Furosemide

• (fyu-ROH-se-mide) Lasix, Apo-Furosemide,

Furoside, Novo-Semide
• Class: Loop diuretic
 Action
• Inhibits reabsorption of sodium and chloride
in proximal and distal tubules and loop of
Henle.
 Indications
• Treatment of edema associated with CHF,
hepatic cirrhosis, and renal disease;
hypertension.
 Contraindications
• Hypersensitivity to sulfonylureas; anuria.
 Route/Dosage
• Edema
• ADULTS: PO 20 to 80 mg/day as a single dose;
may titrate up to 600 mg/day. IV/IM 20 to 40
mg qd or bid.
• Hypertension
• ADULTS: PO 40 mg bid. Maximum dose: 6
mg/kg.
• CHF and Chronic Renal Failure
• ADULTS: PO Up to 2 to 2.5 g/day. IV Up to 2 to 2.5
g/day. Maximum IV bolus: 1 g/day over 30 min.
• Acute Pulmonary Edema
• ADULTS: IV 40 mg (over 1 to 2 min). If response
not satisfactory within 1 hr, increase to 80 mg.
INFANTS & CHILDREN: PO Usual dose: 0.5 to 2
mg/kg qd or bid. Maximum dose: 6 mg/kg. IV/IM
Usual dose: 1 mg/kg. Maximum dose 6 mg/kg.
 Interactions
• Aminoglycosides: May increase auditory toxicity.
• Charcoal: May reduce absorption of furosemide.
• Cisplatin: May cause additive ototoxicity.
• Digitalis glycosides:
• Electrolyte disturbances may predispose to
digitalis-induced arrhythmias
• . Lithium: May increase plasma lithium levels and
toxicity.
• Nonsteroidal anti-inflammatory drugs:
• May decrease effects of furosemide.
• Phenytoin:
• May reduce diuretic effects of furosemide.
Salicylates:
• May impair diuretic response in patients with
cirrhosis and ascites.
• Thiazide diuretics:
• Synergistic effects that may result in profound
diuresis and serious electrolyte abnormalities.
 INCOMPATIBILITIES
• Gentamicin, milrinone, or netilmicin in D5W
or normal saline: Do not add to furosemide
solution; precipitate forms. Highly acidic
solutions of pH < 5.5: Do not mix with
furosemide solution.
 Adverse Reactions
• CV: Orthostatic hypotension; thrombophlebitis; chronic
aortitis.
• CNS: Vertigo; headache; dizziness; paresthesia;
restlessness; fever.
• DERM: Photosensitivity; urticaria; pruritus; necrotizing
angiitis (eg, vasculitis, cutaneous vasculitis); exfoliative
dermatitis; erythema multiforme; rash; occasionally,
local irritation and pain with parenteral use.
• EENT: Blurred vision; xanthopsia (yellow vision);
tinnitus; hearing impairment.
• GI: Anorexia; nausea; vomiting; diarrhea; oral and
gastric irritation; cramping; constipation; pancreatitis
• GU: Urinary bladder spasm; interstitial
nephritis; glycosuria.
• HEMA: Anemia; leukopenia; purpura; aplastic
anemia; thrombocytopenia; agranulocytosis.
HEPA: Jaundice; ischemic hepatitis.
• META: Hyperuricemia; hyperglycemia;
hypokalemia; metabolic alkalosis.
• OTHER: Muscle spasm; weakness.
 Precautions
• Pregnancy: Category C.
• Lactation: Excreted in breast milk.
• Children: May increase incidence of patent ductus
arteriosus in premature infants with respiratory
distress syndrome, especially in first few weeks of life.
• Dehydration: Excessive diuresis may cause dehydration
and decreased blood volume with circulatory collapse
and possible vascular thrombosis and embolism,
especially in elderly.
• Diarrhea: Furosemide solution vehicle contains
sorbitol and may induce diarrhea, especially in
children.
• Hepatic cirrhosis and ascites: Sudden alterations of
electrolyte balance may precipitate hepatic
encephalopathy and coma; monitor carefully.
• Hypersensitivity: Patients with known sulfonamide
sensitivity may show allergic reactions to furosemide.
• Ototoxicity: Associated with rapid injection, severe renal
impairment, very large doses, or concurrent use of other
ototoxic drugs.
• Photosensitivity: Photosensitization may occur. Renal
impairment: If severe effects occur, may need to
discontinue. If high-dose parenteral therapy is used,
controlled IV infusion is advised. Systemic lupus
• erythematosus: May be exacerbated or activated.
 PATIENT CARE CONSIDERATIONS
• Administration/Storage
• Administer oral medication with food to prevent GI
irritation.
• Administer qd dose in morning and bid doses at 8 AM and 2
PM to avoid nocturia and sleep disturbance.
• Do not exceed infusion rate of 4 mg/min in adults.
• Use infusion solutions mixed with cefoperazone sodium in
5% Dextrose within 24 hr if stored at room temperature
and within 5 days if kept refrigerated.
• Do not use if discolored.
• Store medication at room temperature; avoid excessive
exposure to light.
 Assessment/Interventions
• Obtain patient history, including drug history and
any known allergies. Note renal or hepatic
impairment, systemic lupus erythematosus,
hearing impairment or hypersensitivity to
sulfonamides.
• Obtain baseline hearing evaluation.
• Ensure that baseline BP; apical pulse; weight;
serum electrolyte, calcium, glucose, uric acid,
CO2, BUN and serum creatine levels; CBC; and
liver and renal function tests have been obtained
before beginning therapy and monitor regularly.
• Monitor I&O and weigh patient daily.
• Monitor renal function and notify physician if
increasing azotemia, oliguria, or increases in
BUN or creatinine occur.
• Notify physician if sudden alteration in fluid
and electrolyte status is noted.
• Monitor for signs and symptoms of
hypokalemia.
 OVERDOSAGE: SIGNS & SYMPTOMS
• Acute profound water loss, volume and
electrolyte depletion, dehydration, reduction
of blood volume, circulatory collapse with
possibility of vascular thrombosis and
embolism
• Thank you.