Pronunciation:

(fyoor OH se mide)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonylurea allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Adverse Reactions:

Cardiovascular: Orthostatic hypotension, necrotizing angiitis, thrombophlebitis, chronic aortitis, acute hypotension, sudden death from cardiac arrest (with I.V. or I.M. administration)

Central nervous system: Paresthesias, vertigo, dizziness, lightheadedness, headache, blurred vision, xanthopsia , fever, restlessness

Dermatologic: Exfoliative dermatitis, erythema multiforme, purpura, photosensitivity, urticaria, rash, pruritus, cutaneous vasculitis

Endocrine & metabolic: Gout, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, metabolic alkalosis

Gastrointestinal: Nausea, vomiting, anorexia, oral and gastric irritation, cramping, diarrhea, constipation, pancreatitis, intrahepatic cholestatic jaundice, ischemia hepatitis

Genitourinary: Urinary bladder spasm, urinary frequency

Hematological: Aplastic anemia (rare), thrombocytopenia, agranulocytosis (rare), hemolytic anemia, leukopenia, anemia, purpura

Neuromuscular & skeletal: Muscle spasm, weakness

Otic: Hearing impairment (reversible or permanent with rapid I.V. or I.M. administration), tinnitus, reversible deafness (with rapid I.V. or I.M. administration)

Renal: Vasculitis, allergic interstitial nephritis, glycosuria, fall in glomerular filtration rate and renal blood flow (due to overdiuresis), transient rise in BUN

Miscellaneous: Anaphylaxis (rare), exacerbate or activate systemic lupus erythematosus

Overdosage/Toxicology:

Drug Interactions:

ACE inhibitors: Hypotensive effects and/or renal effects are potentiated by hypovolemia.

Antidiabetic agents: Glucose tolerance may be decreased.

Antihypertensive agents: Hypotensive effects may be enhanced.

Cephaloridine or cephalexin: Nephrotoxicity may occur.

Cholestyramine or colestipol may reduce bioavailability of furosemide.

Digoxin: Furosemide-induced hypokalemia may predispose to digoxin toxicity. Monitor potassium.

Fibric acid derivatives: Blood levels of furosemide and fibric acid derivatives (ie, clofibrate and fenofibrate) may be increased during concurrent dosing (particularly in hypoalbuminemia). Limited documentation; monitor for increased effect/toxicity.

Indomethacin (and other NSAIDs) may reduce natriuretic and hypotensive effects of furosemide.

Lithium: Renal clearance may be reduced. Isolated reports of lithium toxicity have occurred; monitor lithium levels.

Metformin may decrease furosemide concentrations.

Metformin blood levels may be increased by furosemide.

NSAIDs: Risk of renal impairment may increase when used in conjunction with furosemide.

Ototoxic drugs (aminoglycosides, cis-platinum): Concomitant use of furosemide may increase risk of ototoxicity, especially in patients with renal dysfunction.

Peripheral adrenergic-blocking drugs or ganglionic blockers: Effects may be increased.

Phenobarbital or phenytoin may reduce diuretic response to furosemide.

Salicylates (high-dose) with furosemide may predispose patients to salicylate toxicity due to reduced renal excretion or alter renal function.

Succinylcholine: Action may be potentiated by furosemide.

Sucralfate may limit absorption of furosemide, effects may be significantly decreased; separate oral administration by 2 hours.

Thiazides: Synergistic diuretic effects occur.

Tubocurarine: The skeletal muscle-relaxing effect may be attenuated by furosemide.

Ethanol/Nutrition/Herb Interactions:

Food: Furosemide serum levels may be decreased if taken with food.

Herb/Nutraceutical: Avoid dong quai if using for hypertension (has estrogenic activity). Avoid ephedra, yohimbe, ginseng (may worsen hypertension). Limit intake of natural licorice. Avoid garlic (may have increased antihypertensive effect).

Stability:

Furosemide injection should be stored at controlled room temperature and protected from light

Exposure to light may cause discoloration; do not use furosemide solutions if they have a yellow color

Refrigeration may result in precipitation or crystallization, however, resolubilization at room temperature or warming may be performed without affecting the drug's stability

Furosemide solutions are unstable in acidic media but very stable in basic media

I.V. infusion solution mixed in NS or D5W solution is stable for 24 hours at room temperature. May also be diluted for infusion 1-2 mg/mL (maximum: 10 mg/mL) over 10-15 minutes (following infusion rate parameters).

