Furosemide
Classification
Antihypertensive, loop diuretic
Indications
CCP: Cardiogenic pulmonary edema
Contraindications
- Systolic blood pressure < 100 mmHg
- Hypersensitivity to furosemide or sulfonamide-derived drugs
- Complete renal shutdown
- Hepatic coma or precoma
- Known or suspected electrolyte imbalance, hypovolemia, dehydration, or hypotension
- Jaundice in newborn infants or infants with diseases capable of causing hyperbilirubinemia
- Pregnancy or breast-feeding
Adult dosages
CCP: Acutely decompensated cardiogenic pulmonary edema
- For patients with intact renal function: 40-80 mg IV/IO, or double the patient's usual daily dose
- For patients with known or suspected renal impairment (eGFR < 30 mL/minute/1.73 m2): higher doses may be required to achieve diuretic responses; single doses > 160-200 mg IV are unlikely to produce additional diuresis.
Pediatric Considerations And Dosing
Caution: Limited data available. Consultation with CliniCall is required.
Mechanism Of Action
Furosemide inhibits the reabsorption of sodium and chloride in the ascending loop of Henle, as well as the proximal and distal tubules.
Adverse Effects
Cardiovascular: Necrotizing angiitis, orthostatic hypotension, thrombophlebitis
Dermatologic: Acute generalized exanthematous pustulosis, bulla (hemorrhagic), bullous pemphigoid, erythema multiforme , exfoliative dermatitis, lichenoid eruption, pruritus, skin photosensitivity, skin rash, Stevens-Johnson syndrome , toxic epidermal necrolysis, urticaria.
Endocrine & metabolic: Glycosuria, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hypovolemia, increased serum cholesterol, increased serum triglycerides
Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, oral irritation, pancreatitis, vomiting
Genitourinary: Bladder spasm
Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, hemolytic anemia, leukopenia, purpuric disease, thrombocytopenia
Hepatic: Hepatic encephalopathy, increased liver enzymes, intrahepatic cholestatic jaundice
Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, nonimmune anaphylaxis
Immunologic: Drug reaction with eosinophilia and systemic symptoms
Nervous system: Dizziness, headache, paresthesia, restlessness, vertigo
Neuromuscular & skeletal: Asthenia, muscle spasm
Ophthalmic: Blurred vision, xanthopsia
Otic: Deafness, tinnitus
Renal: Acute kidney injury, calcium nephrolithiasis (pediatric patients), interstitial nephritis (allergic) (Jennings 1986), nephrolithiasis (pediatric patients)
Miscellaneous: Fever
Source: Furosemide. In: Lexicomp Online, UpToDate, Waltham, MA. (Accessed November 20, 2020.)
Warning And Precautions
- If given in excessive amounts, furosemide can lead to profound diuresis, causing fluid and electrolyte depletion. Supervise therapy closely.
- Monitor fluid status and renal function to prevent oliguria, azotemia, and increases in BUN and creatinine.
Drug Interactions
May enhance the hypotensive effect of angiotensin-converting enzyme inhibitors.
Beta-2 adrenergic agonists may enhance the hypokalemic effect of loop diuretics, including furosemide.
Non-steroidal anti-inflammatory agents may diminish the effectiveness of loop diuretic.
Opioid agonists may enhance the toxic effects of diuretics, and diminish their therapeutic effectiveness.