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FUROSEMIDE TABLETS B.P. 40MG
Active substance(s): FUROSEMIDE
NAME OF THE MEDICINAL PRODUCT
Furosemide Tablets BP 40mg
QUALITATIVE AND QUANTITATIVE COMPOSITION
Furosemide BP 40mg
Uncoated tablets for oral administration
The treatment of oedema associated with congestive heart failure, cirrhosis of
the liver, renal disease including nephrotic syndrome.
The treatment of peripheral oedema due to mild to moderate hypertension
(alone or in combination with other antihypertensive agents in the treatment of
more severe cases).
Management of oliguria due to acute or chronic renal insufficiency.
Posology and method of administration
Route of Administration:
The usual initial adult dose is 40mg daily, reduced to 20mg daily or 40mg on
alternative days. In some patients daily doses of 80mg or higher (given in
divided doses) may be required. In patients with chronic renal insufficiency,
an initial daily dose of 250mg is employed. If a satisfactory diuresis is not
produced then the dose may be increased in steps of 250mg at four to six
hourly intervals up to a maximum daily dose of 1500mg in 24 hours. In
exceptional cases up to 2000mg in 24 hours may be given.
The usual dose is 1 to 3mg/kg body weight daily, up to a maximum total dose
The usual adult dose but caution is advised as Furosemide is excreted more
slowly in the elderly.
Furosemide is contraindicated in the presence of anuria, electrolyte
deficiency, precoma associated with hepatic cirrhosis, digitalis
intoxication, porphyria and hypersensitivity to Furosemide or
Special warnings and precautions for use
Where indicated, steps should be taken to correct hypotension or
hypovolaemia before commencing therapy.
Regular monitoring of fluid and electrolyte balance is recommended.
Use with caution in patients with impaired hepatic or renal function, diabetes
mellitus or adrenal disease.
Use with care in the elderly patients or those with prostatic hypertrophy or
impairment of micturition.
Latent diabetes may become manifest or the insulin requirements of diabetic
patients may increase.
Hypotension may occur if ACE inhibitors are added to Furosemide therapy.
The dose of Furosemide should be reduced or the drug stopped before
initiating the ACE inhibitor.
Use with caution in patients with a history of gout.
Discontinue Furosemide if bone morrow suppression occurs.
Interaction with other medicinal products and other forms of interaction
Furosemide may enhance the toxicity of cardiac glycosides by electrolyte
disturbance particularly potassium and magnesium.
The action of antihypertensive agents such as methyldopa may be enhanced by
Furosemide. The nephrotoxic effect of Cephaloridine and the Aminoglycoside
antibiotics may be increased by Furosemide.
The action of diuretics such as Furosemide may be antagonised by certain
non-steroidal anti-inflammatory agents.
The renal clearance of lithium is decreased by Furosemide, resulting in
increased and possibly toxic serum levels. Concomitant administration should
be avoided unless plasma levels can be monitored.
Concurrent administration of glucocorticoids may cause sodium retention and
exacerbate potassium loss.
Furosemide decreases the effects of some drugs (e.g. antidiabetics and pressor
amines) and may potentiate the effects of others (e.g. salicylates, theophylline
and curare type muscle relaxants).
Resultant hypokalaemia may potentiate the cardiac toxicity of certain drugs
such as antihistamines and antiarrhythmics. It may also antagonise the action
of antiarrhythmics such as lignocaine, mexiletine and tocainide.
Fertility, Pregnancy and lactation
Furosemide has been given after the first trimester of pregnancy or
oedema, hypertension and toxaemia of pregnancy without causing foetal
or new-born adverse effects. However, it should only be given during
pregnancy if strictly indicated and for short-term treatment.
As it may inhibit lactation and passes into breast milk, Furosemide
should be used with caution in nursing mothers.
Effects on ability to drive and use machines
Reduced mental alertness and rarely dizziness and blurred vision have
been reported. Patients so affected should not drive or operate
Fluid and electrolyte imbalance is the most common side effect.
Uncommonly, nausea, diarrhoea, blurred vision, dizziness, headache,
pancreatitis, photosensitivity, vasculitis and interstitial nephritis have
occurred very rarely. The incidence of allergic reactions such as skin
rashes is very low, but when these occur treatment should be withdrawn.
A transient rise in creatinine may occur as may hypotension and liver
dysfunction. Muscle spasm and paraesthesia have also been reported.
Temporary increase in plasma cholesterol and triglyceride
concentrations may occur. Latent diabetes may become manifest and the
insulin requirements of diabetic patients may increase. Bone marrow
depression is a rare complication and treatment should be withdrawn.
The haemopoeitic status should therefore be regularly monitored.
Calcium depletion may occur and nephrocalcinosis has been reported in
premature infants. Tinnitus and deafness have occurred, usually with
large parenteral doses and rapid administration and in renal impairment.
Treatment of overdose should be directed to correcting dehydration and
electrolyte depletion resulting from excessive diuresis. Gastric lavage
may be useful if ingestion is recent.
Furosemide is a potent diuretic with rapid action. It primary site of action is in
the ascending loop of henle where it inhibits electrolyte reabsorption, thus
enhancing the excretion of water and sodium, potassium and chloride ions.
Furosemide is rapidly absorbed from the GI Tract. Bioavailability has
been reported to be about 60 - 70%. It has a biphasic half-life in plasma
with a terminal elimination phase up to about 2 hours but this is
prolonged in neonates, and in patients with hepatic and renal
insufficiency. About 99% is bound to plasma proteins. It is excreted
mainly in the urine, largely unchanged. Furosemide crosses the
placental barrier and is excreted in milk. The clearance of Furosemide is
not increased by haemodialysis.
Preclinical safety data
There is no pre-clinical data of relevance to a prescriber which is additional to
that already included in other sections of the SPC.
List of excipients
Special precautions for storage
Store in a cool dry place, below 20ºC. Protect from light.
Nature and contents of container
The product is available in packs of 500 and 1000 tablets in Securitainers. The
container is made up of High Density Polypropylene body and Low Density
Polyethylene cap. Packs of 20 and 50 tablets are available in Pharmapac
plastic bottles with Clic-Loc caps.
The product is also available in blister packs of 28, 56, 84 or 980 tablets.
Blister Pack Specification:
- PVC (white, rigid, opaque): 250 microns
- Aluminium foil (hard tempered): 20 microns
- Primer (nitrocellulose): 1.5 – 2.5 gsm
- Heat seal lacquer: 6.5 – 8.5 gsm
Special precautions for disposal
No special handling instructions are necessary.
MARKETING AUTHORISATION HOLDER
Strides Pharma Limited
Themistokli Dervi 3
MARKETING AUTHORISATION NUMBER(S)
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT