Please check your internet connection and try again.
# Furosemide
## Overview
Furosemide is a potent loop diuretic used to reduce fluid overload in conditions such as heart failure, liver disease, and kidney disease.
## Primary Indications
* Edema associated with congestive heart failure (CHF)
* Edema associated with liver cirrhosis
* Edema associated with renal disease, including nephrotic syndrome
* Hypertension (adjunct therapy, typically when edema is also present)
## Adult Dosing
* **Edema:** Oral: 20-80 mg once daily, may increase by 20-40 mg every 6-8 hours as needed. Usual maintenance: 20-80 mg daily. Maximum: 600 mg/day in divided doses for severe edema, though higher doses have been used cautiously. IV/IM: 20-40 mg once daily. May increase by 20 mg every 2 hours as needed. Maximum: 600 mg/day in divided doses.
* **Hypertension:** Oral: 40 mg twice daily.
## Pediatric Dosing
* **Edema:** Oral: 1-4 mg/kg/day divided into 1-4 doses. Maximum: 40 mg/day. IV/IM: 1 mg/kg/dose, may increase by 1 mg/kg every 2 hours as needed. Maximum: 40 mg/dose.
## Dose Adjustments
* **Renal Impairment:** Reduced doses may be necessary. In patients with severe renal impairment, escalating doses may be required to achieve diuresis, but caution is warranted due to potential for increased ototoxicity and accumulation.
* **Hepatic Impairment:** Use with caution; may precipitate hepatic encephalopathy.
## Contraindications
* Anuria
* Hypersensitivity to furosemide or sulfonamides
## Adverse Effects
* **Electrolyte Imbalance:** Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypocalcemia.
* **Ototoxicity:** Hearing loss, tinnitus (especially with rapid IV administration or high doses).
* **Metabolic:** Hyperuricemia, hyperglycemia.
* **Renal:** Increased BUN/creatinine, interstitial nephritis.
* **Other:** Hypotension, dizziness, rash, photosensitivity.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of ototoxicity and nephrotoxicity.
* **NSAIDs:** May reduce diuretic and antihypertensive effects; increased risk of renal dysfunction.
* **Lithium:** Reduced renal clearance of lithium, increased risk of lithium toxicity.
* **Corticosteroids:** Increased risk of hypokalemia.
* **Antihypertensives:** Additive hypotensive effects.
* **Digoxin:** Increased risk of digoxin toxicity due to furosemide-induced 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 rapid IV administration)
## Clinical Pearls
* Administer oral furosemide in the morning to minimize nocturia.
* For IV administration, infuse slowly (e.g., over 30-60 minutes) to reduce the risk of ototoxicity. Rapid IV push may be associated with irreversible hearing loss.
* Monitor for signs of dehydration and electrolyte imbalances. Potassium supplementation or potassium-sparing diuretics may be necessary, especially with concurrent use of digoxin or corticosteroids.
* Effectiveness can be reduced in patients with significant edema due to impaired GI absorption. Consider IV administration in such cases.
***
*This information is for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any medical decisions.*
