about Furosemide class, uses, side effects contraindications
Furosemide
Short Description
Furosemide is a fast-acting, effective loop diuretic that has been in use for more than twenty years. It works by causing the kidneys to remove excess water and salt from the body into the urine.
Furosemide, like other diuretics, is mainly used to treat fluid retention in body tissues or edema caused by?heart failure??,?pulmonary edema,?and liver and kidney disease. Furosemide is also used to treat high blood pressure. ?
Furosemide is particularly effective in treating people with impaired kidney function who do not respond well to thiazide diuretics.
Furosemide may increase potassium loss, which may result in a wide range of side effects, which is why furosemide is often combined with potassium supplements or potassium-sparing diuretics.
Category
Chemical class: Sulfonamide
Therapeutic class: Antihypertensive, diuretic
Pregnancy category: C
Indications
To reduce edema caused by cirrhosis, heart failure, and renal disease, including nephrotic syndrome furosemide 472
ORALL
,
Adults. 20 to 80 mg as a single dose, increased by 20 to 40 mg every 6 to 8 hr until desired response occurs. Maximum: 600 mg daily. Children.2 mg/kg as a single dose, increased by 1 to 2 mg/kg every 6 to 8 hr until desired response occurs. Maximum: 6 mg/kg/dose.
IV:, I.V.OR
I.M.INJECTION
Adults. 20 to 40 mg as a single dose, increased by 20 mg every 2 hr until desired response occurs. Children.1 mg/kg as a single dose, increased by 1 mg/kg every 2 hr until desired response occurs. Maximum: 6 mg/kg/dose.
DOSAGE ADJUSTMENT Initial single dose limited to 20 mg for elderly patients. To manage mild to moderate hypertension, as adjunct to treat acute pulmonary edema and hypertensive crisis
ORALL
,
Adults.Initial: 40 mg b.i.d., adjusted until desired response occurs. Maximum: 600 mg daily.
IV: OR INJECTION Adults with normal renal function.40 to 80 mg as a single dose over several minutes. Adults with acute renal failure or pulmonary edema. 100 to 200 mg as a single dose over several minutes.
DOSAGE ADJUSTMENT For patients with acute pulmonary edema without hypertensive crisis, dosage reduced to 40 mg followed by 80 mg 1 hr later if therapeutic response doesn’t occur. Route Onset Peak Duration P.O. 20–60 min 1–2 hr 6–8 hr I.V. 5 min In 30 min 2 hr I.M. 30 min Unknown 2 hr
Mechanism of Action
Inhibits sodium and water reabsorption in the loop of Henle and increases urine formation. As the body’s plasma volume decreases, aldosterone production increases, which promotes sodium reabsorption and the loss of potassium and hydrogen ions. Furosemide also increases the excretion of calcium, magnesium, bicarbonate, ammonium, and phosphate. By reducing intracellular and extracellular fluid volume, the drug reduces blood pressure and decreases cardiac output. Over time, cardiac output returns to normal.
Incompatibilities
Don’t mix furosemide (a milky, buffered alkaline solution) with highly acidic solutions.
Contraindications
Anuria unresponsive to furosemide; hypersensitivity to furosemide, sulfonamides, or their components
Interactions
ACE inhibitors: Possibly first-dose hypotension aminoglycosides, cisplatin: Increased risk of ototoxicity amiodarone: Increased risk of arrhythmias from hypokalemia chloral hydrate: Possibly diaphoresis, hot flashes, and hypertension digoxin: Increased risk of digitalis toxicity related to hypokalemia insulin, oral antidiabetic : Increased blood glucose level lithium: Increased risk of lithium toxicity
NSAIDs: Possibly decreased diuresis phenytoin, probenecid: Possibly decreased therapeutic effects of furosemide propranolol: Possibly increased blood propranolol level thiazide diuretics: Possibly profound diuresis and electrolyte imbalances
alcohol use: Possibly increased hypotensive and diuretic effects of furosemide
Side Efect
CNS: Dizziness, fever, headache, paresthesia, restlessness, vertigo, weakness
CV: Orthostatic hypotension, shock, thromboembolism, thrombophlebitis
EENT: Blurred vision, oral irritation, ototoxicity, stomatitis, tinnitus, transient hearing loss (rapid I.V. injection), yellow vision
ENDO: Hyperglycemia
GI: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, hepatocellular insufficiency, indigestion, jaundice, nausea, pancreatitis, vomiting
GU: Bladder spasms, glycosuria
HEME: Agranulocytosis (rare), anemia, aplastic anemia (rare), azotemia, hemolytic furosemide 473 E F anemia, leukopenia, thrombocytopenia
MS: Muscle spasms
SKIN: Bullous pemphigoid, erythema multiforme, exfoliative dermatitis, photosensitivity, pruritus, purpura, rash, urticaria
Other: Allergic reaction (interstitial nephritis, necrotizing vasculitis, systemic vasculitis), dehydration, hyperuricemia, hypochloremia, hypokalemia, hyponatremia, hypovolemia
Cautions
WARNING Use furosemide cautiously in patients with advanced hepatic cirrhosis, especially those who also have a history of electrolyte imbalance or hepatic encephalopathy; drug may lead to lethal hepatic coma.
