furosemide

(fur oh' se mide)

Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN)

Pregnancy Category C

Drug class
Loop diuretic

Therapeutic actions
Inhibits the reabsorption of sodium and chloride from the ascending limb of the loop of
Henle, leading to a sodium-rich diuresis.

Indications
• Oral, IV: Edema associated with CHF, cirrhosis, renal disease
• IV: Acute pulmonary edema
• Oral: Hypertension

Contraindications and cautions

• Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in
oral solution); anuria, severe renal failure; hepatic coma; pregnancy; lactation.
• Use cautiously with SLE, gout, diabetes mellitus.

Available forms
Tablets—20, 40, 80 mg; oral solution—10 mg/mL, 40 mg/5 mL; injection—10 mg/mL

Dosages
ADULTS
• Edema: Initially, 20–80 mg/day PO as a single dose. If needed, a second dose
may be given in 6–8 hr. If response is unsatisfactory, dose may be increased in 20-
to 40-mg increments at 6- to 8-hr intervals. Up to 600 mg/day may be given.
Intermittent dosage schedule (2–4 consecutive days/wk) is preferred for
maintenance, or 20–40 mg IM or IV (slow IV injection over 1–2 min). May
increase dose in increments of 20 mg in 2 hr. High-dose therapy should be given
as infusion at rate not exceeding 4 mg/min.
• Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to 80 mg IV
given over 1–2 min if response is unsatisfactory after 1 hr.
• Hypertension: 40 mg bid PO. If needed, additional antihypertensive agents may
be added.
PEDIATRIC PATIENTS
Avoid use in premature infants: stimulates PGE2 synthesis and may increase incidence of
patent ductus arteriosus and complicate respiratory distress syndrome.
• Edema: Initially, 2 mg/kg/day PO. If needed, increase by 1–2 mg/kg in 6–8 hr. Do
not exceed 6 mg/kg. Adjust maintenance dose to lowest effective level.
• Pulmonary edema: 1 mg/kg IV or IM. May increase by 1 mg/kg in 2 hr until the
desired effect is seen. Do not exceed 6 mg/kg.
PATIENTS WITH RENAL IMPAIRMENT
Up to 4 g/day has been tolerated. IV bolus injection should not exceed 1 g/day given over
30 min.

Pharmacokinetics
Route Onset Peak Duration
Oral 60 min 60–120 min 6–8 hr
IV, IM 5 min 30 min 2 hr

Metabolism: Hepatic; T1/2: 30–60 min

Distribution: Crosses placenta; enters breast milk
Excretion: Urine, feces

IV facts
Preparation: Store at room temperature; exposure to light may slightly discolor solution.
Infusion: Inject directly or into tubing of actively running IV; inject slowly over 1–2
min.
Incompatibilities: Do not mix with acidic solutions. Isotonic saline, lactated Ringer's
injection, and 5% dextrose injection may be used after pH has been adjusted (if
necessary); precipitates form with gentamicin, netilimicin, milrinone in 5% dextrose,
0.9% sodium chloride.

Adverse effects
• CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache,
drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss
• CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias,
thrombophlebitis
• Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative
dermatitis, erythema multiforme
• GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation,
diarrhea, acute pancreatitis, jaundice
• GU: Polyuria, nocturia, glycosuria, urinary bladder spasm
• Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte
imbalances
• Other: Muscle cramps and muscle spasms

Interactions
Drug-drug
• Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte
imbalance)
• Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin
• Decreased absorption of furosemide with phenytoin
• Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen,
other NSAIDs
• Decreased GI absorption with charcoal
 • May reduce effect of insulin or oral antidiabetic agents because blood glucose
levels can become elevated

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between furosemide and torsemide; use
extreme caution.

Assessment
• History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion
anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation,
pregnancy
• Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses,
baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver
evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes
(including calcium), blood sugar, liver and renal function tests, uric acid,
urinalysis, weight

Interventions
• Administer with food or milk to prevent GI upset.
• Reduce dosage if given with other antihypertensives; readjust dosage gradually as
BP responds.
• Give early in the day so that increased urination will not disturb sleep.
• Avoid IV use if oral use is at all possible.
• Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
• Do not expose to light, may discolor tablets or solution; do not use discolored
drug or solutions.
• Discard diluted solution after 24 hr.
• Refrigerate oral solution.
• Measure and record weight to monitor fluid changes.
• Arrange to monitor serum electrolytes, hydration, liver function.
• Arrange for potassium-rich diet or supplemental potassium as needed.

Teaching points
• Record intermittent therapy on a calendar or dated envelopes. When possible, take
the drug early so increased urination will not disturb sleep. Take with food or
meals to prevent GI upset.
• Weigh yourself on a regular basis, at the same time and in the same clothing, and
record the weight on your calendar.
• These side effects may occur: Increased volume and frequency of urination;
dizziness, feeling faint on arising, drowsiness (avoid rapid position changes;
hazardous activities, like driving; and consumption of alcohol); sensitivity to
sunlight (use sunglasses, wear protective clothing, or use a sunscreen); increased
thirst (suck on sugarless lozenges; use frequent mouth care); loss of body
potassium (a potassium-rich diet or potassium supplement will be needed).
 • Report loss or gain of more than 3 lb in 1 day, swelling in your ankles or fingers,
unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle
weakness or cramps.

Adverse effects in Italic are most common; those in Bold are life-threatening.