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# Furosemide (Lasix)
## Overview
Furosemide is a potent loop diuretic used for the management of fluid overload associated with conditions such as heart failure, liver disease, and renal disease.
## Primary Indications
* Edema due to congestive heart failure, liver cirrhosis, and renal disease (including the nephrotic syndrome).
* Hypertension (when not controllable with other antihypertensives).
* Acute pulmonary edema.
## Adult Dosing
* **Edema:**
* Oral: 20-80 mg once daily. Doses may be increased by 20-40 mg every 6-8 hours as needed. Maximum daily dose is 600 mg.
* IV/IM: 20-40 mg once daily. Doses may be increased by 20 mg every 2 hours as needed. Maximum daily dose is 600 mg.
* **Hypertension:**
* Oral: 40 mg twice daily.
* **Acute Pulmonary Edema:**
* IV/IM: 20-40 mg. If a satisfactory response is not obtained, subsequent doses of 20-40 mg can be administered every 2 hours.
## Pediatric Dosing
* **Edema:**
* Oral: 1-4 mg/kg/day divided into 1-4 doses. Maximum daily dose is 40 mg.
* IV/IM: 1 mg/kg/dose. Maximum single dose is 20 mg. If needed, doses can be increased by 1 mg/kg every 2 hours.
## Dose Adjustments
* **Renal Impairment:** Dose may need to be increased in patients with renal impairment due to decreased renal clearance. However, use with caution and monitor for toxicity.
* **Hepatic Impairment:** Use with caution; monitor for electrolyte imbalances and hepatic encephalopathy.
## Contraindications
* Anuria.
* History of hypersensitivity to furosemide or sulfonamides.
## Adverse Effects
* Electrolyte imbalances (hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia).
* Dehydration.
* Hypotension.
* Ototoxicity (especially with rapid IV administration or high doses).
* Hyperglycemia.
* Hyperuricemia.
* Photosensitivity.
## Key Drug Interactions
* **Aminoglycosides and other ototoxic drugs:** Increased risk of ototoxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced hypokalemia.
* **Lithium:** Reduced renal clearance of lithium, increasing lithium toxicity risk.
* **NSAIDs:** May reduce the diuretic and antihypertensive effect.
* **Antihypertensives:** Additive hypotensive effect.
* **Thiazide diuretics:** Increased risk of severe diuresis and electrolyte depletion.
## Monitoring
* Serum electrolytes (sodium, potassium, chloride, magnesium, calcium).
* Renal function (BUN, creatinine).
* Fluid status (weight, intake/output).
* Blood pressure.
* Blood glucose in diabetic patients.
* Uric acid levels.
* Auditory function (especially with high doses or IV administration).
## Clinical Pearls
* Administer IV furosemide slowly (over at least 30-60 minutes for doses >40 mg) to reduce the risk of ototoxicity.
* Oral administration is generally preferred for chronic management.
* Monitor for signs and symptoms of dehydration and electrolyte imbalance.
* Patients with heart failure may require higher doses to achieve a desired response due to altered pharmacokinetics.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines for complete details and to verify current recommendations before making clinical decisions.*
