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## Furosemide (Lasix)
### Overview
Furosemide is a potent loop diuretic used to reduce excess fluid in the body (edema) associated with conditions like heart failure, liver disease, and kidney disease. It is also used to treat high blood pressure, sometimes in combination with other antihypertensives.
### Primary Indications
* Edema associated with congestive heart failure, liver cirrhosis, and renal disease.
* Hypertension.
### Adult Dosing
* **Edema:** Initial dose is typically 20-80 mg orally once daily. The dose may be increased by 20-40 mg every 6-8 hours as needed, not exceeding 600 mg/day in severe cases. Doses may be given once or twice daily.
* **Hypertension:** Initial dose is typically 40 mg orally twice daily. Maintenance doses range from 20-40 mg orally once or twice daily.
* **Intravenous (IV)/Intramuscular (IM):** Initial dose is typically 20-40 mg. May be increased by 20 mg every 2 hours as needed. The maximum daily dose is generally considered to be 600 mg, but higher doses may be used under close medical supervision in specific situations.
### Pediatric Dosing
* **Edema and Hypertension:** 1-2 mg/kg/dose orally once daily. May be increased by 1-2 mg/kg/dose every 6-8 hours as needed. Do not exceed 6 mg/kg/day.
* **IV/IM:** 1 mg/kg/dose. May be increased by 1 mg/kg/dose every 2 hours as needed. Do not exceed 6 mg/kg/day.
### Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to decreased GFR and increased plasma protein binding. However, patients with anuria may not respond.
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary.
### Contraindications
* Anuria.
* Known hypersensitivity to furosemide or sulfonamides.
### Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration.
* Hypotension, orthostatic hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperuricemia, Gout.
* Hyperglycemia.
* Photosensitivity.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **Other Ototoxic Drugs:** Increased risk of ototoxicity.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect of furosemide.
* **Antihypertensives:** Additive hypotensive effects.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Increased risk of lithium toxicity.
* **Corticosteroids:** Increased risk of electrolyte imbalances.
### Monitoring
* Electrolytes (sodium, potassium, chloride, magnesium, calcium), BUN, creatinine, glucose, and uric acid.
* Fluid status (weight, intake/output).
* Blood pressure.
* Hearing (especially with high doses or risk factors for ototoxicity).
### Clinical Pearls
* Rapid IV administration can cause ototoxicity. Administer IV furosemide slowly, typically over 30-60 minutes.
* Dosing frequency for edema may be adjusted based on patient response and urine output to minimize nocturia.
* Monitor electrolytes closely, especially potassium, due to the risk of hypokalemia. Patients may require potassium supplementation.
* The maximum daily dose of 600 mg is a general guideline; higher doses may be used in refractory edema but require close monitoring.
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*This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information for furosemide or to exercise professional judgment.*
