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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: Furosemide oral solution is indicated in all conditions requiring prompt diuresis in patients who are unable to take solid dose forms. Indications, include cardiac, pulmonary, hepatic and renal oedema, peripheral oedema due to mechanical obstruction or venous insufficiency and hypertension.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Furosemide 40mg/5ml has an exceptionally wide therapeutic range, the effect being proportional to the dosage. Furosemide 40mg/5ml is best given as a single dose either daily or on alternate days. The recommended initial daily dose is 40mg.
This may require adjustment until the effective dose is achieved as a maintenance dose. In mild cases, 20mg daily or 40mg on alternate days may be sufficient, whereas in cases of resistant oedema, daily doses of 80mg and above may be used as one or two dose daily, or intermittently.
Severe cases may require gradual titration of the furosemide dosage up to 600mg daily. The recommended maximum daily dose of furosemide administration is 1500mg.
Elderly:
The dosage recommendations for adults apply, but in the elderly, furosemide is generally eliminated more slowly. Dosage should be titrated until the required response is achieved.
Children:
Oral doses for children range from 1 to 3 mg/Kg body weight daily up to a maximum total dose of 40 mg/day.
Undesirable effects can occur with the following frequencies:
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, including isolated reports), not known (cannot be estimated from the available data) Blood and lymphatic system disorders: Uncommon: Thrombocytopenia Rare: Eosinophilia Leukopenia Bone marrow depression (necessitates withdrawal of treatment).
The haemopoietic status should be therefore be regularly monitored. Very Rare: aplastic anaemia or haemolytic anaemia agranulocytosis Nervous system disorders Rare: paraesthesia hyperosmolar coma Not known: Dizziness, fainting and loss of consciousness (caused by symptomatic hypotension).
Endocrine disorder 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. Insulin requirements of diabetic patients may increase.
g. in nephritic syndrome) and/or when intravenous furosemide has been given too rapidly.
Uncommon:
Deafness (sometimes irreversible) Cardiac disorders Uncommon: Cardiac arrhythmias Furosemide may cause a reduction in blood pressure which, if pronounced may cause signs and symptoms such as impairment of concentration and reactions, light headedness, sensations of pressure in the head, headache, dizziness, drowsiness, weakness, disorders of vision, dry mouth, orthostatic intolerance.
The diuretic effect of furosemide can result in hypovolaemia and dehydration, especially in the elderly. There is an increased risk of thrombosis. Hepatobiliary disorders In isolated cases, intrahepatic cholestasis, an increase in liver transaminases or acute pancreatitis may develop.
3) Hypotension. Hypovolaemia. Severe electrolyte disturbances – particularly hypokalaemia, hyponatraemia and acid-base disturbances. Furosemide is not recommended In patients at high risk for radiocontrast nephropathy - it should not be used for diuresis as part of the preventative measures against radiocontrast-induced nephropathy.
Particular caution and/or dose reduction 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.
2). difficulty with micturition including prostatic hypertrophy (increased risk of urinary retention: consider lower dose). g. nephritic syndrome (effect of furosemide may be impaired and its ototoxicity potentiated - cautious dose titration required).
acute hypercalcaemia (dehydration results from vomiting and diuresis - correct before giving furosemide). Treatment of hypercalcaemia with a high dose of furosemide results in fluid and electrolyte depletion - meticulous fluid replacement and correction of electrolyte required.
Patients who are at risk from a pronounced fall in blood pressure premature infants (possible development nephrocalcinosis/nephrolithiasis; renal function must be monitored and renal ultrasonography performed). 5 for other interactions) concurrent NSAIDs should be avoided – if not possible diuretic effect of furosemide may be attenuated ACE-inhibitors & Angiotensin II receptor antagonists – severe hypotension may occur – dose of furosemide should be reduced/stopped (3 days) before starting or increasing the dose of these Laboratory monitoring requirements: Serum sodium Particularly in the older people or in patients liable to electrolyte deficiency Serum potassium The possibility of hypokalaemia should be taken into account, in particular in patients with cirrhosis of the liver, those receiving concomitant treatment with corticosteroids, those with an unbalanced diet and those who abuse laxatives.
1. Hypersensitivity to sulphonamides or sulphonamide derivatives. 4). 4). 4). 4). 4). 5). Porphyria. 6).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Furosemide in United Kingdom.
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3). g. itching, urticaria, other rashes or bullous lesions, fever, hypersensitivity to light, exsudative erythema multiforme (Lyell's syndrome and Stevens-Johnson syndrome), bullous exanthema, exfoliative dermatitis, purpura, AGEP (acute generalized exanthematous pustulosis) and DRESS (Drug rash with eosinophilia and systemic symptoms).
Metabolism and nutrition disorders As with other diuretics, electrolytes and water balance may be disturbed as a result of diuresis after prolonged therapy. Furosemide leads to increased excretion of sodium and chloride and consequently increase excretion of water.
In addition, excretion of other electrolytes (in particular potassium, calcium and magnesium) is increased. Metabolic acidosis can also occur. g. 5) and diet. g. where higher furosemide doses are administered to patients with normal renal function, acute severe electrolyte losses Symptoms of electrolyte imbalance depend on the type of disturbance: Sodium deficiency can occur; this can manifest itself in the form of confusion, muscle cramps, muscle weakness, loss of appetite, dizziness, drowsiness and vomiting.
Potassium deficiency manifests itself in neuromuscular symptoms (muscular weakness, paralysis), intestinal symptoms (vomiting, constipation, meterorism), renal symptoms (polyuria) or cardiac symptoms. Severe potassium depletion can result in paralytic ileus or confusion, which can result in coma.
Magnesium and calcium deficiency result very rarely in tetany and heart rhythm disturbances. Serum calcium levels may be reduced; in very rare cases tetany has been observed. Nephrocalcinosis/Nephrolithiasis has been reported in premature infants.
Serum cholesterol (reduction of serum HDL-cholesterol, elevation of serum LDL-cholesterol) and triglyceride levels may rise during furosemide treatment. During long term therapy they will usually return to normal within six months As with other diuretics, treatment with furosemide may lead to transitory increase in blood creatinine and urea levels.
Serum levels of uric acid may increase and attacks of gout may occur. The diuretic action of furosemide may lead to or contribute to hypovolaemia and dehydration, especially in elderly patients. Severe fluid depletion may lead to haemoconcentration with a tendency for thromboses to develop.
Increased production of urine may provoke or aggravate complaints in patients with an obstruction of urinary outflow. Thus, acute retention of urine with possible secondary complications may occur. For example, in patients with bladder-emptying disorders, prostatic hyperplasia or narrowing of the urethra.
Congenital, familial and genetic disorders If furosemide is administered to premature infants during the first weeks of life, it may increase the risk of persistence of patent ductus arteriosus. g. with shock) occurs rarely. fever Malaise Gastrointestinal disorders Uncommon: dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhoea, constipation.
Rare:
Acute Pancreatitis Gastro-intestinal disorders such as nausea, malaise or gastric upset (vomiting or diarrhoea) and constipation may occur but not usually severe enough to necessitate withdrawal of treatment. Renal and urinary disorders Uncommon: serum creatinine and urea levels can be temporarily elevated during […]
Regular monitoring of the potassium, and if necessary treatment with a potassium supplement, is recommended in all cases, but is essential at higher doses and in patients with impaired renal function. 5). A potassium-rich diet is recommended during long-term use.
8 for details of electrolyte and metabolic abnormalities) Renal function Frequent BUN in first few months of treatment, periodically thereafter. Long- term/high-dose BUN should regularly be measured. Marked diuresis can cause reversible impairment of kidney function in patients with renal dysfunction.
Adequate fluid intake is necessary in such patients. Serum creatinine and urea levels tend to rise during treatment Glucose Adverse effect on carbohydrate metabolism - exacerbation of existing carbohydrate intolerance or diabetes mellitus.
Regular monitoring of blood glucose levels is desirable. Other electrolytes Patients with hepatic failure/alcoholic cirrhosis are particularly at risk of hypomagnesia (as well as hypokalaemia). During long-term therapy (especially at high doses) magnesium, calcium, chloride, bicarbonate and uric acid should be regularly measured.
8): Regular monitoring for blood dyscrasias. 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.
Irrespective of treatment, dehydration was an overall risk factor for […]