Furosemide (Lexi-Drugs)

ALERT: US Boxed Warning
  Fluid/electrolyte loss:
Drug Shortages

One or more forms of this drug may be in short supply or unavailable. Refer to the following for additional information:

ASHP: http://www.ashp.org/menu/DrugShortages

Pronunciation

(fyoor OH se mide)

Brand Names: US

Lasix

Brand Names: Canada

APO-Furosemide; BIO-Furosemide; Furosemide Special; Lasix Oral; Lasix Special; MINT-Furosemide; NTP-Furosemide [DSC]; PMS-Furosemide; TEVA-Furosemide

Pharmacologic Category

AntihypertensiveDiuretic, Loop

Dosing: Adult

Note: Oral dose equivalency (approximate) for patients with normal renal function (Brater 1983; Cody 1994; Vargo 1995): Furosemide 40 mg = bumetanide 1 mg = ethacrynic acid 50 mg = torsemide 20 mg

Acute pulmonary edema: IV: Initial: 40 mg/dose. If response not adequate within 1 hour, may increase to 80 mg/dose. Note: Minimal additional response is gained by single doses over 160 to 200 mg; maximum: 200 mg/dose (Brater 1998).

Edema:

Oral: Initial: 20 to 80 mg/dose; if response is not adequate, may repeat the same dose or increase dose in increments of 20 to 40 mg/dose at intervals of 6 to 8 hours; may titrate up to 600 mg/day with severe edematous states; usual maintenance dose interval is once or twice daily.

Heart failure: Initial: 20 to 40 mg once or twice daily; maximum 600 mg/day (ACCF/AHA [Yancy 2013]). Note: Dosing frequency may be adjusted based on patient-specific diuretic needs.

IM, IV: Initial: 20 to 40 mg/dose; if response is not adequate, may repeat the same dose or increase dose in increments of 20 mg/dose and administer 1 to 2 hours after previous dose (maximum: 200 mg/dose [Brater 1998]). Note: A higher initial dose may be considered for those receiving chronic oral diuretic therapy (the dose of chronic oral therapy may guide the IM/IV 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: Initial: IV bolus dose 40 to 100 mg over 1 to 2 minutes, followed by continuous IV infusion rate of 10 to 40 mg/hour; repeat loading dose before increasing infusion rate (ACCF/AHA [Yancy 2013]); Brater 1998; Howard 2001). Note: In clinical trials evaluating dosing strategies in acute decompensated heart failure, median and maximum doses were ≤ 20 mg/hour (Felker 2011; Triposkiadis 2014). 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 80 to 160 mg/hour (Howard 2001; Schuller 1997). The risk associated with higher infusion rates (80 to 160 mg/hour) must be weighed against alternative strategies.

Hypertension (alternative agent): Oral: Initial: 20 to 40 mg twice daily; individualize according to patient response and use minimal dose necessary to maintain therapeutic response. Usual dosage range: 20 to 80 mg/day in 2 divided doses (ACC/AHA [Whelton 2017]).

Ascites, due to cirrhosis (off-label dose): Oral: Initial: 40 mg once daily; titrate every 3 to 5 days as clinically indicated (usual maximum: 160 mg once daily); a furosemide to spironolactone dosing ratio of 40 mg (furosemide) to 100 mg (spironolactone) should be maintained (AASLD [Runyon 2012]).

Dosing: Geriatric

Oral, IM, IV: Initial: 20 mg/day; increase slowly to desired response.

Dosing: Renal Impairment: Adult

Acute renal failure: Doses up to 1 to 3 g daily may be necessary to initiate desired response; avoid use in oliguric states.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Dosing: Hepatic Impairment: Adult

Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis. Monitor effects, particularly with high doses.

Dosing: Pediatric

Note: Oral and parenteral (IV, IM) doses may not be interchangeable; due to differences in bioavailability, oral doses are typically higher than IV. Oral solution is available in multiple concentrations (8 mg/mL and 10 mg/mL); extra precautions should be taken to verify and avoid confusion between the different concentrations; dose should be clearly presented as mg (not mL). Oral dose equivalency for adult patients with normal renal function (approximate): Furosemide 40 mg = bumetanide 1 mg = torsemide 20 mg = ethacrynic acid 50 mg (Brater 1983; Cody 1994; Vargo 1995)

Edema (diuresis):

Oral: Infants, Children, and Adolescents: Limited data available: Initial: 0.5 to 2 mg/kg/dose every 6 to 24 hours; usual initial adult dose: 20 to 80 mg/dose; if initial dose ineffective, may increase dose in increments of 1 to 2 mg/kg/dose; maximum daily dose: 6 mg/kg/day not to exceed maximum adult daily dose: 600 mg/day; adjust dose to minimal effective dose for maintenance (Flynn 2011; Kliegman 2016; NHBPEP 2004; van der Vorst 2006). Note: Smaller doses on a mg/kg basis may be needed in larger children, especially in those who are diuretic naive.

IM, intermittent IV: Infants, Children, and Adolescents: Limited data available: Initial: 0.5 to 2 mg/kg/dose every 6 to 12 hours; usual initial adult dose: 20 to 40 mg/dose; if initial dose ineffective after 2 hours, may increase dose by 1 mg/kg/dose; maximum dose: 6 mg/kg/dose not to exceed maximum adult dose: 200 mg/dose; adjust to minimal effective dose for maintenance (Brater 1998; Fuhrman 2017; Kliegman 2016; van der Vorst 2006; Wells 1990). Note: Smaller doses on a mg/kg basis may be needed in larger children, especially in those who are diuretic naive. Dosing in adolescents based on experience in adult and pediatric patients.

Continuous IV infusion:

Infants and Children: Limited data available: Initial: IV bolus dose of 0.1 mg/kg followed by continuous IV infusion of 0.05 to 0.4 mg/kg/hour; titrate dosage to clinical effect (Copeland 1983; Luciani 1997; Singh 1992; van der Vorst 2001)

Adolescents: Very limited data available; dosing in adolescents based on reported experience in adult and pediatric patients (ACCF/AHA [Yancy 2013]); Brater 1998; Copeland 1983; Howard 2001; Luciani 1997; Singh 1992; van der Vorst 2001): IV bolus dose of 0.1 mg/kg; usual adult bolus dose: 40 to 100 mg over 1 to 2 minutes; followed by continuous IV infusion of 0.1 to 0.4 mg/kg/hour; usual adult dosing range: 10 to 40 mg/hour.

Dosing: Renal Impairment: Pediatric

There are no pediatric specific recommendations; in adults with acute renal failure, very high doses may be necessary to initiate diuretic effect; avoid use in oliguric states.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Dosing: Hepatic Impairment: Pediatric

Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis; monitor effects, particularly with high doses

Use: Labeled Indications

Edema: Management of edema associated with heart failure and hepatic or renal disease; acute pulmonary edema.

Hypertension: Management of hypertension.

Note: Not recommended for the initial treatment of hypertension (ACC/AHA [Whelton 2017]).

Clinical Practice Guidelines

Ascites:

AASLD Practice Guidelines: “Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012,” 2012

Heart Failure:

ACCF/AHA, “2013 ACCF/AHA Guideline for the Management of Heart Failure,” June 2013

Canadian Cardiovascular Society, “2012 Heart Failure Management Guidelines Update: Focus on Acute and Chronic Heart Failure,” 2012

“HFSA 2010 Comprehensive Heart Failure Practice Guideline,” July 2010

Hypertension:

“2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults,” November 2017.

