Furosemide - Drug Information

17/9/2015 Furosemide:
Drug information
Official reprint from UpToDate®
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Furosemide: Drug information
Copyright 19782015 Lexicomp, Inc. All rights reserved.
(For additional information see "Furosemide: Patient drug information" and see "Furosemide: Pediatric drug
information")
For abbreviations and symbols that may be used in Lexicomp (show table)
ALERT: US 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.
Brand Names: US Lasix
Brand Names: Canada ApoFurosemide; AVAFurosemide; BioFurosemide; DomFurosemide;
Furosemide Injection Sandoz Standard; Furosemide Injection, USP; Furosemide Special; Furosemide Special
Injection; Lasix; Lasix Special; NovoSemide; NTPFurosemide; NuFurosemide; PMSFurosemide; Teva
Furosemide
Pharmacologic Category Antihypertensive; Diuretic, Loop
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: 2080 mg/dose; if response is not adequate, may repeat the same dose or increase dose in
increments of 2040 mg/dose at intervals of 68 hours; may be titrated up to 600 daily with severe
edematous states; usual maintenance dose interval is once or twice daily. ACCF/AHA 2013 heart
failure guidelines recommend initial dosing of 2040 mg once or twice daily and a maximum total daily
dose of 600 mg (Yancy, 2013). Note: Dosing frequency may be adjusted based on patientspecific
diuretic needs.
IM, IV: Initial: 2040 mg/dose; if response is not adequate, may repeat the same dose or increase dose in
increments of 20 mg/dose and administer 12 hours after previous dose (maximum dose: 200
mg/dose). 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 12 minutes, followed by continuous IV infusion rate of 1040 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 80160 mg/hour (Howard, 2001; Schuller, 1997). The risk
associated with higher infusion rates (80160 mg/hour) must be weighed against alternative strategies.
Acute pulmonary edema: IV: 40 mg over 12 minutes. If response not adequate within 1 hour, may increase
dose to 80 mg. Note: Minimal additional response is gained by single doses over 160200 mg; maximum
dose: 200 mg (Brater, 1998).
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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: Pediatric
(For additional information see "Furosemide: Pediatric drug information")
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 12 mg/kg/dose with each succeeding dose at
intervals of 68 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 612 hours; maximum dose: 6 mg/kg/dose
Hypertension, resistant (offlabel; AAP, 2004): Children 117 years: Oral: Initial: 0.52 mg/kg/dose once or
twice daily; maximum dose: 6 mg/kg/dose
Dosing: Geriatric Oral, IM, IV: Initial: 20 mg/day; increase slowly to desired response.
Dosing: Renal Impairment
Acute renal failure: Doses up to 13 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.
Dosage Forms: US 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
Dosage Forms: Canada Excipient information presented when available (limited, particularly for
generics); consult specific product labeling.
Injection, solution [preservative free]:
Furosemide Special Injection: 10 mg/mL (25 mL)
Tablet, oral:
Lasix Special: 500 mg [scored]
Generic Equivalent Available: US Yes
Administration
IV: IV injections should be given slowly. In adults, undiluted direct IV injections may be administered at a rate
of 2040 mg per minute; maximum rate of administration for shortterm 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).
Usual Infusion Concentrations: Adult IV infusion: 1 mg/mL or 2 mg/mL or undiluted as 10
mg/mL
Usual Infusion Concentrations: Pediatric IV infusion: 1 mg/mL or 2 mg/mL or undiluted as 10
mg/mL
Compatibility Stable in D5LR, D5NS, D5W, D10W, D20W, mannitol 20%, LR, NS.
Ysite administration:
Compatible: Allopurinol, alprostadil, amifostine, amphotericin B cholesteryl sulfate complex,

anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, calcium gluconate, cefepime,
ceftazidime, cefuroxime, cisplatin, cladribine, cyclophosphamide, cytarabine, dexmedetomidine,
docetaxel, doripenem, doxorubicin liposome, epinephrine, etoposide phosphate, fentanyl, fludarabine,
fluorouracil, foscarnet, gallium nitrate, granisetron, heparin, hetastarch in lactated electrolyte
(Hextend®), hydrocortisone sodium succinate, hydromorphone, indomethacin, insulin (regular),
leucovorin calcium, linezolid, lorazepam, magnesium sulfate, melphalan, meropenem, methotrexate,
micafungin, mitomycin, nitroprusside, norepinephrine, oxaliplatin, paclitaxel, piperacillin/tazobactam,
potassium chloride, procainamide, propofol, ranitidine, remifentanil, sargramostim, sodium
bicarbonate, tacrolimus, teniposide, thiopental, thiotepa, tirofiban, tobramycin.
Incompatible: 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, telavancin, vecuronium, vinblastine, vincristine, vinorelbine.
Variable (consult detailed reference): Amikacin, amiodarone, cisatracurium, dobutamine, dopamine,
doxorubicin HCl, drotrecogin alfa, famotidine, kanamycin, meperidine, metoprolol, morphine,
nitroglycerin, pantoprazole, vasopressin, vitamin B complex with C.
Compatibility in syringe:
Compatible: Bleomycin, cisplatin, cyclophosphamide, dexamethasone sodium phosphate, fluorouracil,

