Furosemiade " Lasix "

dr.joan

Furosemiade " Lasix " :
Trade names: Apo-Furosemide, Lasix
Drug class: Loop diuretics
Pregnancy: (Category C/ D if used in pregnancy-induced hypertension.]

Therapeutic actions

§ Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

Indications

· Edema associated with CHF, cirrhosis, renal disease (oral, IV)
· Acute pulmonary edema (IV)
· Hypertension (oral)

Contraindications/cautions

· Contraindications: allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.
· Use cautiously with SLE, gout, diabetes mellitus.
Dose
§ by mouth, oedema, initially 40 mg in the morning; maintenance 20–40 mg daily, increased in resistant oedema to 80 mg daily or more;
§ CHILD 1–3 mg/kg daily, max. 40 mg daily
Oliguria, initially 250 mg daily; if necessary larger doses, increasing in steps of 250 mg, may be given every 4–6 hours to a max. Of a single dose of 2 g (rarely used)
§ By intramuscular injection or slow intravenous injection, initially 20–50 mg; CHILD 0.5–1.5 mg/kg to a max. daily dose of 20 mg
§ By intravenous infusion (by syringe pump if necessary), in oliguria, initially 250 mg over 1 hour (rate not exceeding 4 mg/minute), if satisfactory urine output not obtained in the subsequent hour further 500 mg over 2 hours, then if no satisfactory response within subsequent hour, further 1 g over 4 hours, if no response obtained dialysis probably required; effective dose (up to 1 g) can be repeated every 24 hours
Adverse effects

• CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss
• GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice
• CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis
• Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances
• GU: Polyuria, nocturia, glycosuria, urinary bladder spasm
• Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme
• Other: Muscle cramps and muscle spasms

Clinically important interactions

• Drug-drug

• Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance)
• Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin
• Decreased absorption of furosemide with phenytoin
• Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs
• Decreased GI absorption with charcoal

Nursing Considerations

• Administer with food or milk to prevent GI upset.
• Reduce dosage if given with other antihypertensive; readjust dosages gradually as BP responds.
• Give early in the day so that increased urination will not disturb sleep.
• Avoid IV use if oral use is at all possible.
• Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
• Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.
• Discard diluted solution after 24 h.
• Refrigerate oral solution.
• Measure and record weight to monitor fluid changes.
• Arrange to monitor serum electrolytes, hydration, and liver function.
• Arrange for potassium-rich diet or supplemental potassium as needed.