Yes

Diuretic, Loop

Management of edema associated with congestive heart failure and hepatic or renal disease; alone or in combination with antihypertensives in treatment of hypertension

C

Clinical effects on the fetus: Crosses the placenta. Increased fetal urine production, electrolyte disturbances reported. Generally, use of diuretics during pregnancy is avoided due to risk of decreased placental perfusion.

Breast-feeding/lactation: Crosses into breast milk; may suppress lactation. American Academy of Pediatrics has NO RECOMMENDATION.

Hypersensitivity to furosemide, any component, or sulfonylureas; anuria; patients with hepatic coma or in states of severe electrolyte depletion until the condition improves or is corrected

Adjust dose to avoid dehydration. In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Ototoxicity is associated with rapid I.V. administration, renal impairment, excessive doses, and concurrent use of other ototoxins. Hypersensitivity reactions can rarely occur. Monitor fluid status and renal function in an attempt to prevent oliguria, azotemia, and reversible increases in BUN and creatinine. Close medical supervision of aggressive diuresis required. Monitor closely for electrolyte imbalances particularly hypokalemia. Watch for and correct electrolyte disturbances. Coadministration of antihypertensives may increase the risk of hypotension. Avoid use of medications in which the toxicity is enhanced by hypokalemia (including quinolones with QT prolongation). Use caution in patients with known hypersensitivity to sulfonamides or thiazides (due to possible cross-sensitivity); avoid in patients with history of severe reactions.

Incidence of adverse events is not reported.

Central nervous system: Paresthesias, vertigo, dizziness, lightheadedness, headache, blurred vision, xanthopsia , fever, restlessness

Dermatologic: Exfoliative dermatitis, erythema multiforme, purpura, photosensitivity, urticaria, rash, pruritus, cutaneous vasculitis

Endocrine & metabolic: Hyperglycemia, hyperuricemia, hypokalemia, hypochloremia, metabolic alkalosis, hypocalcemia, hypomagnesemia, gout

Gastrointestinal: Nausea, vomiting, anorexia, oral and gastric irritation, cramping, diarrhea, constipation, pancreatitis, intrahepatic cholestatic jaundice, ischemia hepatitis

Genitourinary: Urinary bladder spasm, urinary frequency

Hematological: Aplastic anemia (rare), thrombocytopenia, agranulocytosis (rare), hemolytic anemia, leukopenia, anemia, purpura

Neuromuscular & skeletal: Muscle spasm, weakness

Otic: Hearing impairment (reversible or permanent with rapid I.V. or I.M. administration), tinnitus, reversible deafness (with rapid I.V. or I.M. administration)

Renal: Vasculitis, allergic interstitial nephritis, glycosuria, fall in glomerular filtration rate and renal blood flow (due to overdiuresis), transient rise in BUN

Miscellaneous: Anaphylaxis (rare), exacerbate or activate systemic lupus erythematosus

Symptoms of overdose include electrolyte imbalance, volume depletion, hypotension, dehydration, hypokalemia and hypochloremic alkalosis

Following GI decontamination, treatment is supportive; hypotension responds to fluids and Trendelenburg position

ACE inhibitors: Hypotensive effects and/or renal effects are potentiated by hypovolemia.

Antidiabetic agents: Glucose tolerance may be decreased.

Antihypertensive agents: Hypotensive effects may be enhanced.

Cephaloridine or cephalexin: Nephrotoxicity may occur.

Cholestyramine or colestipol may reduce bioavailability of furosemide.

Clofibrate: Protein binding may be altered in hypoalbuminemic patients receiving furosemide, potentially increasing toxicity.

Digoxin: Furosemide-induced hypokalemia may predispose to digoxin toxicity. Monitor potassium.

Indomethacin (and other NSAIDs) may reduce natriuretic and hypotensive effects of furosemide.

Lithium: Renal clearance may be reduced. Isolated reports of lithium toxicity have occurred; monitor lithium levels.

Metformin may decrease furosemide concentrations.

Metformin blood levels may be increased by furosemide.

NSAIDs: Risk of renal impairment may increase when used in conjunction with furosemide.

Ototoxic drugs (aminoglycosides, cis-platinum): Concomitant use of furosemide may increase risk of ototoxicity, especially in patients with renal dysfunction.

Peripheral adrenergic-blocking drugs or ganglionic blockers: Effects may be increased.

Phenobarbital or phenytoin may reduce diuretic response to furosemide.

Salicylates (high-dose) with furosemide may predispose patients to salicylate toxicity due to reduced renal excretion or alter renal function.

Sparfloxacin, gatifloxacin, and moxifloxacin: Risk of hypokalemia and cardiotoxicity may be increased Avoid use.

Succinylcholine: Action may be potentiated by furosemide.

Sucralfate may limit absorption of furosemide, effects may be significantly decreased; separate oral administration by 2 hours.

Thiazides: Synergistic diuretic effects occur.

Tubocurarine: The skeletal muscle-relaxing effect may be attenuated by furosemide.