heparin, leucovorin calcium, methotrexate, mitomycin.
Incompatible: Caffeine citrate, diphenhydramine, dimenhydrinate, doxapram, doxorubicin HCl, droperidol,
meperidine, metoclopramide, milrinone, pantoprazole, protamine, thiamine, vinblastine, vincristine.
Use
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
Medication Safety Issues
Soundalike/lookalike issues:
Furosemide may be confused with famotidine, finasteride, fluconazole, FLUoxetine, fosinopril, loperamide,
torsemide
Lasix may be confused with Lanoxin, Lidex, Lomotil, Lovenox, Luvox, Luxiq
International issues:
Lasix [U.S., Canada, and multiple international markets] may be confused with Esidrex brand name for
hydrochlorothiazide [multiple international markets]; Esidrix brand name for hydrochlorothiazide
[Germany]; Losec brand name for omeprazole [multiple international markets]
Urex [Australia, Hong Kong, Turkey] may be confused with Eurax brand name for crotamiton [U.S.,
Canada, and multiple international markets]
Adverse Reactions Significant 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, StevensJohnson 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
Contraindications Hypersensitivity to furosemide or any component of the formulation; anuria
Canadian labeling: Additional contraindications (not in U.S. labeling): Hypersensitivity to sulfonamidederived
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; breastfeeding. 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
sulfonamidecontaining drug classes, the scientific basis of this statement has been challenged. See
“Warnings/Precautions” for more detail.
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 radiocontrastinduced nephropathy in highrisk patients.
• Ototoxicity: Rapid IV administration, 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 crossreactivity between members of a specific class (eg,
two antibiotic sulfonamides). However, concerns for crossreactivity have previously extended to all
compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic
mechanisms indicates crossreactivity 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 crossreaction due to
antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. Tcell
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 (StevensJohnson syndrome/TEN), some clinicians choose to avoid exposure to these
classes.
Diseaserelated 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.
• 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: Diureticinduced hypokalemia may potentiate digoxinrelated 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).
Metabolism/Transport Effects Substrate of OAT3
Drug Interactions
(For additional information: Launch LexiInteract™ Drug Interactions Program)
ACE Inhibitors: Loop Diuretics may enhance the hypotensive effect of ACE Inhibitors. Loop Diuretics may
enhance the nephrotoxic effect of ACE Inhibitors. Risk C: Monitor therapy
Alfuzosin: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Aliskiren: May decrease the serum concentration of Furosemide. Risk C: 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. Risk C: Monitor therapy
Amifostine: Antihypertensives may enhance the hypotensive effect of Amifostine. Management: When
amifostine is used at chemotherapy doses, antihypertensive medications should be withheld for 24 hours
prior to amifostine administration. If antihypertensive therapy can not be withheld, amifostine should not be
administered. Risk D: Consider therapy modification
Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically,
nephrotoxicity and ototoxicity. Risk C: Monitor therapy
Analgesics (Opioid): May enhance the adverse/toxic effect of Diuretics. Risk C: Monitor therapy
Antidiabetic Agents: HyperglycemiaAssociated Agents may diminish the therapeutic effect of Antidiabetic
Agents. Risk C: Monitor therapy
Antihypertensives: May enhance the hypotensive effect of other Antihypertensives. Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Hypotensive Agents. Risk C: Monitor therapy
Beta2Agonists: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Risk D: Consider therapy modification
Brimonidine (Topical): May enhance the antihypertensive effect of Antihypertensives. Risk C: 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. Risk D:
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. Risk C: Monitor therapy
Chloral Hydrate: Furosemide may enhance the adverse/toxic effect of Chloral Hydrate. Risk X: Avoid
combination
CISplatin: Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the
ototoxic effect of CISplatin. Risk C: Monitor therapy
Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor
therapy
