FUROSEMIDE(FRUSEMIDE)

Indications & Dose:

Adult By Mouth

By mouth, oedema:

Initially 40mg in the morning; maintenance 20mg daily or 40mg on alternate days, increased in resistant oedema to 80mg daily.

Oliguria:

Initially 250mg daily, if necessary larger doses, increasing in steps of 250mg, may be given every 4-6 hours to a max. of a single dose of 2g (rarely used).

BY INJECTION

By i.m. or slow i.v. inj: rate not exceeding 4mg/min. Initially 20-50mg. By i.v. infusion: (by syringe pump if necessary) In oliguria, initially 250mg over 1 hour (rate not exceeding 4mg/min), if satisfactory urine output not obtained in the subsequent hour further 500mg over 2 hours, then if no satisfactory response within subsequent hour, further 1g over 4 hours, if no response obtained dialysis probably required; effective dose (up to 1g) can be repeated every 24 hours.

Children

By mouth: Oedema: 1-3mg/kg daily. By i.m. or slowi.v inj: 0.5-1.5mg/kg to a max. daily dose of 20mg.

Contraindications:

Anuria, hepatic coma

Side Effects:

CNS: Dizziness, fever, headache, paresthesia, restlessness, vertigo

CV: Chest pain, circulatory collapse, ECG changes, orthostatic hypotension

ENT: Blurred vision, ototoxicity

GI: Anorexia, constipation, cramping, diarrhea, dry mouth, ischemic hepatitis, jaundice, nausea, oral and gastric irritation, pancreatitis, vomiting

GU: Glycosuria, hyperuricemia, urinary bladder spasm

HEME: Agranulocytosis, anemia, aplastic anemia, leukopenia, purpura, thrombocytopenia

METAB: Hyperglycemia

SKIN: Erythema multiform, exfoliative dermat, interstitial nephritis, necrotizing angiitis, photosensitivity, pruritus, rash, urticaria

Cautions:

Precautions:

Fluid and electrolyte imbalance (including sodium, chloride, potassium, magnesium, calcium), renal disease, hepatic disease (may precipitate hepatic encephalopathy), gout, COPD, lupus erythematosus, diabetes mellitus, hyperparathyroidism, vomiting, diarrhea, elevated cholesterol/triglycerides.

PREGNANCY: breast-feeding & old age: Use with caution.

Interaction:

Drugs

Anticoagulants: Activity of anticoagulants may be enhanced.

Aminoglycoside antibiotics: Furosemide increases potential for ototoxicity.

Cisplatin: Furosemide increases potential for ototoxicity.

Digitalis glycosides: Diuretic-induced potassium loss may precipitate digitalis toxicity, increased frequency of cardiac arrhythmias.

NSAIDs: Effect of furosemide reduced.

Lithium: Therapeutic and toxic effects of lithium increased.

Metolazone: Profound diuresis and greater than predicted electrolyte loss related to the ability of metolazone to block proximal tubular sodium reabsorption useful in patients refractory to furosemide.

Non-depolarising muscle relaxants: Action of succinylcholine and tubocurarine poten-tiated by low doses and reversed by high doses.

Food: Efficacy reduced when administered with food.

Propranolol: Plasma propranolol level may be increased.

Clofibrate: Increased diuretic response.

Hydantoins: May decrease the diuretic effect.

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: