Presentation and Status in Health Basket
5 x 20 mg/2 ml
10 x 20 mg/2 ml
25 x 20 mg/2 ml
Parenteral drug products should be inspected visually for particulate matter and discoloration, prior to administration, whenever solution and container permit. Route of administration: intramuscular or intravenous Since furosemide is a potent diuretic which, if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion, careful medical supervision is required. Dosage should be adjusted to the individual needs of each patient.
Adults Edema: The usual initial dose is 20-40 mg, administered as a single dose, injected intramuscularly or intravenously. The intravenous injection should be administered slowly (over 1-2 minutes). If the patient’s response is unsatisfactory, the following is recommended:
– a second dose may be administered in the same manner 2 hours later after the first dose.
– alternatively, the dose may be raised by increments of 20 mg administered not sooner than 2 hours after the previous dose, until the desired diuretic effect has been obtained. This individually-determined dose should then be administered once or twice daily. If the high dose parenteral therapy is chosen, the drug should be administered as a controlled intravenous infusion at a rate not exceeding 4 mg/min.
Acute Pulmonary Edema: The usual initial dose is 40 mg, injected intravenously. The injection should be administered slowly (over 1-2 minutes). If a satisfactory response does not occur within 1 hour, the dose may be increased to 80 mg, administered intravenously (over 1-2 minutes).
Infants and Children: The usual initial dose injected intramuscularly or intravenously is 1 mg/kg body weight. It should be administered slowly, and under close medical supervision. If the diuretic response after the initial dose is unsatisfactory, dosage may be increased by 1 mg/kg body weight administered not sooner than 2 hours after the previous dose, until the desired diuretic effect has been obtained. Doses greater than 6 mg/kg body weight are not recommended.
Oliguria due to acute/chronic renal insufficiency, Glomerular filter rate below 20 ml/minute, hypertension.
Known hypersensitivity to furosemide or sulfonamides. Renal failure due to nephrotoxic or hepatotoxic agents. Renal failure associated with hepatic coma. Anuria.
In patients with hepatic cirrhosis and ascites, initiation of therapy with furosemide is best carried out in hospital. In hepatic coma and states of electrolyte depletion. Strict observation is necessary during the period of diuresis. Supplemental potassium chloride and, if required, an aldosterone antagonist, are helpful in preventing hypokalemia and metabolic alkalosis. If increasing azotemia and oliguria occur during treatment of severe progressive renal disease, the drug should be discontinued. Patients should be observed regularly for the possible occurrence of blood dyscrasias, liver damage, or other idiosyncratic reactions. Pregnancy and lactation. Excessive diuresis may result in dehydration and reduction in blood volume. Electrolyte depletion may occur. Frequent serum electrolyte, CO2 and BUN determinations should be performed. May lower serum calcium levels.
Anorexia, oral and gastric irritation, nausea, vomiting, cramping, diarrhea, constipation, intrahepatic cholestatic jaundice, pancreatitis, dizziness, vertigo, paresthesias, headache, xanthopsia, blurred vision, tinnitus, hearing loss, anemia, leukopenia, thrombocytopenia, agranulocytosis (rare), aplastic anemia (rare). Purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis, cutaneous vasculitis), exfoliative dermatitis, erythema multiforme, pruritus, thrombophlebitis, orthostatic hypotension, hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, urinary bladder spasm. For full details see prescribing information.
Furosemide/Other Antihypertensive Drugs: Furosemide may intensify the therapeutic effect of other antihypertensive drugs. Concurrent administration requires dosage adjustment.
Furosemide/Salicylates in High Doses: Furosemide and salicylates have competitive renal excretory sites. Therefore patients receiving high doses of salicylates concomitantly administered with furosemide, such as in rheumatic diseases, may experience salicylate toxicity in lower furosemide doses than usual. Therefore, caution should be exercised when administering this combination.
Furosemide/Ototoxic and/or Nephrotoxic Medications: Concurrent and/or sequential administration of furosemide with ototoxic and /or nephrotoxic medications such as parenteral amphotericin B, aminoglycoside antibiotics, the cephalosporin antibiotics cephaloridine and cephalothin, parenteral amphotericin, and cisplatin, should be avoided because of the potential for these toxicities being increased. This is especially important in patients presenting with renal function impairment. Impairment of renal function may develop in patients receiving concurrent treatment with furosemide and high doses of certain cephalosporins.
Furosemide/Cardiac Glycosides: Concurrent use may increase the possibility of digitalis toxicity associated with hypokalemia.
Furosemide/Risperidone: Caution should be exercised and the risks and benefits of the combination or co-treatment with furosemide or with other potent diuretics should be considered prior to the decision to use. In risperidone placebo controlled trials in elderly patients with dementia, a higher incidence of mortality was observed in patients treated with furosemide plus risperidone when compared to patients treated with risperidone alone or furosemide alone. Concomitant use of risperidone with other diuretics (mainly thiazide diuretics used in low dose) was not associated with similar findings. No pathophysiological mechanism has been identified to explain this finding, and no consistent pattern for cause of death observed. Cautions should be exercised and the risks and benefits of this combination or co-treatment should be considered prior to the decision to use. Dehydration should be avoided.
Pregnancy and Lactation
Pregnancy: Safety of use in pregnancy has not been established. Furosemide should be used during pregnancy only if the potential benefit to the mother outweighs the possible risk to the fetus. Treatment during pregnancy requires monitoring of fetal growth because of the potential for higher birth weights. Furosemide has been shown to cause unexplained maternal deaths and abortions in rabblts at 2, 4 and 8 times the maximal recommended human dose.
Lactation: Furosemide appears in breast milk. Therefore, having taken into account the importance of the drug to the mother, either discontinue nursing or discontinue the drug. Furosemide may inhibit lactation.
Manifestations: The principal signs and symptoms of overdose with furosemide are dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, and are extensions of the diuretic action. The acute toxicity of furosemide has been determined in mice, rats, and dogs. In all three, the oral LD 50 exceeded 1000 mg/kg body weight while the intravenous LD 50 ranged from 300 to 680 mg/kg. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats. The concentration of furosemide in biological fluid associated with toxicity or death is not known.
Treatment: Treatment of overdose is supportive and consists of replacement of excessive fluid and electrolyte losses. Serum electrolytes, carbon dioxide level and blood pressure should be determined frequently. Adequate drainage must be assured in patients with urinary bladder outlet obstruction (such as prostatic hypertrophy). Hemodialysis does not accelerate furosemide elimination.