or in combination with other antihypertensives.
## Primary Indications
* Edema due to congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension.
## Adult Dosing
* **Edema:** The usual initial dose is 20-80 mg orally once a day. The dose may be adjusted depending on the patient's response. If a greater diuresis is required than can be obtained by the daily dose, the same dose may be given twice a day. Doses up to 600 mg daily have been used in patients with severe edema. The dose should be adjusted to the smallest effective dose.
* **Hypertension:** The usual initial dose is 40 mg orally twice a day. If the patient does not respond adequately, the dose may be increased to 80 mg twice a day. Doses of 20 mg orally once a day are also used in mild hypertension.
## Pediatric Dosing
* **Edema and Hypertension:** Dosing in neonates and infants is highly individualized. A common starting range is 1-4 mg/kg/day orally in divided doses. For premature infants, the initial dose is typically 1 mg/kg/dose every 12-24 hours. Doses may be increased based on response and tolerance. Intravenous dosing is usually 1 mg/kg/dose every 6-12 hours.
## Dose Adjustments
* **Renal Impairment:** Furosemide is primarily renally eliminated. In patients with severe renal insufficiency, a higher dose may be needed to achieve a diuretic effect. However, excessive doses can lead to further renal damage. Monitor closely.
* **Hepatic Impairment:** Furosemide is metabolized by the liver. Patients with severe hepatic impairment may have altered pharmacokinetics. Monitor electrolytes and fluid status closely.
## Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* **Electrolyte imbalances:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Dehydration and hypotension.**
* **Ototoxicity:** Especially with rapid IV administration or in patients with renal impairment.
* **Hyperuricemia and gout.**
* **Hyperglycemia.**
* **Rash, pruritus, photosensitivity.**
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May antagonize the diuretic and antihypertensive effects of furosemide. May also increase the risk of nephrotoxicity.
* **Lithium:** Furosemide can decrease renal clearance of lithium, increasing the risk of lithium toxicity.
* **Digoxin:** Hypokalemia induced by furosemide can increase digoxin toxicity.
* **Antihypertensives:** Additive hypotensive effects.
* **Corticosteroids:** 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 and signs of ototoxicity
* Blood glucose in diabetic patients
## Clinical Pearls
* Administer oral furosemide on an empty stomach for better absorption; however, it can be given with food or milk if gastric irritation occurs.
* Intravenous administration should be given slowly to minimize ototoxicity.
* Patients taking furosemide should be advised to maintain adequate fluid intake and report signs of dehydration or electrolyte imbalance.
* Monitor for signs of hypokalemia, such as muscle cramps or weakness, especially in patients taking digoxin.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant literature for complete details and to verify current recommendations before making clinical decisions. Dosing may vary based on patient-specific factors and local protocols.*