Corticosteroids (Systemic): May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Loop Diuretics. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Dofetilide: Loop Diuretics may enhance the QTcprolonging effect of Dofetilide. Risk C: Monitor therapy
DULoxetine: Hypotensive Agents may enhance the orthostatic hypotensive effect of DULoxetine. Risk C:
Monitor therapy
Ethacrynic Acid: Furosemide may enhance the ototoxic effect of Ethacrynic Acid. Risk X: Avoid combination
Foscarnet: Loop Diuretics may increase the serum concentration of Foscarnet. Risk D: Consider therapy
modification
Fosphenytoin: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy
Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensives. Risk C:
Monitor therapy
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor
therapy
Hypotensive Agents: May enhance the adverse/toxic effect of other Hypotensive Agents. Risk C: Monitor
therapy
Ivabradine: Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy
Levodopa: Hypotensive Agents may enhance the orthostatic hypotensive effect of Levodopa. Risk C: Monitor
therapy
Levosulpiride: Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride. Risk X: Avoid
combination
Licorice: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Lithium: Loop Diuretics may decrease the serum concentration of Lithium. Loop Diuretics may increase the
serum concentration of Lithium. Risk C: Monitor therapy
MAO Inhibitors: May enhance the orthostatic hypotensive effect of Orthostatic Hypotension Producing Agents.
Exceptions: Linezolid; Tedizolid. Risk C: Monitor therapy
MAO Inhibitors: May enhance the hypotensive effect of Antihypertensives. MAO Inhibitors may enhance the
orthostatic hypotensive effect of Antihypertensives. Exceptions: Linezolid; Tedizolid. Risk C: Monitor
therapy
Mecamylamine: Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. Risk X: 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. Risk D: Consider therapy modification
Methylphenidate: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
NeuromuscularBlocking Agents: Loop Diuretics may diminish the neuromuscularblocking effect of
NeuromuscularBlocking Agents. Loop Diuretics may enhance the neuromuscularblocking effect of
NeuromuscularBlocking Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Hypotensive Agents. Risk C: Monitor therapy
Nonsteroidal AntiInflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Management:
Monitor for decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider
avoiding concomitant use of these agents in CHF or cirrhosis with ascites. Concomitant use of
bumetanide with indomethacin is not recommended. Risk D: Consider therapy modification
Obinutuzumab: Antihypertensives may enhance the hypotensive effect of Obinutuzumab. Management:
Consider temporarily withholding antihypertensive medications beginning 12 hours prior to obinutuzumab
infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Phenytoin: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the antihypertensive effect of Antihypertensives. Risk C: 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. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Antihypertensives. Risk C: 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. Risk D: Consider therapy modification
RiTUXimab: Antihypertensives may enhance the hypotensive effect of RiTUXimab. Risk D: Consider therapy
modification
Salicylates: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum
concentration of Salicylates. Risk C: 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.
Risk D: 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. Risk D:
Consider therapy modification
Teriflunomide: May increase the serum concentration of OAT3 Substrates. Risk C: Monitor therapy
Topiramate: Loop Diuretics may enhance the hypokalemic effect of Topiramate. Risk C: Monitor therapy
Yohimbine: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Food Interactions Furosemide serum levels may be decreased if taken with food. Management:
Administer on an empty stomach.
Pregnancy Risk Factor C (show table)
Pregnancy Implications 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; JohnsonCoyle 2012). Monitor fetal growth if used during pregnancy; may increase birth
weight.
BreastFeeding Considerations Furosemide is excreted into breast milk; maternal use may
suppress lactation. The U.S. manufacturer recommends that caution be used if administered to a nursing
woman. Canadian labeling contraindicates use while breastfeeding.
Dietary Considerations May cause potassium loss; potassium supplement or dietary changes may
be required.
Pricing: US
Solution (Furosemide Injection)
10 mg/mL (4 mL): $3.44
Solution (Furosemide Oral)
8 mg/mL (5 mL): $1.78
10 mg/mL (60 mL): $10.40
Tablets (Furosemide Oral)
20 mg (100): $14.30
40 mg (100): $16.79
