Skip to Content
New To Chronic Myeloid Leukemia? Get Information Today >>

Furosemide

Pronunciation

Pronunciation

(fyoor OH se mide)

Index Terms

  • Frusemide

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection:

Generic: 10 mg/mL (2 mL, 4 mL, 10 mL)

Solution, Injection [preservative free]:

Generic: 10 mg/mL (2 mL, 4 mL, 10 mL)

Solution, Oral:

Generic: 8 mg/mL (5 mL, 500 mL); 10 mg/mL (60 mL, 120 mL)

Tablet, Oral:

Lasix: 20 mg

Lasix: 40 mg, 80 mg [scored]

Generic: 20 mg, 40 mg, 80 mg

Brand Names: U.S.

  • Lasix

Pharmacologic Category

  • Antihypertensive
  • Diuretic, Loop

Pharmacology

Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calcium

Metabolism

Minimally hepatic

Excretion

Urine (Oral: 50%, IV: 80%) within 24 hours; feces (as unchanged drug); nonrenal clearance prolonged with renal impairment

Onset of Action

Diuresis: Oral, S.L.: 30-60 minutes; IM: 30 minutes; IV: ~5 minutes

Symptomatic improvement with acute pulmonary edema: Within 15-20 minutes; occurs prior to diuretic effect

Peak effect: Oral: 1-2 hours

Duration of Action

Oral, S.L.: 6-8 hours; IV: 2 hours

Half-Life Elimination

Normal renal function: 0.5-2 hours; End-stage renal disease: 9 hours

Protein Binding

91% to 99%; primarily to albumin

Use: Labeled Indications

Management of edema associated with heart failure and hepatic or renal disease; acute pulmonary edema; treatment of hypertension (alone or in combination with other antihypertensives)

Note: According to the Eighth Joint National Committee (JNC 8) guidelines, loop diuretics are not recommended for the initial treatment of hypertension (James, 2013). In patients with chronic kidney disease (ie, eGFR <30 mL/minute/1.73 m2), the American Society of Hypertension/International Society of Hypertension (ASH/ISH) suggests that the use of a loop diuretic may be necessary (Weber, 2014).

Canadian labeling: Additional use: Furosemide Special Injection and Lasix Special (products not available in the U.S.): Adjunctive treatment of oliguria in patients with severe renal impairment

Contraindications

Hypersensitivity to furosemide or any component of the formulation; anuria

Canadian labeling: Additional contraindications (not in U.S. labeling): Hypersensitivity to sulfonamide-derived drugs; complete renal shutdown; hepatic coma and precoma; uncorrected states of electrolyte depletion, hypovolemia, or hypotension; jaundiced newborn infants or infants with disease(s) capable of causing hyperbilirubinemia and possibly kernicterus; breast-feeding. Note: Manufacturer labeling for Lasix® Special and Furosemide Special Injection also includes: GFR <5 mL/minute or GFR >20 mL/minute; hepatic cirrhosis; renal failure accompanied by hepatic coma and precoma; renal failure due to poisoning with nephrotoxic or hepatotoxic substances.

Note: Although the approved product labeling states this medication is contraindicated with other sulfonamide-containing drug classes, the scientific basis of this statement has been challenged. See “Warnings/Precautions” for more detail.

Dosing: Adult

Note: Dose equivalency for patients with normal renal function (approximate): Furosemide 40 mg = bumetanide 1 mg = torsemide 20 mg = ethacrynic acid 50 mg

Edema, heart failure:

Oral: Initial: 20-80 mg/dose; if response is not adequate, may repeat the same dose or increase dose in increments of 20-40 mg/dose at intervals of 6-8 hours; may be titrated up to 600 mg daily with severe edematous states; usual maintenance dose interval is once or twice daily. ACCF/AHA 2013 heart failure guidelines recommend initial dosing of 20-40 mg once or twice daily and a maximum total daily dose of 600 mg (Yancy, 2013). Note: Dosing frequency may be adjusted based on patient-specific diuretic needs.

IM, IV: Initial: 20-40 mg/dose; if response is not adequate, may repeat the same dose or increase dose in increments of 20 mg/dose and administer 1-2 hours after previous dose (maximum dose: 200 mg/dose). A higher initial dose may be considered for those receiving chronic oral diuretic therapy. Individually determined dose should then be given once or twice daily although some patients may initially require dosing as frequent as every 6 hours.

Continuous IV infusion (ACCF/AHA [Yancy, 2013]); Brater, 1998; Howard, 2001): Initial: IV bolus dose 40-100 mg over 1-2 minutes, followed by continuous IV infusion rate of 10-40 mg/hour; repeat loading dose before increasing infusion rate. Note: With lower baseline CrCl (eg, CrCl <25 mL/minute), the upper end of the initial infusion dosage range should be considered. If urine output is <1 mL/kg/hour, double as necessary to a maximum of 80-160 mg/hour (Howard, 2001; Schuller, 1997). The risk associated with higher infusion rates (80-160 mg/hour) must be weighed against alternative strategies.

