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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 Tablets BP 20mg are recommended for use in all indications when a prompt and effective diuresis is required. They are indicated for the maintenance therapy of mild oedema of any origin.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Adult s:
Initially 40mg in the morning; maintenance 20mg daily or 40mg on alternate days, increasing in resistant oedema to 80mg daily.
Elderl y:
Furosemide is generally eliminated more slowly in the elderly. The dosage should be titrated until the required response is achieved. Paediatric population: 1mg to 3mg/kg daily up to maximum total dose of 40mg/day.
Method of administration:
Oral.
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); 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 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 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. Insulin requirements of diabetic patients may increase. g. in nephritic syndrome) and/or when intravenous furosemide has been given too rapidly.
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.
Hepatobiliary disorders:
In isolated cases, intrahepatic cholestasis, an increase in liver transaminases or acute pancreatitis may develop. 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, and DRESS (Drug rash with eosinophilia and systemic symptoms).
3) • Hypotension. • Hypovolaemia. • Severe electrolyte disturbance – particularly hypokalaemia, hyponatraemia and acid-base disturbances. Furosemide is not recommended • In patients at high risk for radiocontrast nephropathy – should not be used for diuresis as part of the preventative measures against radiocontrast-induced nephropathy.
• In patients with rare hereditary problems of glucose-galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
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 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). Closely monitor patients with partial occlusion of the urinary tract. • Diabetes mellitus (latent diabetes may become overt: insulin requirements in established diabetes may increase: stop furosemide before a glucose tolerance test).
6). • Gout (furosemide may raise uric acid levels/precipitate gout) • Patients with hepatorenal syndrome. 3 – contraindication in Addison’s disease). g. nephrotic syndrome (effect of furosemide may be impaired and its ototoxicity potentiated – cautious dose titration required).
• Acute hypercalaemia (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 (furosemide may cause nephrocalcinosis/nephrolithiasis; renal function must be monitored and renal ultrasonography preformed. 5 for other interactions) • Concurrent NSAIDs should be avoided – if not possible diuretic effect of furosemide may be attenuated.
1. • Hypersensitivity to amiloride, sulphonamides or sulphonamide derivatives. 4). 4). 4). • Anuria or renal failure with anuria not responding to furosemide, renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents or renal failure associated with hepatic coma.
4). 4). 5). 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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Not known:
Acute generalised exanthematous pustulosis (AGEP) 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. g. with shock) occur rarely, fever, malaise Gastrointestinal disorders: Uncommon: dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhea, constipation.
Gastrointestinal disorders such as nausea, gastric upset (vomiting or diarrhoea) and constipation may occur but not usually severe enough to necessitate withdrawal of treatment.
Rare:
Acute pancreatitis Renal and urinary disorders: Uncommon: Serum creatinine and urea levels can be temporarily elevated during treatment with furosemide.
Rare:
Interstitial nephritis, acute renal failure Increased urine production, urinary incontinence, can be caused or symptoms can be exacerbated in patients with urinary tract obstruction. Acute urine retention, possibly accompanied by complications, can occur for example in patients with bladder disorders, prostatic hyperplasia or narrowing of the urethra.
Pregnancy, puerperium and perinatal conditions:
In premature infants with respiratory distress syndrome, administration of Furosemide Tablets in the initial weeks after birth entails an increased risk of a persistent patent ductus arteriosus. In premature infants, furosemide can be […]
• ACE-inhibitors and 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 elderly 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.
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. If these occur, stop furosemide immediately. • Liver damage. • Idiosyncratic reactions. Other alterations in lab values • Serum cholesterol and triglycerides may rise but usually return to normal within 6 months of starting furosemide.
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 cotreatment with other potent diuretics should be considered prior to the decision […]