AHA/ACC/ASH, “Treatment of Hypertension in Patients with Coronary Artery Disease: A Scientific Statement by the American Heart Association, American College of Cardiology and American Society of Hypertension,” May 2015

“ACCF/AHA Expert Consensus Document on Hypertension in the Elderly,” 2011

ASH/ISH “Clinical Practice Guidelines for the Management of Hypertension in the Community: A Statement by the American Society of Hypertension and the International Society of Hypertension,” January 2014

Eighth Joint National Committee (JNC 8), “2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults,” December 2013

“National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents,” May 2005

Usual Infusion Concentrations: Pediatric

IV infusion: 1 mg/mL or 2 mg/mL or undiluted as 10 mg/mL

Usual Infusion Concentrations: Adult

IV infusion: 1 mg/mL or 2 mg/mL or undiluted as 10 mg/mL

Administration: IM

May administer IM.

Administration: IV

Undiluted direct IV injections may be administered at a rate of 20 to 40 mg per minute; maximum rate of administration for short-term intermittent infusion is 4 mg/minute; exceeding this rate increases the risk of ototoxicity.

Administration: Injectable Detail

pH: 8-9.3

Administration: Oral

Administer on an empty stomach (Bard 2004). May administer with food or milk if GI distress occurs; however, this may reduce diuretic efficacy.

Administration: Other

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).

Administration: Pediatric

Oral: May administer with food or milk to decrease GI distress

Parenteral: IV: May be administered undiluted direct IV at a maximum rate of 0.5 mg/kg/minute (not to exceed 4 mg/minute); may also be diluted and infused over 10 to 15 minutes (following maximum rate as above); in adults, 20 to 40 mg undiluted solution may be administered over 1 to 2 minutes

Dietary Considerations

May cause potassium loss; potassium supplement or dietary changes may be required.

Storage/Stability

Injection: Store at room temperature. Protect from light. Exposure to light may cause discoloration; do not use furosemide solutions if they have a yellow color. Furosemide solutions are unstable in acidic media, but very stable in basic media. Refrigeration may result in precipitation or crystallization; however, resolubilization at room temperature or warming may be performed without affecting the drug’s stability. Infusion solution in D5W, NS, or LR is stable for 24 hours at room temperature.

Tablet, solution: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 89°F). Protect from light. Discard opened bottle of solution after 90 days (10 mg/mL concentration only).

Preparation for Administration: Adult

IV infusion solution may be mixed in NS or D5W solution. May also be diluted for infusion to 1 to 2 mg/mL (maximum: 10 mg/mL).

Preparation for Administration: Pediatric

Parenteral: IV: May be further diluted in NS or D5W to a concentration of 1 to 2 mg/mL for IV infusion; maximum concentration: 10 mg/mL. ISMP and Vermont Oxford Network recommend a standard concentration of 2 or 10 mg/mL for neonates (ISMP 2011).

Compatibility

See Trissel’s IV Compatibility Database

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience constipation, lack of appetite, abdominal cramps, diarrhea, nausea, vomiting, or headache. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, tachycardia, increased thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in amount of urine passed, dry mouth, dry eyes, nausea, or vomiting), signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), signs of infection, severe dizziness, passing out, burning or numbness feeling, blurred vision, agitation, severe loss of strength and energy, bruising, bleeding, tinnitus, or hearing impairment (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Medication Safety Issues
  Sound-alike/look-alike issues:
  Geriatric Patients: High-Risk Medication:
  International issues:
Contraindications

Hypersensitivity to furosemide or any component of the formulation; anuria

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to sulfonamide-derived drugs; complete renal shutdown; hepatic coma and precoma; uncorrected states of electrolyte depletion, hypovolemia, dehydration, or hypotension; jaundiced newborn infants or infants with disease(s) capable of causing hyperbilirubinemia and possibly kernicterus; breast-feeding. 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 sulfonamide-containing 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: [US 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, may precipitate gout.

• 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 radiocontrast-induced nephropathy in high-risk patients.

• Ototoxicity: Rapid IV administration, severe 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 cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity 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 cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-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 (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

• Thyroid effects: Doses >80 mg may result in transient increase in free thyroid hormones, followed by an overall decrease in total thyroid hormone levels.

Disease-related concerns:

• Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension (Bornstein 2016; Inder 2015).

• 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. Supplemental potassium or an aldosterone antagonist, when appropriate, may reduce risk of hypokalemia and metabolic alkalosis. Close monitoring warranted, especially with initiation of therapy.

• 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:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Pediatric: May lead to nephrocalcinosis or nephrolithiasis in premature infants and in infants and 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 (ACC/AHA [Yancy 2013]; Cody 1994; HFSA 2010).

Geriatric Considerations

Loop diuretics are potent diuretics; excess amounts can lead to profound diuresis with fluid and electrolyte loss; close medical supervision and dose evaluation is required, particularly in the elderly. Severe loss of sodium and/or increase in BUN can cause confusion. For any change in mental status in patients on furosemide, monitor electrolytes and renal function.

Warnings: Additional Pediatric Considerations

Premature very low birth weight (VLBW) neonates are at increased risk for toxicity (eg, ototoxicity) due to immature renal function allowing for elevated plasma concentrations if dosed too frequently. A pharmacokinetic study in premature neonates (n=10, birthweight <1,250 g, GA 26.6 ± 2.9 weeks) reported drug accumulation and increased risk of toxicity in premature neonates PMA ≤31 weeks with doses given more frequently than every 24 hours; more frequent dosing of every 12 hours can be administered in premature neonates PMA >32 weeks due to maturing renal function (Mirochnick 1988).

Furosemide stimulates prostaglandin E2 (PGE2) which may prevent closure of patent ductus arteriosus (PDA) in premature infants. However, one large, retrospective cohort study involving 43,576 VLBW infants (median birth weight and GA: 1,120 g and 29 weeks) evaluated the association between the exposure to furosemide and the occurrence of PDA. Exposure to furosemide was not associated with an increased odds of PDA treatment (Thompson 2018). Another smaller placebo-controlled study (n=68, GA <34 weeks, birth weight <2,000 g) found no difference in PDA closure rate between patients treated with furosemide or placebo in combination with indomethacin (Lee 2010).

Pregnancy Considerations

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; Johnson-Coyle 2012). Monitor fetal growth if used during pregnancy; may increase birth weight.

Breast-Feeding Considerations

Furosemide is present in breast milk; maternal use may suppress lactation. The manufacturer recommends that caution be used if administered to a breastfeeding woman. Although some sources consider furosemide compatible with breastfeeding (Garg 2015), others recommend to avoid if possible because usual maternal doses can suppress lactation (WHO 2002).

Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

Frequency not defined:

Cardiovascular: Necrotizing angiitis, orthostatic hypotension, thrombophlebitis, vasculitis

Central nervous system: Dizziness, headache, paresthesia, restlessness, vertigo

Dermatologic: Acute generalized exanthematous pustulosis, bullous pemphigoid, erythema multiforme, exfoliative dermatitis, pruritus, skin photosensitivity, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Glycosuria, hyperglycemia, hyperuricemia, increased serum cholesterol, increased serum triglycerides

Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, mouth irritation, nausea, pancreatitis, vomiting

Genitourinary: Bladder spasm

Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, eosinophilia, hemolytic anemia, leukopenia, purpura, thrombocytopenia

Hepatic: Hepatic encephalopathy, intrahepatic cholestatic jaundice, liver enzymes increased

Hypersensitivity: Anaphylaxis, anaphylactoid reaction, anaphylactic shock

Immunologic: DRESS syndrome

Local: Pain at injection site (following IM injection)

Neuromuscular & skeletal: Muscle spasm, weakness

Ophthalmic: Blurred vision, xanthopsia

Otic: Deafness, tinnitus

Renal: Interstitial nephritis (allergic), renal disease

Miscellaneous: Fever

Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects

Substrate of OAT3; Inhibits MRP2

Drug Interactions 

Acebrophylline: May enhance the therapeutic effect of Furosemide. Risk C: Monitor therapy

Ajmaline: Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Risk D: Consider therapy modification

Amikacin (Oral Inhalation): Loop Diuretics may enhance the nephrotoxic effect of Amikacin (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Amikacin (Oral Inhalation). Risk C: Monitor therapy

Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Loop Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Bilastine: Loop Diuretics may enhance the QTc-prolonging effect of Bilastine. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Risk D: Consider therapy modification

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Risk X: Avoid combination

Cabozantinib: MRP2 Inhibitors may increase the serum concentration of Cabozantinib. 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

Cefazedone: May enhance the nephrotoxic effect of Loop Diuretics. Risk C: Monitor therapy

Cefotiam: Loop Diuretics may enhance the nephrotoxic effect of Cefotiam. Risk C: Monitor therapy

Cefpirome: Loop Diuretics may enhance the nephrotoxic effect of Cefpirome. Risk C: Monitor therapy

Ceftizoxime: Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime. Risk C: Monitor therapy

Cephalothin: Loop Diuretics may enhance the nephrotoxic effect of Cephalothin. Risk C: Monitor therapy

Cephradine: May enhance the nephrotoxic effect of Loop Diuretics. Risk C: Monitor therapy

Chloral Betaine: Furosemide may enhance the adverse/toxic effect of Chloral Betaine. Risk D: Consider therapy modification

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

Desmopressin: Loop Diuretics may enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dofetilide: Loop Diuretics may enhance the QTc-prolonging effect of Dofetilide. Management: Monitor serum potassium and magnesium more closely when dofetilide is combined with loop diuretics. Some therapy modification may be required. Risk D: Consider therapy modification

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Empagliflozin: May enhance the hypotensive effect of Loop Diuretics. 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 Antihypertensive Agents. Risk C: Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Ipragliflozin: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor therapy

Ivabradine: Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy

Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. 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

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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 Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Neuromuscular-Blocking Agents: Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider therapy modification

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Phenytoin: May diminish the diuretic effect of Loop Diuretics. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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

Promazine: Loop Diuretics may enhance the QTc-prolonging effect of Promazine. Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

RisperiDONE: Loop Diuretics may enhance the adverse/toxic effect of RisperiDONE. Risk C: Monitor therapy

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

Tobramycin (Oral Inhalation): Loop Diuretics may enhance the nephrotoxic effect of Tobramycin (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Tobramycin (Oral Inhalation). Risk C: Monitor therapy

Tolvaptan: May increase the serum concentration of OAT3 Substrates. Risk D: Consider therapy modification

Topiramate: Loop Diuretics may enhance the hypokalemic effect of Topiramate. Risk C: Monitor therapy

Xipamide: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk of hypovolemia, electrolyte disturbances, and prerenal azotemia may be increased. Risk C: Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Food Interactions

Furosemide serum levels may be decreased if taken with food. Management: Administer on an empty stomach.

Test Interactions

May lead to false-negative aldosterone/renin ratio (ARR) (Funder 2016).

Genes of Interest
Monitoring Parameters

Monitor I & O (inpatient setting) and weight daily; blood pressure, orthostasis; serum electrolytes, renal function; monitor hearing with high doses or rapid IV administration

Advanced Practitioners Physical Assessment/Monitoring

Assess for allergy to sulfonylurea before beginning therapy. For intravenous use. Monitor for dehydration, electrolyte imbalance, and postural hypotension on a regular basis during therapy.

Nursing Physical Assessment/Monitoring

Allergy history should be assessed before beginning therapy. Monitor for dehydration, electrolyte imbalance, and postural hypotension on a regular basis during therapy.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

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 [DSC], 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.