Compatibility:

Y-site administration: Compatible: Allopurinol, amifostine, amikacin, amphotericin B cholesteryl sulfate complex, aztreonam, bleomycin, cefepime, cisplatin, cladribine, cyclophosphamide, cytarabine, docetaxel, doxorubicin liposome, epinephrine, etoposide phosphate, fentanyl, fludarabine, fluorouracil, foscarnet, granisetron, heparin, hydrocortisone sodium succinate, hydromorphone, indomethacin, kanamycin, leucovorin, linezolid, lorazepam, melphalan, meropenem, methotrexate, mitomycin, nitroglycerin, norepinephrine, paclitaxel, piperacillin/tazobactam, potassium chloride, propofol, ranitidine, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, tobramycin, tolazoline, vitamin B complex with C. Incompatible: Alatrofloxacin, amsacrine, chlorpromazine, ciprofloxacin, clarithromycin, diltiazem, droperidol, esmolol, filgrastim, fluconazole, gatifloxacin, gemcitabine, gentamicin, hydralazine, idarubicin, levofloxacin, metoclopramide, midazolam, milrinone, netilmicin, nicardipine, ondansetron, quinidine gluconate, thiopental, vecuronium, vinblastine, vincristine, vinorelbine. Variable (consult detailed reference): Cisatracurium, dobutamine, dopamine, doxorubicin, famotidine, labetalol, meperidine, morphine

Compatibility in syringe: Compatible: Bleomycin, cisplatin, cyclophosphamide, fluorouracil, heparin, leucovorin, methotrexate, mitomycin. Incompatible: Doxapram, doxorubicin, droperidol, metoclopramide, milrinone, vinblastine, vincristine

Compatibility when admixed: Compatible: Amikacin, aminophylline, ampicillin, atropine, bumetanide, calcium gluconate, cefamandole, cefoperazone, cefuroxime, cimetidine, dexamethasone sodium phosphate, diamorphine, digoxin, epinephrine, heparin, isosorbide, kanamycin, lidocaine, meropenem, morphine, nitroglycerin, penicillin G, potassium chloride, ranitidine, scopolamine, sodium bicarbonate, sulfadimidine, theophylline, tobramycin. Incompatible: Buprenorphine, chlorpromazine, diazepam, dobutamine, erythromycin lactobionate, isoproterenol, meperidine, metoclopramide, netilmicin, prochlorperazine edisylate, promethazine. Variable (consult detailed reference): Amiodarone, gentamicin, hydrocortisone sodium succinate, verapamil

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Diuresis: Oral: 30-60 minutes; I.M.: 30 minutes; I.V.: ~5 minutes

Peak effect: Oral: 1-2 hours

Duration: Oral: 6-8 hours; I.V.: 2 hours

Absorption: Oral: 60% to 67%

Protein binding: >98%

Metabolism: Minimally hepatic

Half-life elimination: Normal renal function: 0.5-1.1 hours; End-stage renal disease: 9 hours

Excretion: Urine (Oral: 50%, I.V.: 80%) within 24 hours; feces (as unchanged drug); nonrenal clearance prolonged in renal impairment

Dosage:

Infants and Children:

Oral: 1-2 mg/kg/dose increased in increments of 1 mg/kg/dose with each succeeding dose until a satisfactory effect is achieved to a maximum of 6 mg/kg/dose no more frequently than 6 hours.

I.M., I.V.: 1 mg/kg/dose, increasing by each succeeding dose at 1 mg/kg/dose at intervals of 6-12 hours until a satisfactory response up to 6 mg/kg/dose.

Adults:

Oral: 20-80 mg/dose initially increased in increments of 20-40 mg/dose at intervals of 6-8 hours; usual maintenance dose interval is twice daily or every day; may be titrated up to 600 mg/day with severe edematous states.

Hypertension (JNC 7): 20-80 mg/day in 2 divided doses

I.M., I.V.: 20-40 mg/dose, may be repeated in 1-2 hours as needed and increased by 20 mg/dose until the desired effect has been obtained. Usual dosing interval: 6-12 hours; for acute pulmonary edema, the usual dose is 40 mg I.V. over 1-2 minutes. If not adequate, may increase dose to 80 mg.

Continuous I.V. infusion: Initial I.V. bolus dose of 0.1 mg/kg followed by continuous I.V. infusion doses of 0.1 mg/kg/hour doubled every 2 hours to a maximum of 0.4 mg/kg/hour if urine output is <1 mL/kg/hour have been found to be effective and result in a lower daily requirement of furosemide than with intermittent dosing. Other studies have used a rate of 4 mg/minute as a continuous I.V. infusion.

Refractory heart failure: Oral, I.V.: Doses up to 8 g/day have been used.

Elderly: Oral, I.M., I.V.: Initial: 20 mg/day; increase slowly to desired response.

Dosing adjustment/comments in renal impairment: Acute renal failure: High doses (up to 1-3 g/day - oral/I.V.) have been used to initiate desired response; avoid use in oliguric states.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Dosing adjustment/comments in hepatic disease: Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis; monitor effects, particularly with high doses.

Administration:

Monitoring Parameters:

Dietary Considerations:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Oncology: Emetic Potential:

Oncology: Vesicant:

Dosage Forms:

Injection, solution: 10 mg/mL (2 mL, 4 mL, 8 mL, 10 mL)

Solution, oral: 10 mg/mL (60 mL, 120 mL) [orange flavor]; 40 mg/5 mL (5 mL, 500 mL) [pineapple-peach flavor]

Tablet (Lasix®): 20 mg, 40 mg, 80 mg

International Brand Names: