Fumide , Furomide , Lasix, Luramide
Classifications: electrolytic and water balance agent; loop diuretic; antihypertensive; Therapeutic:loop diuretic; antihypertensive
Pregnancy Category: C
20 mg, 40 mg, 80 mg tablets; 10 mg/mL, 40 mg/5 mL oral solution; 10 mg/mL injection
Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive. Inhibits reabsorption of sodium and chloride
primarily in loop of Henle and also in proximal and distal renal tubules; decreases renal vascular resistance and may increase
renal blood flow.
An antihypertensive that decreases edema and intravascular volume.
Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used
for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia.
Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.
History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states;
hepatic coma; preclampsia, eclampsia; pregnancy (category C).
Infants, older adults; hepatic disease; hepatic cirrhosis; renal disease, nephrotic syndrome; cardiogenic shock associated
with acute MI; ventricular arrhythmias, CHF, diarrhea; history of SLE, history of gout; diabetes mellitus; patients receiving
digitalis glycosides or potassium-depleting steroids, lactation.
Route & Dosage
Adult: PO 2080 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 2040 mg in 1 or more divided doses up to 600 mg/d
Child: PO 2 mg/kg, may be increased by 12 mg/kg q68h (max: 6 mg/kg/dose) IV/IM 12 mg/kg, may be increased by 1 mg/kg q2h if needed (max: 6 mg/kg/dose)
Neonate: PO 14 mg/kg q1224h IV/IM 12 mg/kg q1224h
Adult: PO 1040 mg b.i.d. (max: 480 mg/d)
- Give with food or milk to reduce possibility of gastric irritation.
- Schedule doses to avoid sleep disturbance (e.g., a single dose is generally given in the morning; twice-a-day doses at 8 a.m.
and 2 p.m.).
- Note: Slight discoloration of tablets reportedly does not alter potency.
- Store tablets at controlled room temperature, preferably at 15°30° C (59°86° F) unless
otherwise directed. Protect from light.
- Store oral solution in refrigerator, preferably at 2°8° C (36°46° F). Protect from light
- Protect syringes from light once they are removed from package.
- Discard yellow or otherwise discolored injection solutions.
- Note: Verify correct IV concentration and rate of infusion/injection with physician before administration to infants or children.
PREPARE: Direct: Give undiluted.
ADMINISTER: Direct: Give undiluted at a rate of 20 mg or a fraction thereof over 1 min. With high doses a rate of 4 mg/min is recommended to decrease
risk of ototoxicity.
INCOMPATIBILITIES Solution/additive: Amiodarone, buprenorphine, chlorpromazine, diazepam, dobutamine, erythromycin, fructose, gentamicin, isoproterenol, meperidine, metoclopramide, milrinone, netilmicin, pancuronium, papaveretum, prochlorperazine, promethazine, quinidine, thiamine. Y-site: Amrinone, amsacrine, azithromycin, chloropromazine, ciprofloxacin, clarithromycin, diltiazem, dobutamine, dopamine, doxorubicin, droperidol, esmolol, fenoldopam, filgrastim, fluconazole, gemcitabine, gentamicin, hydralazine, idarubicin, labetalol, lansoprazole, levofloxacin, meperidine, methocarbamol, metoclopramide, midazolam, milrinone, morphine, netilmicin, nicardipine, ondansetron, quinidine, tetracycline, thiopental, tobramycin, vecuronium, vinblastine, vincristine, vinorelbine, TPN.
- Use infusion solutions within 24 h.
- Store parenteral solution at controlled room temperature, preferably at 15°30° C (59°86°
F) unless otherwise directed. Protect from light.
Adverse Effects (≥1%)CV:
Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse
Hypovolemia, dehydration, hyponatremia, hypokalemia,
hypochloremia, metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia. GI:
Nausea, vomiting, oral and gastric burning, anorexia, diarrhea
, abdominal cramping, acute pancreatitis
nephritis, irreversible renal
failure, urinary frequency. Hematologic: Anemia
, thrombocytopenic purpura; aplastic anemia, agranulocytosis
(rare). Special Senses:
Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision. Skin:
Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarda, necrotizing angiitis (vasculitis). Body as a Whole:
Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site.
Diagnostic Test Interference
Furosemide may cause elevations in BUN, serum amylase, cholesterol, triglycerides, uric acid and blood glucose levels, and may decrease serum calcium, magnesium, potassium, and sodium levels.
InteractionsDrug: other diuretics
enhance diuretic effects; with digoxin
increased risk of toxicity
because of hypokalemia; nondepolarizing neuromuscular blocking agents
) prolong neuromuscular blockage; corticosteroids
, amphotericin B
potentiate hypokalemia; decreased lithium
elimination and increased toxicity
blunt hypoglycemic effects; nsaid
s may attenuate diuretic effects.
60% PO dose from GI tract. Peak:
6070 min PO; 2060 min IV
3060 min PO; 5 min IV
2 h. Distribution:
Crosses placenta. Metabolism:
Small amount in liver. Elimination:
Rapidly in urine; 50% of oral dose and 80% of IV
dose excreted within 24 h; excreted in breast milk. Half-Life:
Assessment & Drug Effects
- Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest
has been reported.
- Monitor for S&S of hypokalemia (see Appendix F).
- Monitor BP during periods of diuresis and through period of dosage adjustment.
- Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate
significant adverse reactions. Report symptoms to physician.
- Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.
- Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration
and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.
- Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
- Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction,
or those receiving sympatholytic agents.
Patient & Family Education
- Consult physician regarding allowable salt and fluid intake.
- Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion.
- Learn S&S of hypokalemia (see Appendix F). Report muscle cramps or weakness to physician.
- Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness
- Avoid replacing fluid losses with large amounts of water.
- Avoid prolonged exposure to direct sun.