Recommended Dosage: Posology: The lowest dose with which the desired effect is achieved should always be used.
The duration of the treatment should be determined by the doctor and be appropriate to the type and severity of the disease.
The parenteral administration of furosemide is indicated in cases where oral administration is not feasible or not efficient (for example in case of reduced intestinal absorption) or when a quick effect is required. In cases where parenteral administration is used, the switch to oral administration is recommended, as soon as possible.
To achieve optimum efficacy and suppress counter-regulation, a continuous furosemide infusion is generally to be preferred to repeated bolus injections.
Where continuous furosemide infusion is not feasible for follow-up treatment after one or several acute bolus doses, a follow-up regimen with low doses given at short intervals (approx. 4 hours) is to be preferred to a regimen with higher bolus doses at longer intervals.
Intravenous administration of furosemide must be slow; a rate of 4 mg per minute must not be exceeded and should never be given in association with other medicinal products in the same syringe.
Intramuscular administration must be restricted to exceptional cases where neither oral nor intravenous administrations are feasible. It must be noted that intramuscular injection is not suitable for the treatment of acute conditions such as pulmonary oedema.
If there is no opposing medical advice, the initial dose recommended for adults and adolescents over 15 years, is of 20 to 40 mg (1 or 2 ampoules) by intravenous (or in exceptional cases intramuscular) administration; the maximum dose varying according to individual response. If larger doses are required, they should be given increasing by 20 mg increments and not given more often than every two hours.
In adults, the recommended maximum daily dose of furosemide is 1500 mg.
Weight loss induced by enhanced diuresis should not exceed 1 kg/day.
Paediatric population: Children and adolescents (up to 18 years of age): The intravenous administration of furosemide to children and adolescents below 15 years is only recommended in exceptional cases.
The dosage will be adapted to the body weight, and the recommended dose ranges from 0.5 to 1 mg/kg body weight daily up to a maximum total daily dose of 20 mg.
Patients with renal impairment: In patients with severe impairment of renal function (serum creatinine > 5 mg/dl) it is recommended that an infusion rate of 2.5 mg per minute is not exceeded.
Older people: The recommended initial dose is 20 mg/day, increasing gradually until the required response is achieved.
Special dosage recommendations: For adults, the dose is based on the following conditions: Oedema associated to chronic and acute congestive heart failure: The recommended initial dose is 20 to 40 mg daily. This dose can be adapted to the patient's response, as necessary. The dose should be given in two or three individual doses per day for chronic congestive heart failure and as a bolus for acute congestive heart failure.
Oedema associated with renal disease: The recommended initial dose is 20 to 40 mg daily. This dose can be adapted to the response as necessary. The total daily dose can be administered as a single dose or as several doses throughout the day.
If this does not lead to an optimal fluid excretion increase, furosemide must be administered in continuous intravenous infusion, with an initial rate of 50 mg to 100 mg per hour.
Before beginning the administration of furosemide, hypovolaemia, hypotension and acid-base and electrolytic imbalances must be corrected.
In dialyzed patients, the usual maintenance dose ranges from 250 mg to 1500 mg daily.
In patients with nephrotic syndrome the dosage must be determined with caution, because of the risk of a higher incidence of adverse events.
Hypertensive crisis (in addition to other therapeutic measures): The recommended initial dose in hypertensive crisis is 20 mg to 40 mg administrated in bolus by intravenous injection. This dose can be adapted to the response as necessary.
Oedema associated to hepatic disease: When intravenous treatment is absolutely needed, the initial dose should range from 20 mg to 40 mg. This dose can be adapted to the response as necessary. The total daily dose can be administered as a single dose or in several doses.
Furosemide can be used in combination with aldosterone antagonists in cases in which these agents in monotherapy are not sufficient. In order to avoid complications such as orthostatic intolerance or acid-base and electrolytic imbalances or hepatic encephalopathy, the dose must be carefully adjusted to achieve a gradual fluid loss. This dose may produce in adults a daily body weight loss of approximately 0.5 kg.
Pulmonary oedema (in acute heart failure): The initial dose to be administered is 40 mg furosemide by intravenous application. If required by the condition of the patient, another injection of 20 to 40 mg furosemide is given after 30-60 minutes.
Furosemide should be used in addition to other therapeutic measures.
Method of administration: For instructions on dilution of the medicinal product before administration, see Precautions.
Route of administration: Solution for injection.