Acute pulmonary edema: IV: 40 mg over 1-2 minutes. If response not adequate within 1 hour, may increase dose to 80 mg. Note: Minimal additional response is gained by single doses over 160-200 mg; maximum dose: 200 mg (Brater, 1998).

Hypertension: Oral: Initial: 40 mg twice daily; individualize according to patient response and use minimal dose necessary to maintain therapeutic response. If response inadequate, may add another antihypertensive. Usual dosage (ASH/ISH [Weber, 2014]): 40 mg twice daily.

Dosing: Geriatric

Oral, IM, IV: Initial: 20 mg/day; increase slowly to desired response.

Dosing: Pediatric

Note: Dose equivalency for patients with normal renal function (approximate): Furosemide 40 mg = bumetanide 1 mg = torsemide 20 mg = ethacrynic acid 50 mg

Edema, heart failure: Infants and Children:

Oral: Initial: 2 mg/kg/dose increased in increments of 1-2 mg/kg/dose with each succeeding dose at intervals of 6-8 hours until a satisfactory response is achieved; maximum dose: 6 mg/kg/dose

IM, IV: Initial: 1 mg/kg/dose; if response not adequate, may increase dose in increments of 1 mg/kg/dose and administer not sooner than 2 hours after previous dose, until a satisfactory response is achieved; may administer maintenance dose at intervals of every 6-12 hours; maximum dose: 6 mg/kg/dose

Hypertension, resistant (off-label; AAP, 2004): Children 1-17 years: Oral: Initial: 0.5-2 mg/kg/dose once or twice daily; maximum dose: 6 mg/kg/dose

Dosing: Renal Impairment

Acute renal failure: Doses up to 1-3 g daily may be necessary to initiate desired response; avoid use in oliguric states.

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

Dosing: Hepatic Impairment

Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis. Monitor effects, particularly with high doses.

Reconstitution

IV infusion solution may be mixed in NS or D5W solution. May also be diluted for infusion to 1-2 mg/mL (maximum: 10 mg/mL).

Administration

IV: IV injections should be given slowly. In adults, undiluted direct IV injections may be administered at a rate of 20-40 mg per minute; maximum rate of administration for short-term intermittent infusion is 4 mg/minute; exceeding this rate increases the risk of ototoxicity. In children, a maximum rate of 0.5 mg/kg/minute has been recommended.

Oral: Administer on an empty stomach (Bard, 2004). May be administered with food or milk if GI distress occurs; however, this may reduce diuretic efficacy.

Note: When IV or oral administration is not possible, the sublingual route may be used. Place 1 tablet under tongue for at least 5 minutes to allow for maximal absorption. Patients should be advised not to swallow during disintegration time (Haegeli, 2007).

Dietary Considerations

May cause potassium loss; potassium supplement or dietary changes may be required.

Compatibility

Stable in D5LR, D5NS, D5W, D10W, D20W, mannitol 20%, LR, NS.

Y-site administration: Incompatible with amsacrine, azithromycin, caffeine citrate, caspofungin, chlorpromazine, ciprofloxacin, diltiazem, droperidol, eptifibatide, esmolol, fenoldopam, filgrastim, fluconazole, gemcitabine, gentamicin, haloperidol, hydralazine, idarubicin, labetalol, levofloxacin, methocarbamol, metoclopramide, midazolam, milrinone, nesiritide, nicardipine, ondansetron, phenylephrine, promethazine, quinidine gluconate, vecuronium, vinblastine, vincristine, vinorelbine.

Compatibility in syringe: Incompatible with caffeine citrate, diphenhydramine, dimenhydrinate, doxapram, doxorubicin HCl, droperidol, meperidine, metoclopramide, milrinone, pantoprazole, protamine, thiamine, vinblastine, vincristine.

Storage

Injection: Store at room temperature of 15°C to 30°C (59°F to 86°F). Protect from light. Exposure to light may cause discoloration; do not use furosemide solutions if they have a yellow color. Furosemide solutions are unstable in acidic media, but very stable in basic media. Refrigeration may result in precipitation or crystallization; however, resolubilization at room temperature or warming may be performed without affecting the drug's stability. Infusion solution is stable for 24 hours at room temperature.

Tablet, solution: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 89°F). Protect from light. Discard opened bottle of solution after 90 days (10 mg/mL concentration only).

