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furosemide

(fur oh' se mide)
Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN)

Pregnancy Category C

Drug class
Loop diuretic

Therapeutic actions
Inhibits the reabsorption of sodium and chloride from the ascending limb of the loop of
Henle, leading to a sodium-rich diuresis.

Indications
• Oral, IV: Edema associated with CHF, cirrhosis, renal disease
• IV: Acute pulmonary edema
• Oral: Hypertension

Contraindications and cautions
• Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in
oral solution); anuria, severe renal failure; hepatic coma; pregnancy; lactation.
• Use cautiously with SLE, gout, diabetes mellitus.

Available forms
Tablets—20, 40, 80 mg; oral solution—10 mg/mL, 40 mg/5 mL; injection—10 mg/mL

Dosages
ADULTS
• Edema: Initially, 20–80 mg/day PO as a single dose. If needed, a second dose
may be given in 6–8 hr. If response is unsatisfactory, dose may be increased in 20-
to 40-mg increments at 6- to 8-hr intervals. Up to 600 mg/day may be given.
Intermittent dosage schedule (2–4 consecutive days/wk) is preferred for
maintenance, or 20–40 mg IM or IV (slow IV injection over 1–2 min). May
increase dose in increments of 20 mg in 2 hr. High-dose therapy should be given
as infusion at rate not exceeding 4 mg/min.
• Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to 80 mg IV
given over 1–2 min if response is unsatisfactory after 1 hr.
• Hypertension: 40 mg bid PO. If needed, additional antihypertensive agents may
be added.
PEDIATRIC PATIENTS
Avoid use in premature infants: stimulates PGE2 synthesis and may increase incidence of
patent ductus arteriosus and complicate respiratory distress syndrome.
• Edema: Initially, 2 mg/kg/day PO. If needed, increase by 1–2 mg/kg in 6–8 hr. Do
not exceed 6 mg/kg. Adjust maintenance dose to lowest effective level.
• Pulmonary edema: 1 mg/kg IV or IM. May increase by 1 mg/kg in 2 hr until the
desired effect is seen. Do not exceed 6 mg/kg.

paresthesias.9% sodium chloride. oral and gastric irritation. lactated Ringer's injection. other NSAIDs • Decreased GI absorption with charcoal .PATIENTS WITH RENAL IMPAIRMENT Up to 4 g/day has been tolerated. volume depletion. erythema multiforme • GI: Nausea. IV bolus injection should not exceed 1 g/day given over 30 min. IM 5 min 30 min 2 hr Metabolism: Hepatic. constipation. Infusion: Inject directly or into tubing of actively running IV. anemia. blurred vision. T1/2: 30–60 min Distribution: Crosses placenta. vomiting. inject slowly over 1–2 min. tinnitus. fatigue. cardiac arrhythmias. thrombocytopenia. pruritus. xanthopsia. enters breast milk Excretion: Urine. purpura. milrinone in 5% dextrose. drowsiness. rash. thrombophlebitis • Dermatologic: Photosensitivity. Isotonic saline. Pharmacokinetics Route Onset Peak Duration Oral 60 min 60–120 min 6–8 hr IV. nocturia. headache. weakness. anorexia. 0. cisplatin • Decreased absorption of furosemide with phenytoin • Decreased natriuretic and antihypertensive effects with indomethacin. Incompatibilities: Do not mix with acidic solutions. feces IV facts Preparation: Store at room temperature. vertigo. glycosuria. Adverse effects • CNS: Dizziness. ibuprofen. irreversible hearing loss • CV: Orthostatic hypotension. exposure to light may slightly discolor solution. netilimicin. precipitates form with gentamicin. diarrhea. and 5% dextrose injection may be used after pH has been adjusted (if necessary). fluid and electrolyte imbalances • Other: Muscle cramps and muscle spasms Interactions Drug-drug • Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance) • Increased risk of ototoxicity with aminoglycoside antibiotics. urticaria. urinary bladder spasm • Hematologic: Leukopenia. jaundice • GU: Polyuria. exfoliative dermatitis. acute pancreatitis.

hazardous activities. sensitivity to sunlight (use sunglasses. bowel sounds. blood sugar. SLE. • Refrigerate oral solution. adventitious sounds. • Give early in the day so that increased urination will not disturb sleep. liver function.5. and record the weight on your calendar. lesions. orthostatic BP. do not use discolored drug or solutions. Assessment • History: Allergy to furosemide. hearing. increased thirst (suck on sugarless lozenges. • These side effects may occur: Increased volume and frequency of urination. sulfonamides. . reflexes. liver evaluation. severe renal failure. loss of body potassium (a potassium-rich diet or potassium supplement will be needed). or use a sunscreen). use frequent mouth care). • Weigh yourself on a regular basis. pregnancy • Physical: Skin color. CBC. • Arrange for potassium-rich diet or supplemental potassium as needed. feeling faint on arising. use extreme caution. orientation. • May reduce effect of insulin or oral antidiabetic agents because blood glucose levels can become elevated Nursing considerations CLINICAL ALERT! Name confusion has occurred between furosemide and torsemide. wear protective clothing. When possible. perfusion. liver and renal function tests. • Reduce dosage if given with other antihypertensives. serum electrolytes (including calcium). • Do not expose to light. Teaching points • Record intermittent therapy on a calendar or dated envelopes. uric acid. BP. and consumption of alcohol). may discolor tablets or solution. lactation. tartrazine. baseline ECG. take the drug early so increased urination will not disturb sleep. edema. drowsiness (avoid rapid position changes. electrolyte depletion anuria. R. readjust dosage gradually as BP responds. Take with food or meals to prevent GI upset. • Measure and record weight to monitor fluid changes. • Discard diluted solution after 24 hr. pulses. • Avoid IV use if oral use is at all possible. • Arrange to monitor serum electrolytes. hydration. • Do not mix parenteral solution with highly acidic solutions with pH below 3. dizziness. pattern. like driving. urinary output patterns. urinalysis. gout. at the same time and in the same clothing. diabetes mellitus. weight Interventions • Administer with food or milk to prevent GI upset. hepatic coma.

Adverse effects in Italic are most common. those in Bold are life-threatening. • Report loss or gain of more than 3 lb in 1 day. trembling. unusual bleeding or bruising. numbness. muscle weakness or cramps. swelling in your ankles or fingers. fatigue. dizziness. .