Furosemide


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Oedema associated w/ heart failure Initial: 40 mg/day, may reduce to 20 mg/day or 40 mg on alternate days. In some cases, 80 mg or more daily in divided doses. HTN 40-80 mg/day, alone or in combination w/ other antihypertensives. IM/IV Oedema associated w/ heart failure 20-50 mg via IM or slow IV inj may increase by increments of 20 mg 2 hrly. Doses >50 mg must be given via slow IV infusion. Max: 1,500 mg/day. IV Acute pulmonary oedema 40 mg via slow inj over 1-2 minutes. If no adequate response within 1 hour,  a further 80 mg may be given via slow IV inj over 1-2 minutes.
Dosage Details
Intravenous
Acute pulmonary oedema
Adult: 40 mg via slow inj over 1-2 minutes. If no adequate response within 1 hour,  a further 80 mg may be given via slow IV inj over 1-2 minutes.

Oral
Oedema associated with heart failure
Adult: Initially, 40 mg daily, may reduce to 20 mg daily or 40 mg on alternate days. In some cases, 80 mg or more daily in divided doses may be required.
Elderly: Initially, 20 mg and titrate upward if needed.

Oral
Hypertension
Adult: 40-80 mg daily, alone or in combination w/ other antihypertensives.

Parenteral
Oedema associated with heart failure
Adult: 20-50 mg via IM or slow IV inj, may increase by increments of 20 mg 2 hrly. Doses >50 mg must be given via slow IV infusion. Max: 1,500 mg daily.
Child: 0.5-1.5 mg/kg daily. Max: 20 mg daily.
Administration
Oral Solution: May be taken with or without food. May be taken w/o meals for better absorption. May be taken w/ meals to reduce GI discomfort.
Incompatibility
Y-site: Amsacrine, azithromycin, caffeine citrate, caspofungin, chlorpromazine, ciprofloxacin, diltiazem, droperidol, eptifibatide, esmolol, fenoldopam, filgrastim, fluconazole, gemcitabine, gentamicin, haloperidol, hydralazine, idarubicin, labetalol, levofloxacin, methocarbamol, metoclopramide, midazolam, milrinone, nesiritide, nicardipine, ondansetron, phenylephrine, promethazine, quinidine, gluconate, telavancin, vecuronium, vinblastine, vincristine, vinorelbine. Syringe: Diphenhydramine, dimenhydrinate, doxapram, doxorubicin HCl, meperidine, pantoprazole, protamine, thiamine.
Contraindications
Hypersensitivity to furosemide and sulfonamides. Anuria or renal failure, Addison's disease, hypovolaemia or dehydration, precomatose state associated w/ liver cirrhosis.
Special Precautions
Patient w/ prediabetes or DM, hepatic cirrhosis, gout, impaired micturition, at risk from a pronounced fall in BP. Risk of ototoxicity w/ rapid inj. Renal and hepatic impairment. Elderly, childn. Pregnancy and lactation.
Adverse Reactions
Hyponatraemia, hypochloraemic alkalosis, hypokalaemia, headache, drowsiness, muscle cramps, hypotension, dry mouth, thirst, weakness, lethargy, restlessness, oliguria, GI disturbances, hypovolaemia, dehydration, hyperuricaemia, acute generalised exanthematous pustulosis, drug rash w/ eosinophilia and systemic symptoms, reversible or irreversible hearing impairment, deafness, tinnitus, severe anaphylactic or anaphylactoid reactions (e.g. w/ shock), Stevens-Johnson syndrome, toxic epidermal necrolysis; increased liver enzyme, cholesterol and triglyceride serum levels.
Potentially Fatal: Serious cardiac arrhythmias.
IM/IV/Parenteral/PO: C
MonitoringParameters
Monitor BP, serum electrolytes, renal function, orthostasis, hearing (on high doses or rapid IV admin).
Overdosage
Symptoms: Dehydration, electrolyte disturbances, hypotension and cardiac toxicity, hypochloremic alkalosis, hypokalaemia, blood volume reduction. Management: Symptomatic and supportive treatment. Replacement of excessive fluid and electrolyte losses. Ensure adequate drainage in patients w/ urinary bladder outlet obstruction (e.g. prostatic hypertrophy). Treat hypotension w/ appropriate IV fluids.
Drug Interactions
May increase nephrotoxicity of cephalosporins (e.g. cefalotin), NSAIDs. May increase ototoxicity of aminoglycoside, ethacrynic acid, other ototoxic drugs. Reduced serum level w/ aliskiren. May increase hypotensive effect of ACE inhibitors or angiotensin II receptor antagonists. Increased risk of hyperkalaemia w/ K-sparing diuretics. Increased risk of cardiotoxicity w/ cardiac glycosides, antihistamines. May reduce serum level of lithium. May antagonise hypoglycaemic effect of antidiabetics. Increased hypotensive effect w/ MAOIs. Increased hyponatraemia w/ carbamazepine. Reduced natriuretic and hypotensive effect w/ indometacin. Diminished diuretic effect w/ salicylates.
Action
Description: Furosemide inhibits reabsorption of Na and Cl mainly in the medullary portion of the ascending loop of Henle. Excretion of K and ammonia is also increased while uric acid excretion is reduced. It increases plasma-renin activity, plasma-norepinephrine and plasma-arginine-vasopressin concentrations.
Onset: Diuresis: 30-60 min (oral); 30 min (IM); approx 5 min (IV). Oedema: W/in 15-20 min prior to diuretic effect.
Duration: 6-8 hr (oral); 2 hr (IV).
Pharmacokinetics:
Absorption: Fairly rapidly absorbed from the GI tract. Bioavailability: Approx 60-70%.
Distribution: Crosses the placenta; enters breast milk. Plasma protein binding: Up to 99% (mainly albumin).
Metabolism: Undergoes minimal hepatic metabolism.
Excretion: Mainly via urine (as unchanged drug). Half-life: Up to approx 2 hr.
Chemical Structure

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Storage
Store between 15-30°C. Protect from light.
MIMS Class
Disclaimer: This information is independently developed by MIMS based on Furosemide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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