Drug Interactions

ACE Inhibitors: Loop Diuretics may enhance the hypotensive effect of ACE Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of ACE Inhibitors. Monitor therapy

Acebrophylline: May enhance the therapeutic effect of Furosemide. Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Aliskiren: May decrease the serum concentration of Furosemide. Monitor therapy

Allopurinol: Loop Diuretics may enhance the adverse/toxic effect of Allopurinol. Loop Diuretics may increase the serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification

Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Analgesics (Opioid): May enhance the adverse/toxic effect of Diuretics. Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Consider therapy modification

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Canagliflozin: May enhance the hypotensive effect of Loop Diuretics. Management: If canagliflozin is combined with a loop diuretic, monitor for symptoms of intravascular volume depletion and hypotension. Canadian product labeling recommends avoiding the combination of canagliflozin and loop diuretics. Consider therapy modification

Cardiac Glycosides: Loop Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Monitor therapy

Cefazedone: May enhance the nephrotoxic effect of Loop Diuretics. Monitor therapy

Cefotiam: Loop Diuretics may enhance the nephrotoxic effect of Cefotiam. Monitor therapy

Ceftizoxime: Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime. Monitor therapy

Cephradine: May enhance the nephrotoxic effect of Loop Diuretics. Monitor therapy

Chloral Hydrate: Furosemide may enhance the adverse/toxic effect of Chloral Hydrate. Avoid combination

CISplatin: Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin. Monitor therapy

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Loop Diuretics. Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Dofetilide: Loop Diuretics may enhance the QTc-prolonging effect of Dofetilide. Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy

Empagliflozin: May enhance the hypotensive effect of Loop Diuretics. Monitor therapy

Ethacrynic Acid: Furosemide may enhance the ototoxic effect of Ethacrynic Acid. Avoid combination

Foscarnet: Loop Diuretics may increase the serum concentration of Foscarnet. Consider therapy modification

Fosphenytoin: May diminish the diuretic effect of Loop Diuretics. Monitor therapy

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Ivabradine: Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine. Monitor therapy

Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy

Levosulpiride: Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride. Avoid combination

Licorice: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

Lithium: Loop Diuretics may decrease the serum concentration of Lithium. Loop Diuretics may increase the serum concentration of Lithium. Monitor therapy

Mecamylamine: Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. Avoid combination

Methotrexate: May diminish the therapeutic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Methotrexate. Methotrexate may increase the serum concentration of Loop Diuretics. Management: Monitor for increased methotrexate and/or loop diuretic levels/toxicity with concomitant use of these agents and monitor for decreased therapeutic effects of loop diuretics. Methotrexate and/or loop diuretic dose reductions may be necessary. Consider therapy modification

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Neuromuscular-Blocking Agents: Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Consider therapy modification

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Phenytoin: May diminish the diuretic effect of Loop Diuretics. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Probenecid: May enhance the adverse/toxic effect of Loop Diuretics. Probenecid may diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Management: Monitor for decreased diuretic effects or increased adverse effects of loop diuretics with concomitant use of probenecid. Bumetanide prescribing information recommends against concomitant use of probenecid. Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

RisperiDONE: Loop Diuretics may enhance the adverse/toxic effect of RisperiDONE. Management: Consider alternative diuretic therapy (e.g., thiazides) to more potent diuretics (e.g., furosemide) in elderly patients receiving risperidone. Patients who require use of more potent diuretic therapy should be closely monitored and adequately hydrated. Consider therapy modification

Salicylates: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates. Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Consider therapy modification

Sucralfate: May decrease the serum concentration of Furosemide. Sucralfate may impair the absorption of furosemide. Management: Avoid concomitant oral administration of furosemide and sucralfate. Separate administration by at least 2 hours. Does not apply to parenterally administered furosemide. Consider therapy modification

Teriflunomide: May increase the serum concentration of OAT3 Substrates. Monitor therapy

Tobramycin (Oral Inhalation): Loop Diuretics may enhance the nephrotoxic effect of Tobramycin (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Tobramycin (Oral Inhalation). Monitor therapy

Topiramate: Loop Diuretics may enhance the hypokalemic effect of Topiramate. Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Adverse Reactions

Frequency not defined.

Cardiovascular: Acute hypotension, chronic aortitis, necrotizing angiitis, orthostatic hypotension, vasculitis

Central nervous system: Dizziness, fever, headache, hepatic encephalopathy, lightheadedness, restlessness, vertigo

Dermatologic: Bullous pemphigoid, cutaneous vasculitis, drug rash with eosinophilia and systemic symptoms (DRESS), erythema multiforme, exanthematous pustulosis (generalized), exfoliative dermatitis, photosensitivity, pruritus, purpura, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Cholesterol and triglycerides increased, glucose tolerance test altered, gout, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, metabolic alkalosis

Gastrointestinal: Anorexia, constipation, cramping, diarrhea, nausea, oral and gastric irritation, pancreatitis, vomiting

