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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 is a diuretic recommended for use in all indications where a prompt and effective diuresis is required. 1) The treatment of oedema associated with congestive heart failure, cirrhosis of the liver, renal disease including nephrotic syndrome and pulmonary oedema. 2) The treatment of peripheral oedema due to…
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Furosemide has a very wide therapeutic range, the effect being proportional to dosage. Furosemide is best given as a single dose either daily or on alternate days.
Adults and children over 12 years:
Oedema: Initially 40mg daily in the morning; ordinarily a prompt diuresis ensues and the starting dose can then be maintained or even reduced. Diuresis lasts for approximately four hours following administration and hence the time of administration can be adjusted to suit the patient’s requirements.
Maintenance dose is 20mg daily or 40mg on alternate days, increased in resistant oedema to 80mg daily. Hypertension: 20-40mg twice daily; if 40mg twice daily does not lead to a clinically satisfactory response, the addition of other antihypertensive agents, rather than an increase in the dose of furosemide should be considered.
Children under 12 years: 1-3 mg/kg body weight daily.
A more suitable dosage form should be used in this age group Elderly:
In the elderly, furosemide is generally eliminated more slowly. 4).
Method of administration:
Oral
Undesirable effects can occur with the following frequencies: very common (> 1/10), common (> 1/100, < 1/10), uncommon (> 1/1,000, < 1/100), rare (> 1/10,000, < 1/1,000) and very rare (< 1/10,000, including isolated reports).
Blood and lymphatic system disorders:
Uncommon: Thrombocytopenia Rare: • eosinophilia • leukopenia • bone marrow depression (necessitates withdrawal of treatment). The haemopoietic status should therefore be regularly monitored. Very Rare: • aplastic anaemia or haemolytic anaemia • agranulocytosis Nervous system disorders Rare: • paraesthesia • hyperosmolar coma Not known: dizziness, fainting or 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. 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, exudative erythema multiforme (Lyell's syndrome and Stevens- Johnson syndrome), bullous exanthema, various forms of dermatitis (including exfoliative dermatitis), purpura and DRESS (Drug rash with eosinophilia and systemic symptoms).
3): • Hypotension and 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.
• In patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. 2). • difficulty of 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). 3 and below - monitoring required). 3 and below - monitoring required). 3 - contraindication in Addison's disease). g. nephrotic 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) • 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.
1. Known hypersensitivity to sulphonamides and sulphonamide derivatives. Anuria or renal failure with anuria not responding to furosemide. 5). Renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents. Renal failure associated with hepatic coma.
4). 4). 4). Porphyria. 5). 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:
AGEP (acute generalized exanthematous pustulosis). When these occur, treatment with furosemide should be stopped.
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 increased 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.
Nephrolithiasis/Nephrocalcinosis 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, diarrhoea, constipation.
Rare:
Acute Pancreatitis The gastro-intestinal disorders such as nausea 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 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 […]
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 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 plasma electrolytes, particularly sodium and potassium should be carried out and electrolyte replacement therapy instituted accordingly, 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). During long-term or high dose therapy potassium supplements are recommended. 8 for details of electrolyte and metabolic abnormalities). • Renal function Marked diuresis can cause reversible impairment of kidney function in patients with renal dysfunction.
Frequent BUN determinations during the first few months of treatment, periodically thereafter. Long-term/high-dose BUN should regularly be measured. 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.
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 […]