FUROSEMIDE

Posology 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:

A more suitable dosage form should be used in this age group.

Elderly:

Furosemide is generally eliminated more slowly. The dosage should be titrated until the required response is achieved. Method of Administration For oral administration. 4) Dosage adjustment may be necessary in patients with • hypoproteinaemia • liver congestion/dysfunction.

4): Colestyramine and colestipol - Administer 2 to 3 hours apart.

The following classification of CIOMS frequencies according to the MedDRA database is used where applicable: 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).

g. in nephritic syndrome) Cardiac disorders Uncommon orthostatic intolerance, cardiac arrhythmias, increased risk or persistence of patent ductus arteriosus in premature infants Very common hypotension, (which, if pronounced may cause signs and symptoms such as impairment of concentration and reactions, light-headedness, sensations of pressure in the head, headache, drowsiness, weakness, disorders of vision, dry mouth, orthostatic intolerance) Common hypovolaemia Vascular disorders Rare vasculitis, thrombosis, shock Uncommon dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhoea, constipation Gastrointestinal disorders Rare acute pancreatitis (in long-term diuretic treatment, including furosemide) Hepatobiliary disorders Rare pure intrahepatic cholestasis (jaundice), hepatic function abnormal Rare rash, pruritus, photosensitivity, toxic epidermal necrolysis Skin and subcutaneous tissue disorders Frequency not known urticaria, erythema multiforme, purpura, exfoliative dermatitis, itching, allergic reactions, such as skin rashes, various forms of dermatitis including urticaria, bullous lesions, acute generalised exanthematous pustulosis (AGEP).

When these occur treatment should be withdrawn. g. with shock) Investigations Common creatinine increased, blood urea increased Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

3) • Hypotension. • Hypovolaemia. • Severe electrolyte disturbances – particularly hypokalaemia, hyponatraemia and acid-base disturbances. 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. nephrotic syndrome (effect of furosemide may be impaired and its risk of ototoxicity potentiated - cautious dose titration required) • in moderate liver congestion dosage adjustment may be needed • patients who are at risk from a pronounced fall in blood pressure.

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 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.

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