Solution, Injection:

Generic: 10 mg/mL (2ml, 4ml, 30ml)

Solution, Intravenous:

Generic: 10 mg/mL (25ml)

Solution, Oral:

Lasix Oral: 10 mg/mL (25ml, 120ml) [contains ALCOHOL, USP, METHYLPARABEN, POLYSORBATE 80]

Tablet, Oral:

Lasix Special: 500 mg [contains FD&C YELLOW #10 (QUINOLINE YELLOW), FD&C YELLOW #6 (SUNSET YELLOW)]

Generic: 20 mg, 40 mg, 80 mg

Anatomic Therapeutic Chemical (ATC) Classification
  • CO3CA01
Generic Available (US)

Yes

Pricing: US

Solution (Furosemide Injection)

10 mg/mL (per mL): $0.87 – $3.73

Solution (Furosemide Oral)

8 mg/mL (per mL): $0.10

10 mg/mL (per mL): $0.17

Tablets (Furosemide Oral)

20 mg (per each): $0.14 – $0.51

40 mg (per each): $0.16 – $0.59

80 mg (per each): $0.42 – $1.57

Tablets (Lasix Oral)

20 mg (per each): $0.86

40 mg (per each): $1.20

80 mg (per each): $1.94

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Primarily inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal and distal renal tubules, interfering with the chloride-binding cotransport system, thus causing its natriuretic effect (Rose 1991).

Pharmacodynamics/Kinetics

Onset of action: Diuresis: Oral, sublingual (SL): 30 to 60 minutes; IM: 30 minutes; IV: ~5 minutes

Symptomatic improvement with acute pulmonary edema: Within 15 to 20 minutes; occurs prior to diuretic effect

Peak effect: Oral, SL: 1 to 2 hours; IV: 0.5 hours

Duration: Oral, SL: 6 to 8 hours; IV: 2 hours

Protein binding: 91% to 99%; primarily to albumin

Metabolism: Minimally hepatic

Bioavailability: Oral tablet: 47% to 64%; Oral solution: 50%; SL administration of oral tablet: ~60%; results of a small comparative study (n=11) showed bioavailability of SL administration of tablet was ~12% higher than oral administration of tablet (Haegeli 2007)

Half-life elimination: Normal renal function: 0.5 to 2 hours; End-stage renal disease (ESRD): 9 hours

Excretion: Urine (Oral: 50%, IV: 80%) within 24 hours; feces (as unchanged drug); nonrenal clearance prolonged in renal impairment

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Index Terms

Frusemide

FDA Approval Date
March 20, 1968
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Brand Names: International

A Xi Ya (CN); A-Basedock (JP); Accent (JP); Ai Ge (CN); Akoset (MY); Anfuramide (JP); Aquarid (ZA); Aquasin (ZW); Arasemide (JP); Bondiur (CR, DO, GT, HN, NI, PA, SV); Busemida (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, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW); Diurin (NZ); Diurmessel (CR, DO, GT, HN, NI, PA, SV); Diusemide (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, QA, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW); Diuvar (ID); Edemid (HR); Edemin (ID); 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); Frusema (PH); Frusid (HK, NZ); Fruside (IE, ZW); Frusovit (LK); Fulsix (JP); Fuluvamide (JP); Furanthril (CZ); Furanturil (BG); Furetic (TH); Furide (TW); Furix (NO, SE); Furo-Puren (DE); Furolix (LB); Furomen (FI); Furomex (CZ); Furomin (FI); Furon (HU); Furorese (DE, LU); Furoretic (EG); Furose (PH); Furosedon (JP); Furosemid (HR, HU); Furosemid Pharmavit (HU); Furosemid-ratiopharm (LU); Furosemide-Eurogenerics (LU); Furosemix (LU); Furosix (BR); Furovenir (IL); Fursemid (HR); Fursemid[inj.] (HR); Furusemide (JP); Fuseride (TH); Fusid (DE, IL); Fusimex (PH); Fusix (MY); Glosix (ID); Impugan (DK, ID, SE); Indiurex (PH); Jufurix (DE); Katlex (JP); Kutrix (JP); Lafurex (EG); Lasilix (FR, MA, MT); Lasix (AE, AT, AU, BB, BE, BF, BH, BJ, BM, BR, BS, BZ, CH, CI, CL, CO, CR, CU, 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, LK, LR, LU, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, NI, NL, 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); Odement (EG); Odemex (CR, DO, GT, HN, NI, PA, SV); Oedemex (AE, BH, CH, CY, IQ, IR, JO, KW, LY, OM, SA, SY, YE); Pharmix (PH); Promedes (JP); Radisemide (AE, BF, BH, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM); Radouna (JP); Rasitol (MY, PH, SG, TW); Releef (TZ); Retep (AR); Rosemide (PH); Rosis (TW); Roxemid (ID); Salinex (IN); Salurex (MT); Salurin (AE, KW, SA); Seguril (ES); Silax (ID); Sofudac (ZW); Solax (PY); Synephron (JP); Trofurit (HU); Uremide (AU, NZ); Uresix (ID); Urex (AU, HK, JP); Urex Forte (HK); Urex-M (AU); Urimeg (PY); Urinal (BH, JO); Usix (VN); Vusimide (MY)

