MIMS, 2016

z
FUROSEMIDE
z
DOSAGE

Adult

 PO Oedema associated w/ heart failure Initial: 40 mg/day, may reduce to

20 mg/day or 40 mg on alternate days. In some cases, 80 mg or more daily
in divided doses.

 PO HTN 40-80 mg/day, alone or in combination w/ other antihypertensives.

 IM/IV Oedema associated w/ heart failure 20-50 mg via IM or slow IV inj

may increase by increments of 20 mg 2 hrly. Doses >50 mg must be given
via slow IV infusion. Max: 1,500 mg/day.

 IV Acute pulmonary oedema 40 mg via slow inj over 1-2 min. If no

adequate response w/in 1 hr, may increase to 80 mg via inj over 1-2 min.
z
DOSAGE (2)

Adult

 IM/IV Oedema associated w/ heart failure 20-50 mg via IM or

slow IV inj may increase by increments of 20 mg 2 hrly. Doses
>50 mg must be given via slow IV infusion. Max: 1,500 mg/day.

 IV Acute pulmonary oedema 40 mg via slow inj over 1-2 min. If

no adequate response w/in 1 hr, may increase to 80 mg via inj
over 1-2 min.
z
DOSAGE DETAILS

Intravenous
Acute pulmonary oedema

 Adult: 40 mg via slow inj over 1-2 min. If no adequate response

w/in 1 hr, may increase to 80 mg via inj over 1-2 min.

Oral
Oedema associated with heart failure

 Adult: Initially, 40 mg daily, may reduce to 20 mg daily or 40 mg on

alternate days. In some cases, 80 mg or more daily in divided
doses may be required.
Elderly: Initially, 20 mg and titrate upward if needed.
z
DOSAGE DETAILS (2)

Oral
Hypertension

 Adult: 40-80 mg daily, alone or in combination w/ other

antihypertensives.

Parenteral
Oedema associated with heart failure

 Adult: 20-50 mg via IM or slow IV inj, may increase by increments

of 20 mg 2 hrly. Doses >50 mg must be given via slow IV infusion.
Max: 1,500 mg daily.
Child: 0.5-1.5 mg/kg daily. Max: 20 mg daily.
z
ADMINISTRATION

 Oral Solution: May be taken with or without food. May be taken

w/o meals for better absorption. May be taken w/ meals to
reduce GI discomfort.
z
CONTRAINDICATIONS

 Hypersensitivity to furosemide and sulfonamides.

 Anuria or renal failure

 Addison's disease

 Hypovolaemia or dehydration

 Precomatose state associated w/ liver cirrhosis.

z
SPECIAL PRECAUTION

 Patient w/ prediabetes or DM, hepatic cirrhosis, gout, impaired

micturition, at risk from a pronounced fall in BP.

 Risk of ototoxicity w/ rapid inj.

 Renal and hepatic impairment.

 Elderly, children.

 Pregnancy and lactation.

z
ADVERSE DRUG REACTIONS

 Hyponatraemia, hypochloraemic alkalosis, hypokalaemia,

headache, drowsiness, muscle cramps, hypotension, dry mouth,
thirst, weakness, lethargy, restlessness, oliguria, GI
disturbances, hypovolaemia, dehydration, hyperuricaemia, acute
generalised exanthematous pustulosis, drug rash w/
eosinophilia and systemic symptoms, reversible or irreversible
hearing impairment, deafness, tinnitus, severe anaphylactic or
anaphylactoid reactions (e.g. w/ shock), Stevens-Johnson
syndrome, toxic epidermal necrolysis; increased liver enzyme,
cholesterol and triglyceride serum levels.
Potentially Fatal: Serious cardiac arrhythmias.
z
PEGNANCY CATEGORY (US FDA)

 Routes: Parenteral/PO

 Category C: Either studies in animals have revealed adverse

effects on the foetus (teratogenic or embryocidal or other) and
there are no controlled studies in women or studies in women
and animals are not available. Drugs should be given only if the
potential benefit justifies the potential risk to the foetus.
z
MONITORING PARAMETERS

 Monitor BP, serum electrolytes, renal function, orthostasis,

hearing (on high doses or rapid IV admin).
z
OVERDOSAGE

 Symptoms: Dehydration, electrolyte disturbances, hypotension

and cardiac toxicity, hypochloremic alkalosis, hypokalaemia,
blood volume reduction.

 Management: Symptomatic and supportive treatment.

Replacement of excessive fluid and electrolyte losses. Ensure
adequate drainage in patients w/ urinary bladder outlet
obstruction (e.g. prostatic hypertrophy). Treat hypotension w/
appropriate IV fluids.
z
DRUG INTERACTION

 May increase nephrotoxicity of cephalosporins (e.g. cefalotin),

NSAIDs.

 May increase ototoxicity of aminoglycoside, ethacrynic acid,

other ototoxic drugs.

 Reduced serum level w/ aliskiren.

 May increase hypotensive effect of ACE inhibitors or angiotensin

II receptor antagonists.

 Increased risk of hyperkalaemia w/ K-sparing diuretics.

z
DRUG INTERACTIONS (2)

 Increased risk of cardiotoxicity w/ cardiac glycosides,

antihistamines. May reduce serum level of lithium.

 May antagonise hypoglycaemic effect of antidiabetics.

 Increased hypotensive effect w/ MAOIs. Increased

hyponatraemia w/ carbamazepine.

 Reduced natriuretic and hypotensive effect w/ indometacin.

Diminished diuretic effect w/ salicylates
z
MECHANISM OF ACTION

 Furosemide inhibits reabsorption of Na and Cl mainly in the

medullary portion of the ascending loop of Henle. Excretion of K
and ammonia is also increased while uric acid excretion is
reduced. It increases plasma-renin activity, plasma-
norepinephrine and plasma-arginine-vasopressin
concentrations.

 Onset: Diuresis: 30-60 min (oral); 30 min (IM); approx 5 min

(IV). Oedema: W/in 15-20 min prior to diuretic effect.

 Duration: 6-8 hr (oral); 2 hr (IV).

z
PHARMACOKINETICS

 Absorption: Fairly rapidly absorbed from the GI tract.

Bioavailability: Approx 60-70%.

 Distribution: Crosses the placenta; enters breast milk. Plasma

protein binding: Up to 99% (mainly albumin).

 Metabolism: Undergoes minimal hepatic metabolism.

 Excretion: Mainly via urine (as unchanged drug). Half-life: Up to

approx 2 hr.
z
THANKY YOU 
FOR YOUR PATIENT ATTENTION.