Management of edema associated with congestive heart failure and hepatic or
renal disease; alone or in combination with antihypertensives in treatment of
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
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.
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
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
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.
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
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
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 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
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,
Onset of diuresis: Oral: Within 30-60 minutes; I.M.: 30 minutes; I.V.: Within
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
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.
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
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
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
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
|Mental Health: Effects
on Mental Status|
Dizziness is common
Effects on Psychiatric
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
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
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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