Furosemide (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(fyoor OH se mide)

Brand Names: US

Lasix

Brand Names: Canada

Apo-Furosemide; Bio-Furosemide; Furosemide Injection Sandoz Standard; Furosemide Injection, USP; Furosemide Special; Furosemide Special Injection; Lasix; Lasix Special; PMS-Furosemide; Teva-Furosemide

Warning
  • This drug is a strong fluid-lowering drug (diuretic). Sometimes too much water and major elements (potassium) in the blood may be lost. This can lead to serious health problems. Your doctor will follow you closely to change the dose to match your body’s needs.
What is this drug used for?
  • It is used to get rid of extra fluid.
  • It is used to treat high blood pressure.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to furosemide or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you are not able to pass urine.
  • If you are taking any of these drugs: Chloral hydrate, ethacrynic acid, or lithium.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
  • To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.
  • If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
  • If you are on a low-salt or salt-free diet, talk with your doctor.
  • If you are taking this drug and have high blood pressure, talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
  • Have your blood pressure checked often. Talk with your doctor.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • High cholesterol has happened with this drug. If you have questions, talk with the doctor.
  • You may need extra potassium. Talk with your doctor.
  • Talk with your doctor before you drink alcohol or use other drugs and natural products that slow your actions.
  • This drug may make you sunburn more easily. Use care if you will be in the sun. Tell your doctor if you sunburn easily while taking this drug.
  • Watch for gout attacks.
  • If you have lupus, this drug can make your lupus active or get worse. Tell your doctor right away if you get any new or worse signs.
  • If you are 65 or older, use this drug with care. You could have more side effects.
  • Use with care in children. Talk with the doctor.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.
  • Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
  • Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
  • Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Very bad dizziness or passing out.
  • A burning, numbness, or tingling feeling that is not normal.
  • Blurred eyesight.
  • Restlessness.
  • Hearing problems like lowered hearing and loss of hearing have happened with this drug. Sometimes this may go away but sometimes it may not. Call your doctor right away if you have ringing in the ears or any change in your hearing.
  • Low blood cell counts have happened with this drug. If blood cell counts get very low, this can lead to bleeding problems, infections, or anemia. Call your doctor right away if you have signs of infection like fever, chills, or sore throat; any unexplained bruising or bleeding; or if you feel very tired or weak.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Dizziness.
  • Headache.
  • Constipation.
  • Diarrhea.
  • Upset stomach or throwing up.
  • Not hungry.
  • Stomach cramps.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • All oral products:
  • This drug may cause you to pass urine more often. To keep from having sleep problems, try to take before 6 pm.
  • To gain the most benefit, do not miss doses.
  • Do not take sucralfate within 2 hours before or after taking this drug.
  • Do not take if product changes color.
  • Liquid (solution):
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Injection:
  • It is given as a shot into a muscle or vein.
What do I do if I miss a dose?
  • All oral products:
  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
  • Injection:
  • Call your doctor to find out what to do.
How do I store and/or throw out this drug?
  • All oral products:
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Liquid (solution):
  • Do not freeze.
  • Injection:
  • If you need to store this drug at home, talk with your doctor, nurse, or pharmacist about how to store it.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Furosemide (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(fyoor OH se mide)

