Furosemide is a loop diuretic drug used for the treatment of heart disease & kidney disease by addressing the problem of fluid buildup.
USES
- Edema
- Cerebral edema
- Pulmonary edema
- Hypertension
- Congestive heart failure
- Liver cirrhosis
- Chronic kidney disease
- Nephrotic syndrome
- Low level of albumin in blood
- Hypercalcemia
DOSAGE FOR FUROSEMIDE
Dosage forms available:
- Tablets: 20 mg, 40 mg, 80 mg
- Oral solution: 8 mg/ml, 10 mg/ml
- Injection IV solution: 10 mg/ml
Dosage guidelines:
- Congestive Heart Failure: 20 mg to 80 mg orally, once daily, can also be repeated in 6-8 hours till desired effect is achieved. MAX: 600 mg/day
- Edema: 20 mg to 40 mg IV dose once (over 1 to 2 mins), the dose can be repeated after 2 hours till desired effect is reached.
- Hypertension: 80 mg/day, usually divided into 40 mg orally twice a day
Missed dose: Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Overdose:
a) Administration of gastric lavage
b) Dialysis of kidney and maintaining hydration
c) Replacement of electrolytes by ORS powder & electrolyte rehab therapy
d) Treatment of low blood pressure by appropriate medications
e) Vitamin supplementation.
SIDE EFFECTS
- Anorexia
- Decreased urine output
- Dehydration
- Increased thirst
- Increased blood glucose level
- Diarrhea/Constipation
- Nausea & vomiting
- Rash
- Pale skin
- Muscle spasm
- Weakness
- Decreased blood pressure.
ADVERSE EFFECTS ARISING FROM FUROSEMIDE
- Gout due to high amount of uric acid in blood
- Electrolyte imbalance like;
- Decrease in the levels of serum potassium
- Low serum sodium levels
- Decrease in the levels of serum calcium
- Increase in blood cholesterol
- Low levels of Vitamin B1
- Steven-Johnson Syndrome
- Anemia
- Decreased level of WBC
- Ringing in the ear
- Damage/toxicity to the ear
- Liver damage
- Pancreatitis.
PRECAUTIONS & CONTRAINDICATIONS
Furosemide is contraindicated & precaution is advised in patients with following conditions:
- Liver impairment
- Kidney damage
- Adrenal insufficiency (Addison’s Disease)
- After Bariatric surgery
- Elevated levels of serum electrolyte
- Narrowing of the urethra
- Benign prostatic hyperplasia
- Bladder emptying disorders
- Low protein levels in blood & serum
- Chronic diarrhea & dehydration
- Lupus
- People receiving medication for depression & mood disorders.
INTERACTIONS OF FUROSEMIDE
- Furosemide given with NSAIDs can lead to kidney damage & suppression of the diuretic action.
- When given with antibacterial drugs like aminoglycosides, there is an increased risk for ear damage.
- Furosemide when given along with certain antidepressants like MAO inhibitors & TCA antidepressants can lead to adverse effects like hypotension & hypokalemia.
- Increased risk of ventricular arrhythmia when given along with various antipsychotic drugs.
- Low levels of sodium can be seen if furosemide is given along with certain antiepileptic agents.
- Furosemide given in presence of cyclosporin can contribute to kidney damage, ear damage & liver damage.
- Furosemide when given along with ACE inhibitors can lead to severe low blood pressure & renal failure.
- Can enhance the adverse effects of cardiac glycosides.
IN PREGNANCY, BREAST FEEDING & CHILDREN
- Pregnancy: It is a category C drug and damage to fetus and mothers have been reported.
- Breast Feeding: The drug is present in the milk and therefore precaution is advised in nursing mothers.
- Children: Furosemide is contraindicated in pediatric populations & children.