Genitourinary: Urinary bladder spasm, urinary frequency

Hematological: Agranulocytosis (rare), anemia, aplastic anemia (rare), eosinophilia, hemolytic anemia, leukopenia, thrombocytopenia

Hepatic: Intrahepatic cholestatic jaundice, ischemic hepatitis, liver enzymes increased

Local: Injection site pain (following IM injection), thrombophlebitis

Neuromuscular & skeletal: Muscle spasm, paresthesia, weakness

Ocular: Blurred vision, xanthopsia

Otic: Hearing impairment (reversible or permanent with rapid IV or IM administration), tinnitus

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

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

ALERT: U.S. Boxed Warning

Fluid/electrolyte loss:

Furosemide is a potent diuretic that, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose and dose schedule must be adjusted to the individual patient's needs.

Warnings/Precautions

Concerns related to adverse effects:

• Fluid/electrolyte loss: [U.S. Boxed Warning]: If given in excessive amounts, furosemide, similar to other loop diuretics, can lead to profound diuresis, resulting in fluid and electrolyte depletion. Close medical supervision and dose evaluation are required. Watch for and correct electrolyte disturbances; adjust dose to avoid dehydration. When electrolyte depletion is present, therapy should not be initiated unless serum electrolytes, especially potassium, are normalized. Risk of hypokalemia may be increased by: rapid diuresis, poor oral potassium intake, cirrhosis, and combined use with large amounts of licorice, corticosteroids, or laxatives (chronic use). In contrast to thiazide diuretics, a loop diuretic can also lower serum calcium concentrations. Electrolyte disturbances can predispose a patient to serious cardiac arrhythmias.

• Hyperuricemia: Asymptomatic hyperuricemia has been reported with use; rarely, gout may precipitate.

• Nephrotoxicity: Monitor fluid status and renal function in an attempt to prevent oliguria, azotemia, and reversible increases in BUN and creatinine; close medical supervision of aggressive diuresis required. May increase risk of radiocontrast-induced nephropathy in high-risk patients.

• Ototoxicity: Rapid IV administration, severe renal impairment, excessive doses, hypoproteinemia, and concurrent use of other ototoxins is associated with ototoxicity.

• Photosensitivity: Photosensitization may occur.

• Sulfonamide (“sulfa”) allergy: The approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Cirrhosis: In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy; correct electrolyte and acid/base imbalances prior to initiation when hepatic coma is present. Supplemental potassium or an aldosterone antagonist, when appropriate, may reduce risk of hypokalemia and metabolic alkalosis. Close monitoring warranted, especially with initiation of therapy.

• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Prostatic hyperplasia/urinary stricture: May cause urinary retention due to increased urine production, especially upon initiation of therapy.

• Systemic lupus erythematosus (SLE): May cause SLE exacerbation or activation.

Concurrent drug therapy issues:

• Antihypertensives: Coadministration of antihypertensives may increase the risk of hypotension; reduction in antihypertensive dosage may be necessary.

• Digoxin: Diuretic-induced hypokalemia may potentiate digoxin-related cardiac toxicity.

Special populations:

• Pediatric: May lead to nephrocalcinosis or nephrolithiasis in premature infants or in children <4 years of age with chronic use. May prevent closure of patent ductus arteriosus in premature infants.

• Surgical patients: If given the morning of surgery, furosemide may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Dosage form specific issues:

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP, 1997; Zar, 2007).

Other warnings and precautions:

• Diuretic resistance: For some patients, despite higher doses of loop diuretic treatment, an adequate diuretic response cannot be attained. Diuretic resistance can usually be overcome by intravenous administration, the use of two diuretics together (eg, furosemide and chlorothiazide), or the use of a diuretic with a positive inotropic agent. When such combinations are used, serum electrolytes need to be monitored even more closely (Cody, 1994; ACC/AHA [Yancy, 2013]; HFSA, 2010).

Monitoring Parameters

Monitor I & O (inpatient setting) and weight daily; blood pressure, orthostasis; serum electrolytes, renal function; monitor hearing with high doses or rapid IV administration

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies. Furosemide crosses the placenta (Riva 1978). Furosemide has been used to treat heart failure in pregnant women (ESC 2011; Johnson-Coyle 2012). Monitor fetal growth if used during pregnancy; may increase birth weight.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience constipation, diarrhea, nausea, vomiting, or headache. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, nausea, or vomiting), signs of high blood sugar (confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit), signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), signs of a pancreas problem (pancreatitis; severe abdominal pain, severe back pain, severe nausea, vomiting), severe dizziness, passing out, burning or numbness feeling, urinary retention, change in amount of urine passed, loss of strength and energy, bruising, bleeding, chills, pharyngitis, tinnitus, or hearing impairment (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Hide