Furosemide; Uses, Dosage, Side Effects, Interactions, Pregnan

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Furosemide is a sulfamoyl anthranilic acid derivative, also known as frusemide, and a potent loop diuretic. Furosemide is widely used to treat hypertension and edema. This agent is highly bound to albumin and is largely excreted unchanged in the urine.

Furosemide belongs to the class of medications called loops diuretics. It is used to treat edema (fluid retention) that occurs with congestive heart failure and disorders of the liver, kidney, and lung. It is a medication used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used to control mild to moderate high blood pressure. It is a diuretic with fast onset and short duration that is used for edema and chronic renal insufficiency.It can be taken intravenously or by mouth. When taken by mouth it typically begins working within an hour while intravenously it typically begins working within five minutes.

Mechanism of Action of Furosemide

Furosemide, a loop diuretic, inhibits water reabsorption in the nephron by blocking the sodium-potassium-chloride cotransporter (NKCC2) in the thick ascending limb of the loop of Henle. This is achieved through competitive inhibition at the chloride binding site on the cotransporter, thus preventing the transport of sodium from the lumen of the loop of Henle into the basolateral interstitium. Consequently, the lumen becomes more hypertonic while the interstitium becomes less hypertonic, which in turn diminishes the osmotic gradient for water reabsorption throughout the nephron. Because the thick ascending limb is responsible for 25% of sodium reabsorption in the nephron, furosemide is a very potent diuretic.

Indications of Furosemide

  • Edema
  • High Blood Pressure (Hypertension)
  • Heart Failure
  • Liver cirrhosis,
  • Kidney impairment,
  • Nephrotic syndrome,
  • Adjunct therapy for swelling of the brain or lungs
  • Ascites
  • Hypercalcemia
  • Nonobstructive Oliguria
  • Oliguria
  • Pulmonary Edema
  • Renal Failure
  • Renal Transplant

Contra-Indications of Furosemide

  • Diabetes
  • Gout
  • Low amount of magnesium in the blood
  • Low amount of calcium in the blood
  • Low amount of sodium in the blood
  • Low amount of potassium in the blood
  • Low amount of chloride in the blood
  • Hearing loss
  • Heart attack
  • Blood pressure drop upon standing
  • Abnormally low blood pressure
  • Blockage of the urinary bladder
  • Enlarged prostate
  • Systemic lupus erythematosus
  • Blood circulation failure due to a serious heart condition
  • The high amount of uric acid in the blood
  • Azotemia
  • Decreased blood volume
  • Acid Base imbalance of the blood toward the basic side
  • The absence of urine formation
  • Low amount of protein in the blood
  • Pancreatitis

Dosage of Furosemide

Strengths:  20 mg; 40 mg; 80 mg

Hypertension

Oral

  • Initial dose: 80 mg/day, usually divided into 40 mg orally twice a day

Edema

Oral

  • Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
  • Maximum dose: 600 mg/day in patients with clinically severe edematous states

IV/IM

  • Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.

Nephrotic Syndrome

Oral

  • Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
  • Maximum dose: 600 mg/day in patients with clinically severe edematous states

IV/IM

  • Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Renal Failure

Oral

  • Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
  • Maximum dose: 600 mg/day in patients with clinically severe edematous states

IV/IM

  • Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Congestive Heart Failure

Oral

  • Initial dose: 20 to 80 mg orally once; may repeat with the same dose or increase by 20 or 40 mg no sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day (e.g., at 8 am and 2 pm).
  • Maximum dose: 600 mg/day in patients with clinically severe edematous states

IV/IM

  • Initial dose: 20 to 40 mg IV (slowly over 1 to 2 minutes) or IM once; may repeat with the same dose or increase by 20 mg no sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.
  • Maintenance dose: Administer the dose that provided the desired diuretic effect once or twice a day.

Pulmonary Edema

  • 40 mg IV slowly over 1 to 2 minutes; if a satisfactory response doesn’t occur within one hour, may increase to 80 mg IV slowly over 1 to 2 minutes.

Side Effects of Furosemide

Most common

More common

Less common

Drug Interactions of Furosemide

Pregnancy & Lactation of Furosemide

FDA Pregnancy Category C

Pregnancy

The effect of taking furosemide on the unborn baby during pregnancy is unknown. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

Furosemide passes into breast milk and may also partially reduce the amount of breast milk produced. If you are a breastfeeding mother and are taking furosemide, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.

References

 

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