Brand Names: US

Lasix

Brand Names: Canada

Apo-Furosemide; Bio-Furosemide; Furosemide Injection Sandoz Standard; Furosemide Injection, USP; Furosemide Special; Furosemide Special Injection; Lasix; Lasix Special; PMS-Furosemide; Teva-Furosemide

Warning
  • This drug is a strong fluid-lowering drug (diuretic). Sometimes too much water and major elements (potassium) in the blood may be lost. This can lead to serious health problems. The doctor will follow your child closely to change the dose to match your child’s body’s needs.
What is this drug used for?
  • It is used to get rid of extra fluid.
  • It is used to treat high blood pressure.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child is not able to pass urine.
  • If your child is taking any of these drugs: Chloral hydrate, ethacrynic acid, or lithium.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Have your child avoid tasks or actions that call for alertness until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
  • To lower the chance of feeling dizzy or passing out, have your child rise slowly if your child has been sitting or lying down. Have your child be careful going up and down stairs.
  • If your child has high blood sugar (diabetes), you will need to watch his/her blood sugar closely.
  • If your child is on a low-salt or salt-free diet, talk with your child’s doctor.
  • If your child is taking this drug and has high blood pressure, talk with the doctor before giving OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
  • Have your child’s blood pressure checked often. Talk with your child’s doctor.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • High cholesterol has happened with this drug. If you have questions, talk with the doctor.
  • Your child may need extra potassium. Talk with the doctor.
  • Talk with the doctor before giving your child other drugs and natural products that may slow your child’s actions.
  • Alcohol may interact with this drug. Be sure your child does not drink alcohol.
  • This drug may make your child sunburn more easily. Use care if your child will be in the sun. Tell your child’s doctor if your child sunburns easily while taking this drug.
  • Watch for gout attacks.
  • If your child has lupus, this drug can make your child’s lupus active or get worse. Tell the doctor right away if your child gets any new or worse signs.
  • Use with care in children. Talk with the doctor.
  • If your child is pregnant or breast-feeding a baby:
  • Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
  • Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
  • Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Very bad dizziness or passing out.
  • A burning, numbness, or tingling feeling that is not normal.
  • Blurred eyesight.
  • Restlessness.
  • Hearing problems like lowered hearing and loss of hearing have happened with this drug. Sometimes this may go away but sometimes it may not. Call the doctor right away if your child has ringing in the ears or any change in hearing.
  • Low blood cell counts have happened with this drug. If blood cell counts get very low, this can lead to bleeding problems, infections, or anemia. Call your child’s doctor right away if your child has signs of infection like fever, chills, or sore throat; any unexplained bruising or bleeding; or if your child feels very tired or weak.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Dizziness.
  • Headache.
  • Constipation.
  • Diarrhea.
  • Upset stomach or throwing up.
  • Not hungry.
  • Stomach cramps.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • All oral products:
  • This drug may cause your child to pass urine more often. To keep your child from having sleep problems, try to give this drug before 6 PM.
  • To gain the most benefit, do not miss giving your child doses.
  • Do not give sucralfate within 2 hours before or after giving this drug.
  • Do not give if product changes color.
  • Liquid (solution):
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Injection:
  • It is given as a shot into a muscle or vein.
What do I do if my child misses a dose?
  • All oral products:
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
  • Injection:
  • Call your child’s doctor to find out what to do.
How do I store and/or throw out this drug?
  • All oral products:
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Liquid (solution):
  • Do not freeze.
  • Injection:
  • If you need to store this drug at home, talk with your child’s doctor, nurse, or pharmacist about how to store it.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.