Obtain patient’s weight before and periodically during furosemide therapy to monitor fluid loss. For once-a-day dosing, give drug in the morning so patient’s sleep won’t be interrupted by increased need to urinate. Prepare drug for infusion with normal saline solution, lactated Ringer’s solution, or D5W. Administer drug slowly I.V. over 1 to 2 minutes to prevent ototoxicity. Expect patient to have periodic hearing tests during prolonged or high-dose I.V. therapy. Monitor blood pressure and hepatic and renal function as well as BUN, blood glucose, and serum creatinine, electrolyte, and uric acid levels, as appropriate. Be aware that elderly patients are more susceptible to hypotensive and electrolytealtering effects and thus are at greater risk for shock and thromboembolism. If patient is at high risk for hypokalemia, give potassium supplements along with furosemide, as prescribed. Expect to discontinue furosemide at maximum dosage if oliguria persists for more than 24 hours. Be aware that furosemide may worsen left ventricular hypertrophy and adversely affect glucose tolerance and lipid metabolism. Notify prescriber if patient experiences hearing loss, vertigo, or ringing, buzzing, or sense of fullness in her ears. Drug may need to be discontinued. PATIENT SAFTY
Instruct patient to take furosemide at the same time each day to maintain therapeutic effects. Urge her to take it as prescribed, even if she feels well. Instruct patient to take the last dose of furosemide several hours before bedtime to avoid sleep interruption from diuresis. If patient receives once-daily dosing, advise her to take the dose in the morning to avoid sleep disturbance caused by nocturia. Advise patient to change position slowly to minimize effects of orthostatic hypotension and to take furosemide with food or milk to reduce GI distress. Caution patient about drinking alcoholic beverages, standing for prolonged periods, and exercising in hot weather because these actions increase the hypotensive effect of furosemide. Emphasize the importance of weight and diet control, especially limiting sodium intake. Unless contraindicated, urge patient to eat more high-potassium and to take a potassium supplement, if prescribed, to prevent hypokalemia. Instruct patient to keep follow-up appointments with prescriber to monitor progress. Urge her to notify prescriber about persistent, severe nausea, vomiting, and diarrhea because they may cause dehydration. Inform diabetic patient that furosemide may increase blood glucose level, and advise her to check her blood glucose level frequently.
Trade Name & Company Name
effect of Furosemide in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies of furosemide in pregnant women. It is one of the drugs of choice for the treatment of CHF and/or pulmonary edema during pregnancy. High concentrations of furosemide dilate the capacitance vessels and assist the reduction in preload. The long clinical experience for the noted indications is reassuring. In one study of women with preeclampsia, furosemide caused a significant decrease in the intervillous blood flow. This likely reflects an already contracted intravascular volume. In another study of women with hyperdynamic cardiac outputs (COs), furosemide initiated at 22w gestation decreased CO and stroke volume (1.2?0.2L/min and 17?3ml, respectively), whereas total pulmonary resistance increased (101?26 dyne.sec.cm?5; p <.001 for all) after 2.9?1.4w. However, the hemodynamic improvement did not approach that expected for pregnancy. Thus, while furosemide improved the hyperdynamic circulation, it neither lowered BP nor caused clinically significant vasoconstriction. In rabbit studies, a high dose of furosemide was associated with unexplained maternal deaths. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Furosemide crosses the human placenta, achieving an F:M ratio approximating unity after 8-10h. It is unclear, however, how responsive the fetal kidney is to it, and the impact of gestational age on that response. Direct administration of furosemide for fetal therapy, typically in association with hydrops, has been frequently reported. However, no corresponding diuresis has been documented. In rodents, an effect on newborn urine concentrating ability is reported after in utero exposure. An increased prevalence was also noted in one mouse study. Though fetal sheep absorb it from AF presumably via a transmembrane mechanism, direct administration fails to generate a fetal diuresis. In addition, there is no fetal diuresis after administration to the gravid ewe. In summary, the impact of furosemide on the fetus is unclear and likely small. Breastfeeding
There are no adequate reports or well-controlled studies in nursing women. Furosemide does enter human breast milk, but the kinetics remain to be elucidated. It is unlikely one-time or limited use would cause harm during lactation.
the follwing drugs will increse Furosemide by inhepiting cyp450
the follwing drugs will decrease Furosemide by inhancing cyp450
trad drugs based on Furosemide
| Gen name | Trade name | Catagory name |
| furosemide | Lasix | Loop diuretics |
| Furosemide | DIUSEMIDE 20MG-2ML AMP | |
| Furosemide | DIUSEMIDE 40 MG TAB | |
| Furosemide | IMPUGAN 10MG-ML INJ 2ML AMP | |
| Furosemide | IMPUGAN TABLETS 40 MG | |
| Furosemide | LASIX AMP 20MG-2ML | |
| Furosemide | LASIX PAED.?LIQUID | |
| Furosemide | OEDEMAX | |
| Furosemide | SALURIN 20MG-2ML AMPOULES | |
| Furosemide | SALURIN 40 MG TABLETS | |
| Furosemide | SALURIN 5MG-5ML SYRUP | |
other drugs from same cataogory