Furosemide

DEA Class; Rx

Common Brand Names; Lasix, Furoscix

Oral and parenteral loop diuretic
Used for the management of edema associated with congestive heart failure, cirrhosis, and renal disease, pulmonary edema, and hypertension
Available as a subcutaneous on-body Infusor for treatment of congestion due to fluid overload in NYHA Class II or III chronic heart failure

Indicated for the treatment of peripheral edema or edema associated with heart failure, chronic lung disease (CLD), or nephrotic syndrome.

Documented hypersensitivity to furosemide or sulfonamides

Anuria

• Hyperuricemia (40%)
• Hypokalemia (14-60%)
• Anaphylaxis
• Anemia
• Anorexia
• Diarrhea
• Dizziness
• Glucose intolerance
• Glycosuria
• Headache
• Hearing impairment
• Hyperuricemia
• Hypocalcemia
• Hypokalemia
• Hypomagnesemia
• Hypotension
• Increased patent ductus arteriosus during neonatal period
• Muscle cramps
• Nausea
• Photosensitivity
• Rash
• Restlessness
• Tinnitus
• Urinary frequency
• Urticaria
• Vertigo
• Weakness

Use caution in systemic lupus erythematosus, liver disease, renal impairment

Concomitant ethacrynic acid therapy (increases risk of ototoxicity)

Risks of fluid or electrolyte imbalance (including causing hyperglycemia, hyperuricemia, gout), hypotension, metabolic alkalosis, severe hyponatremia, severe hypokalemia, hepatic coma and precoma, hypovolemia (with or without hypotension)

Do not commence therapy in hepatic coma and in electrolyte depletion until improvement is noted

IV route twice as potent as PO

Food delays absorption but not diuretic response

May exacerbate lupus

Possibility of skin sensitivity to sunlight

Prolonged use in premature neonates may cause nephrocalcinosis

Efficacy is diminished and risk of ototoxicity increased in patients with hypoproteinemia (associated with nephrotic syndrome); ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses, concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs

To prevent oliguria, reversible increases in BUN and creatinine, and azotemia, monitor fluid status and renal function; discontinue therapy if azotemia and oliguria occur during treatment of severe progressive renal disease

FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur

Available data from published observational studies, case reports, and postmarketing reports, from decades of use, have not demonstrated a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes with furosemide use during pregnancy

Presence of the drug has been reported in human milk; there are no data on effects on breastfed infant or effects on milk production