Furosemide injection should be stored at controlled room temperature and protected from light

Exposure to light may cause discoloration; do not use furosemide solutions if they have a yellow color

Refrigeration may result in precipitation or crystallization, however, resolubilization at room temperature or warming may be performed without affecting the drug's stability

Furosemide solutions are unstable in acidic media but very stable in basic media

I.V. infusion solution mixed in NS or D₅W solution is stable for 24 hours at room temperature

Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calcium

Onset of diuresis: Oral: Within 30-60 minutes; I.M.: 30 minutes; I.V.: Within 5 minutes

Peak effect: Oral: Within 1-2 hours

Duration: Oral: 6-8 hours; I.V.: 2 hours

Absorption: Oral: 60% to 67%

Protein binding: >98%

Half-life: Normal renal function: 0.5-1.1 hours; End-stage renal disease: 9 hours

Elimination: 50% of an oral or 80% of an I.V. dose is excreted in the urine within 24 hours; the remainder is eliminated by other nonrenal pathways, including liver metabolism and excretion of unchanged drug in the feces

Infants and Children:

Oral: 1-2 mg/kg/dose increased in increments of 1 mg/kg/dose with each succeeding dose until a satisfactory effect is achieved to a maximum of 6 mg/kg/dose no more frequently than 6 hours.

I.M., I.V.: 1 mg/kg/dose, increasing by each succeeding dose at 1 mg/kg/dose at intervals of 6-12 hours until a satisfactory response up to 6 mg/kg/dose.

Adults:

Oral: 20-80 mg/dose initially increased in increments of 20-40 mg/dose at intervals of 6-8 hours; usual maintenance dose interval is twice daily or every day; may be titrated up to 600 mg/day with severe edematous states.

I.M., I.V.: 20-40 mg/dose, may be repeated in 1-2 hours as needed and increased by 20 mg/dose until the desired effect has been obtained. Usual dosing interval: 6-12 hours; for acute pulmonary edema, the usual dose is 40 mg I.V. over 1-2 minutes. If not adequate, may increase dose to 80 mg.

Continuous I.V. infusion: Initial I.V. bolus dose of 0.1 mg/kg followed by continuous I.V. infusion doses of 0.1 mg/kg/hour doubled every 2 hours to a maximum of 0.4 mg/kg/hour if urine output is <1 mL/kg/hour have been found to be effective and result in a lower daily requirement of furosemide than with intermittent dosing. Other studies have used a rate of less than or equal to 4 mg/minute as a continuous I.V. infusion.

Elderly: Oral, I.M., I.V.: Initial: 20 mg/day; increase slowly to desired response.

Refractory heart failure: Oral, I.V.: Doses up to 8 g/day have been used.

Dosing adjustment/comments in renal impairment: Acute renal failure: High doses (up to 1-3 g/day - oral/I.V.) have been used to initiate desired response; avoid use in oliguric states.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Dosing adjustment/comments in hepatic disease: Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis; monitor effects, particularly with high doses.

This product may cause a potassium loss; your physician may prescribe a potassium supplement, another medication to help prevent the potassium loss, or recommend that you eat foods high in potassium, especially citrus fruits; do not change your diet on your own while taking this medication, especially if you are taking potassium supplements or medications to reduce potassium loss; too much potassium can be as harmful as too little; ideally, should be administered on an empty stomach; however, may be administered with food or milk if GI distress; do not mix with acidic solutions; limit intake of natural licorice

Monitor weight and I & O daily; blood pressure, serum electrolytes, renal function; in high doses, monitor hearing

It is important that patients be closely followed for hypokalemia, hypomagnesemia, and volume depletion because of significant diuresis.

Dizziness is common

Orthostatic hypotension is common; use caution with low potency antipsychotics and TCAs; may rarely cause agranulocytosis; caution with clozapine and carbamazepine; may decrease renal clearance of lithium resulting in elevated serum levels and risk for toxicity; more common with thiazide diuretics; monitor lithium levels

No information available to require special precautions

No effects or complications reported

Take as directed, with food or milk early in the day (daily), or if twice daily, take last dose in late afternoon in order to avoid sleep disturbance and achieve maximum therapeutic effect. Keep medication in original container, away from light; do not use discolored medication. Include bananas or orange juice (or other potassium-rich foods) in daily diet; do not take potassium supplements without advice of prescriber. Weigh yourself each day, at the same time, in the same clothes when beginning therapy, and weekly on long-term therapy; report unusual or unanticipated weight gain or loss. You may experience dizziness, blurred vision, or drowsiness; use caution when driving or engaging in tasks that require alertness until response to drug is known. Use caution when rising or changing position. You may experience sensitivity to sunlight; use sunblock or wear protective clothing and sunglasses. Report signs of edema (eg, weight gains, swollen ankles, feet or hands), trembling, numbness or fatigue, any cramping or muscle weakness, palpitations, or unresolved nausea or vomiting. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

I.V. injections should be administered slowly over 1-2 minutes; replace parenteral therapy with oral therapy as soon as possible; for continuous infusion furosemide in patients with severely impaired renal function, do not exceed 4 mg/minute; be alert to complaints about hearing difficulty; check the patient for orthostasis; may be administered undiluted direct I.V. at a maximum rate of 0.5 mg/kg/minute for doses <120 mg and 4 mg/minute for doses >120 mg; may also be diluted for infusion 1-2 mg/mL (maximum: 10 mg/mL) over 10-15 minutes (following maximum rate as above)

Injection: 10 mg/mL (2 mL, 4 mL, 5 mL, 6 mL, 8 mL, 10 mL, 12 mL)

Solution, oral: 10 mg/mL (60 mL, 120 mL); 40 mg/5 mL (5 mL, 10 mL, 500 mL)

Tablet: 20 mg, 40 mg, 80 mg

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