Careful monitoring is required in case of: Patients with partial obstruction of urinary outflow (e.g. patients with prostatic hypertrophy). Urinary output must be secured.
Patients with hypotension or at increased risk from pronounced fall in blood pressure (Patients with coronary artery stenosis or cerebral artery stenosis).
Patients with manifest or latent diabetes mellitus or variation of glycaemia (regular monitoring of blood glucose levels necessary).
Patients with gout and hyperuricaemia (regular monitoring of uric acid levels in serum necessary).
Patients with hepatic disease or hepatorenal syndrome (renal impairment associated to severe hepatic disease).
Hypoproteinaemia (associated to nephrotic syndrome, furosemide's effect may be reduced and it's ototoxicity increased).
Co-administration with lithium salts (monitoring of lithaemia is required, see Interactions).
Acute porphyria (the use of diuretics is considered to be unsafe in acute porphyria and caution should be exercised).
Cautious dose titration is required: Electrolyte variations (e.g. hypokalaemia, hyponatraemia).
Fluid variations, dehydration, blood volume reduction with circulatory collapse and possibility of thrombosis and embolism, particularly in elderly, with excessive use.
Ototoxicity (if administered faster than 4 mg/ml) - other ototoxic compounds administered concomitantly can increase this risk, see Interactions.
Administration of high dosages.
Administration in progressive and severe renal disease.
Administration with sorbitol. Concomitant administration of both substances may lead to increased dehydration (sorbitol might cause additional fluid loss by inducing diarrhea).
Administration in Lupus Erythematosus.
Medication that prolong the QT interval.
Premature infants (possible development nephrocalcinosis/ nephrolithiasis; renal function must be monitored and renal ultrasonography performed). In premature infants with respiratory distress syndrome, diuretic treatment with furosemide during the first weeks of life can increase the risk of persistent ductus arteriosus Botalli.
Particular caution and/or dose reduction required: Symptomatic hypotension leading to dizziness, fainting or loss of consciousness can occur in patients treated with furosemide, particularly in the elderly, patients on other medications which can cause hypotension and patients with other medical conditions that are risks for hypotension.
Regular monitoring of serum sodium, potassium and creatinine is generally recommended during furosemide therapy; particularly close monitoring is required in patients at high risk of developing electrolyte imbalances or in cases of significant additional fluid loss (e.g. due to vomiting or diarrhea).
Hypovolaemia or dehydration as well as any significant electrolyte or acid-base disturbances must be corrected.
This medicinal product contains less than 1 mmol sodium (23 mg) per ampoule, i.e. essentially 'sodium-free'.
Photosensitivity: Cases of photosensitivity reactions have been reported with thiazides diuretics (see Adverse Reactions). If photosensitivity reaction occurs during treatment, it is recommended to stop the treatment. If a re-administration of thiazide is deemed necessary, it is recommended to protect exposed areas to the sun or to artificial UVA.
Athletes: The attention of athletes should be drawn to the fact that this drug contains an active ingredient which may interfere with doping tests by forced diuresis of the doping agents.
Furosemide injection may be mixed with neutral and weak alkaline solution with pH between 7 and 10, such as 0.9 % sodium chloride and Ringer's lactate solution.
Product containing visible particles should not be used.
For single use only, discard any remaining contents after use.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.