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FUROSEMIDE is a brand name for Furosemide (also known as Frusemide). The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Oedema and/or ascites caused by cardiac or hepatic diseases - Oedema caused by renal diseases (in case of nephrotic syndrome, treatment of the underlying disease is essential) - Pulmonary oedema (e.g. in case of acute heart failure) - Hypertensive crisis (in addition to other therapeutic measures) The parenteral…
Verbatim from this product's MHRA label. Tap a section to expand.
Posology:
The lowest dose with which the desired effect is achieved should always be used. The duration of the treatment should be determined by the doctor and be appropriate to the type and severity of the disease. The parenteral administration of furosemide is indicated in cases where oral administration is not feasible or not efficient (for example in case of reduced intestinal absorption) or when a quick effect is required.
In cases where parenteral administration is used, the switch to oral administration is recommended, as soon as possible. To achieve optimum efficacy and suppress counter-regulation, a continuous furosemide infusion is generally to be preferred to repeated bolus injections.
Where continuous furosemide infusion is not feasible for follow-up treatment after one or several acute bolus doses, a follow-up regimen with low doses given at short intervals (approx. 4 hours) is to be preferred to a regimen with higher bolus doses at longer intervals.
Intravenous administration of furosemide must be slow; a rate of 4 mg per minute must not be exceeded and should never be given in association with other medicinal products in the same syringe. Intramuscular administration must be restricted to exceptional cases where neither oral nor intravenous administrations are feasible.
It must be noted that intramuscular injection is not suitable for the treatment of acute conditions such as pulmonary oedema. If there is no opposing medical advice, the initial dose recommended for adults and adolescents over 15 years, is of 20 to 40 mg (1 or 2 ampoules) by intravenous (or in exceptional cases intramuscular) administration; the maximum dose varying according to individual response.
If larger doses are required, they should be given increasing by 20 mg increments and not given more often than every two hours. In adults, the recommended maximum daily dose of furosemide is 1500 mg. Weight loss induced by enhanced diuresis should not exceed 1 kg/day.
Paediatric population Children and adolescents (up to 18 years of age):
The intravenous administration of furosemide to children and adolescents below 15 years is only recommended in exceptional cases. 5 to 1 mg/kg body weight daily up to a maximum total daily dose of 20 mg. 5 mg per minute is not exceeded.
3). In uncommon cases deafness which is sometimes irreversible has been reported. Tabulated list of adverse reactions The evaluation of adverse reactions is based on the following definition of frequency: Very common (≥1/10) Common (≥1/100 to <1/10) Uncommon (≥1/1,000 to <1/100) Rare (≥1/10,000 to <1/1,000) Very rare (<1/10,000) Not known (cannot be estimated from the available data).
m. injection Investigations increased serum cholesterol and triglyceride 1 May become manifest, especially with an increase of haemorrhage tendency. 2 If this occurs, treatment should be discontinued. 9. 3. 5 Tinnitus may occur transitory.
6 For example bullous exanthema, rash, urticaria, purpura, erythema multiforme, exfoliative dermatitis, photosensitivity. Description of the selected adverse reactions Blood and lymphatic system disorders The diuretic action of furosemide may lead to or contribute to hypovolaemia and in severe cases to dehydration especially in elderly patients.
Severe fluid depletion may lead to haemoconcentration with a tendency for thromboses to develop. Endocrine disorders Glucose tolerance may decrease with furosemide. In patients with diabetes mellitus this may lead to a deterioration of metabolic control; latent diabetes mellitus may become manifest.
Metabolism and nutrition disorders Electrolyte and water balance may be disturbed (hypokalaemia, hyponatraemia and metabolic alkalosis), especially after prolonged therapy or when high doses are administered. Regular monitoring of serum electrolytes (especially potassium, sodium and calcium) is therefore indicated.
Potassium depletion may occur, especially due to poor potassium diet. g. in vomiting or chronic diarrhoea) hypokalaemia may occur as a result of increased renal potassium losses. This is manifested as neuromuscular (myasthenia, paraesthesia, pareses), intestinal (vomiting, constipation, meteorism), renal (polyuria, polydipsia) and cardiac (impaired paced setting and conduction disorders) symptoms.
g. patients with prostatic hypertrophy). Urinary output must be secured. 5) - Acute porphyria (the use of diuretics is considered to be unsafe in acute porphyria and caution should be exercised) - Premature infants (possible development nephrocalcinosis/ nephrolithiasis; renal function must be monitored and renal ultrasonography performed).
In premature infants with respiratory distress syndrome, diuretic treatment with furosemide during the first weeks of life can increase the risk of persistent ductus arteriosus Botalli. - NSAIDs may antagonise the diuretic effect of furosemide and other diuretics.
Use of NSAIDs with diuretics may increase the risk of nephrotoxicity Cautious dose titration is required. g. 5 - Administration of high dosages - Administration in progressive and severe renal disease - Administration with sorbitol. Concomitant administration of both substances may lead to increased dehydration (sorbitol might cause additional fluid loss by inducing diarrhea) - Administration in patients with systemic Lupus Erythematosus because of the possibility of exacerbation or activation of SLE - Medication that prolong the QT interval Particular caution and/or dose reduction is required.
Symptomatic hypotension leading to dizziness, fainting or loss of consciousness can occur in patients treated with furosemide, particularly in the elderly, patients on other medications which can cause hypotension and patients with other medical conditions that are risks for hypotension.
g. due to vomiting or diarrhea). Hypovolaemia or dehydration as well as any significant electrolyte or acid-base disturbances must be corrected. 8). If photosensitivity reaction occurs during treatment, it is recommended to stop the treatment.
If a re-administration of thiazide is deemed necessary, it is recommended to protect exposed areas to the sun or to artificial UVA. Athletes The attention of athletes should be drawn to the fact that this drug contains an active ingredient which may interfere with doping tests by forced diuresis of the doping agents.
1. g. Sulfonylureas or antibiotics of sulphonamides group) - Renal failure with oligoanuria not responding to furosemide. - Renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents. - Pre-comatose and comatose state associated with hepatic encephalopathy.
8). - Severe hyponatraemia. - Hypovolaemia with or without hypotension. - Dehydration. 6).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Older people:
The recommended initial dose is 20 mg/day, increasing gradually until the required response is achieved. Special dosage recommendations For adults, the dose is based on the following conditions: Oedema associated to chronic and acute congestive heart failure The recommended initial dose is 20 to 40mg daily.
This dose can be adapted to the patient’s response, as necessary. The dose should be given in two or three individual doses per day for chronic congestive heart failure and as a bolus for acute congestive heart failure. Oedema associated with renal disease The recommended initial dose is 20 to 40 mg daily.
This dose can be adapted to the response as necessary. The total daily dose can be administered as a single dose or as several doses throughout the day. If this does not lead to an optimal fluid excretion increase, furosemide must be administered in continuous intravenous infusion, with an initial rate of 50 mg to 100 mg per hour.
Before beginning the administration of furosemide, hypovolaemia, hypotension and acid- base and electrolytic imbalances must be corrected. In dialyzed patients, the usual maintenance dose ranges from 250 mg to 1500 mg daily. In patients with nephrotic syndrome the dosage must be determined with caution, because of the risk of a higher incidence of adverse events.
Hypertensive crisis (in addition to other therapeutic measures) The recommended initial dose in hypertensive crisis is 20 mg to 40 mg administrated in bolus by intravenous injection. This dose can be adapted to the response as necessary.
Oedema associated to hepatic disease When intravenous treatment is absolutely needed, the initial dose should range from 20 mg to 40 mg. This dose can be adapted to the response as necessary. The total daily dose can be administered as a single dose or in several doses.
Furosemide can be used in combination with aldosterone antagonists in cases in which these agents in monotherapy are not sufficient. In order to avoid complications such as orthostatic intolerance or acid-base and electrolytic imbalances or hepatic encephalopathy, the dose must be carefully adjusted to achieve a gradual fluid loss.
5 kg.
Pulmonary oedema (in acute heart failure):
The initial dose to be administered is 40 mg furosemide by intravenous application. If required by the condition of the patient, another injection of 20 to 40 mg furosemide is given after 30-60 minutes. Furosemide should be used in addition to other therapeutic measures.
6.
Severe potassium losses may lead to paralytic ileus or disturbed consciousness, with coma in extreme cases. g. 5) and nutrition may cause predisposition to potassium deficiency. In such cases, adequate monitoring is necessary as well as therapy substitution.
As a result of increased renal sodium losses, hyponatraemia with corresponding symptoms may occur, particularly if the supply of sodium chloride is restricted. Commonly observed symptoms of sodium deficiency are apathy, systremma, inappetence, asthenia, somnolence, vomiting and confusion.
Increased renal calcium losses can lead to hypocalcaemia, which may induce tetany in rare cases. In patients with increased renal magnesium losses, tetania or cardiac arrhythmias were observed in rare cases as a consequence of hypomagnesaemia.
Certain patients may present increased uric acid levels and gout attacks may occur. g. decompensated hepatic cirrhosis) may become more severe with furosemide. g. in nephrotic syndrome). m. v. administration). Hepato-biliary disorders Intrahepatic cholestasis, cholestatic jaundice, hepatic ischaemia, increase in hepatic […]
1%; mean age 80 years, range 67-90 years). Concomitant use of risperidone with other diuretics (mainly thiazide diuretics used in low dose) was not associated with similar findings. No pathophysiological mechanism has been identified to explain this finding, and no consistent pattern for cause of death observed.
Nevertheless, caution should be exercised and the risks and benefits of this combination or co-treatment with other potent diuretics should be considered prior to the decision to use. There was no increased incidence of mortality among patients taking other diuretics as concomitant treatment with risperidone.
3 Contraindications). 2% of the WHO recommended maximum daily intake of 2 g sodium for an adult.