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Furosemide Pregnancy and Breastfeeding Warnings

Furosemide is also known as: Diaqua-2, Lasix, Lo-Aqua

Furosemide Pregnancy Warnings

Furosemide crosses the human placenta, with some data showing equivalent umbilical cord serum and maternal serum furosemide concentrations. The fetus may experience pharmacologic effects of furosemide, including increased urine output and increased urinary sodium. Most experts do not recommend furosemide for the routine treatment of edema or hypertension during pregnancy because, as a potent diuretic agent, furosemide can induce maternal hypovolemia and decreased placental perfusion pressure. In addition, the use of diuretics for these conditions has not been shown to improve clinical outcome. Some experts suggest that the only conditions during pregnancy where furosemide might be indicated are pulmonary edema, severe hypertension, or congestive heart failure. One study has shown that furosemide promotes patent ductus arteriosus in premature infants with respiratory distress syndrome. Data from the Michigan Medicaid Birth Defects Study (MMBDS) has revealed an association between the use of furosemide and congenital abnormalities (written communication, Franz Rosa, MD, Food and Drug Administration, 1994). The MMBDS is a retrospective study of 229,101 completed pregnancies between 1985 and 1992, of which 350 were exposed to furosemide at some time during the first trimester, and 758 were exposed to the drug at any time during pregnancy. Of the 350 pregnancies that were exposed to furosemide, 18 total birth defects were observed (15 were expected). There were 3 cases of hypospadias (1 was expected). The observed instances of cardiovascular defects, cleft palate, polydactyly, and limb reduction did not attain statistical significance. These data are consistent with an association between furosemide and birth defects, although other factors, including any underlying disease(s) of the mothers, are not accounted for.

Furosemide has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of fetolethality as well as maternal death at high human doses. Treatment during pregnancy requires monitoring of fetal growth because of the potential for higher birth weights. In addition, some animal studies demonstrate an increased incidence of hydronephrosis (distention of the renal pelvis and, in some cases, of the ureters). There are no controlled data in human pregnancy. Furosemide should only be given during pregnancy when benefit outweighs risk.

Furosemide Breastfeeding Warnings

Furosemide is excreted into human milk and may inhibit lactation. There are no reports of adverse effects in nursing infants. The manufacturer recommends that caution be used when administering furosemide to nursing women.

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