80 mg (100): $43.70
Tablets (Lasix Oral)
20 mg (100): $65.05
40 mg (100): $91.16
80 mg (50): $73.70
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of
the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes
only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing
functions. Pricing data is updated monthly.
Monitoring Parameters Monitor weight and I & O daily; blood pressure, orthostasis; serum
electrolytes, renal function; monitor hearing with high doses or rapid IV administration
International Brand Names A Xi Ya (CN); ABasedock (JP); Accent (JP); Ai Ge (CN); Akoset (MY);
Anfuramide (JP); Aquarid (ZA); Aquasin (ZW); Arasemide (JP); Bondiur (CR, DO, GT, HN, NI, PA, SV); Dailix
(KR); Daiteren F (JP); Depix (JP); Desal (PL); Dirine (MY); Disemide (TW); Diural (DK, NO, SE); Diuren (ZW);
Diuresal (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR,
MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW); Diurin (NZ); Diusemide
(BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM,
ZW); Diuvar (ID); Dryptal (IE); Edemid (HR); Errolon (AR); Femide 500 (TH); Foliront (JP); Fretic (PH);
Frusedan (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ,
UG, ZA, ZM, ZW); Frusid (AU, HK, NZ); Fruside (ZW); Fulsix (JP); Fuluvamide (JP); Furanthril (CZ); Furanturil
(BG); Furetic (TH); Furide (TW); Furix (NO, SE); FuroPuren (DE); Furomen (FI); Furomex (CZ); Furomin (FI);
Furon (HU); Furorese (DE, LU); Furose (PH); Furosedon (JP); Furosemid (HR, HU); Furosemid Pharmavit
(HU); Furosemidratiopharm (LU); FurosemideEurogenerics (LU); Furosemix (LU); Furosetic (LB); Furosix
(BR); Furovenir (IL); Fursemid (HR); Fursemid[inj.] (HR); Furusemide (JP); Fuseride (TH); Fusid (DE, IL);
Fusimex (PH); Glosix (ID); Impugan (DK, ID, SE); Indiurex (PH); Jufurix (DE); Katlex (JP); Kutrix (JP); Lasilix
(FR, MA, MT); Lasix (AE, AT, AU, BB, BE, BF, BH, BJ, BM, BR, BS, BZ, CH, CI, CL, CO, CR, CY, CZ,
DE, DK, DO, EC, EG, ET, FI, GB, GH, GM, GN, GR, GT, GY, HK, HN, HR, ID, IE, IN, IQ, IR, IT, JM, JO,
KE, KR, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, NI, NL, NO, NZ, OM, PA, PE, PH,
PK, PR, PT, PY, QA, RU, SA, SC, SD, SE, SG, SI, SL, SN, SR, SV, SY, TH, TN, TR, TT, TW, TZ, UG,
UY, VE, VN, YE, ZM, ZW); Lasix Retard (DK, EE, IS, LT, NO, PT, SE); Lasix[inj.] (HR); Laveric (ID);
Lowpston (JP); Luseck (JP); Maoread (JP); Naclex (ID); Nadis (TW); Nephron (AR); Odemase (DE); Odemex
(CR, DO, GT, HN, NI, PA, SV); Oedemex (AE, BH, CH, CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY,
YE); Pharmix (PH); Promedes (JP); Radisemide (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO,
KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE,
ZM, ZW); Radouna (JP); Rasitol (MY, PH, SG, TW); Releef (TZ); Retep (AR); Rosemide (PH); Rosis (TW);
Salinex (IN); Salurex (MT); Salurin (AE, KW, SA); Seguril (ES); Silax (ID); Solax (PY); Synephron (JP); Trofurit
(HU); Uremide (AU, NZ); Uresix (ID); Urex (AU, HK, JP); Urex Forte (HK); UrexM (AU); Urimeg (PY); Urinal
(BH, JO); Usix (VN)
Mechanism of Action Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and
distal renal tubule, interfering with the chloridebinding cotransport system, thus causing increased excretion of
water, sodium, chloride, magnesium, and calcium
Pharmacodynamics and Pharmacokinetics
Onset of action: Diuresis: Oral, S.L: 3060 minutes; IM: 30 minutes; IV: ~5 minutes
http://www.uptodate.com/contents/furosemidedruginformation?topicKey=DRUG_GEN%2F8482&elapsedTimeMs=0&source=search_result&searchT… 10/12
Symptomatic improvement with acute pulmonary edema: Within 1520 minutes; occurs prior to diuretic
effect
Peak effect: Oral, S.L.: 12 hours
Duration: Oral, S.L.: 68 hours; IV: 2 hours
Protein binding: 91% to 99%; primarily to albumin
Metabolism: Minimally hepatic
Bioavailability: Oral tablet: 47% to 64%; Oral solution: 50%; S.L. administration of oral tablet: ~60%; results of
a small comparative study (n=11) showed bioavailability of S.L. administration of tablet was ~12% higher
than oral administration of tablet (Haegeli, 2007)
Halflife elimination: Normal renal function: 0.52 hours; Endstage renal disease: 9 hours
Excretion: Urine (Oral: 50%, IV: 80%) within 24 hours; feces (as unchanged drug); nonrenal clearance
prolonged in renal impairment
Use of UpToDate is subject to the Subscription and License Agreement.
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17/9/2015 Furosemide:

Compatible: Allopurinol, alprostadil, amifostine, amphotericin B cholesteryl sulfate complex,

Incompatible: Amsacrine, azithromycin, caffeine citrate, caspofungin, chlorpromazine, ciprofloxacin,

Compatible: Bleomycin, cisplatin, cyclophosphamide, dexamethasone sodium phosphate, fluorouracil,

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