Product Name: Furosemid
Common Brand Names: Furorese; Lasix
Pharmaceutical Category: Cardio / Blood Pressure / Cholesterol
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There is an additional general information about this medication active ingredient furosemide:
Furosemid is a loop diuretic. This medication violates the reabsorption of sodium and chlorine in the large segment of the ascending loop of Henle. Due to increasing separation of sodium ions occurs secondary (indirect osmotically bound water) increased excretion of water and increased secretion of potassium ions in the distal renal tubule. Simultaneously increased excretion of calcium and magnesium ions.
Furosemide has secondary effects caused by the release of neurotransmitters and intrarenal redistribution of intrarenal blood flow. On the background of a course of treatment does not occur the weakening effect.
When heart failure Furosemid quickly leads to a reduction of preload on the heart through the expansion of large veins. This drug exerts the hypotensive effect due to increased excretion of sodium chloride and reduction reactions of vascular smooth muscle to vasoconstrictor effects and by decreasing the BCC. Effect of furosemide after IV injection occurs in 5-10 minutes; after oral administration within 30-60 minutes, a maximum of the action is after 1-2 hours, the duration of effect is 2-3 hours (if reduced kidney function - up to 8 hours).
Furosemid reduces the incidence of atrial natriuretic factor in the plasma, causing vasoconstriction.
Diuretic effect develops in 3-4 minutes after IV injection and lasts 1-2 h; after oral taking - 20-30 minutes, lasts up to 4 hours.
After oral administration absorption of Furosemid is 60-70%. In severe kidney disease or chronic heart failure, extent of absorption is reduced.
Vd is 0.1 L / kg. Binding to plasma proteins (mainly albumin) is 95-99%. Furosemide metabolized in the liver. Excreted by the kidneys is 88% with bile - 12%. T1/2 in patients with normal renal function and liver is 0.5-1.5 h. When anuria T1/2 can be increased up to 1.5-2.5 h, with concomitant renal and liver failure - up to 11-20 hours.
Why is Furosemid prescribed?
Edematous syndrome of different genesis, including in chronic heart failure II-III stage, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome. Pulmonary edema, cardiac asthma, cerebral edema, eclampsia, conducting forced diuresis, severe hypertension, some forms of hypertensive crisis, hypercalcemia.
Dosage and administration
Dosing regimen set individually, depending on the evidence, the clinical situation, the patient's age. The treatment dosing regimen is adjusted depending on the value of diuretic response and the dynamics of the patient.
When furosemide administered orally an initial dose for adults is 20-80 mg / day, further, if necessary, the dose gradually increased to 600 mg / day. For children a single dose is 1-2 mg / kg.
The maximum oral dose for children is 6 mg / kg.
For IV jet or IM administration the dose for adults is 20-40 mg 1 time / day, in some cases - 2 times / day. For children the starting daily dosage for parenteral use is 1 mg / kg.
Furosemid side effects, adverse reactions
Cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased BCC.
CNS and peripheral nervous system: dizziness, headache, myasthenia gravis, calf muscle cramps (tetany), paresthesia, apathy, weakness, fatigue, lethargy, drowsiness, confusion.
Senses: blurred vision and hearing.
Digestive system: anorexia, dry mouth, thirst, nausea, vomiting, constipation or diarrhea, cholestatic jaundice, pancreatitis (acute).
Urogenital system: oliguria, acute urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, reduced potency.
Hemopoietic system: leucopenia, thrombocytopenia, agranulocytosis, aplastic anemia.
Water and electrolyte metabolism: hypovolemia, dehydration (the risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, chloropenia, hypocalcemia, hypomagnesemia, metabolic alkalosis.
Metabolism: hypovolemia, hypokalemia, hyponatremia, chloropenia, hypokalemic metabolic alkalosis (as a result of these violations - hypotension, dizziness, dry mouth, thirst, arrhythmias, muscle weakness, cramps), hyperuricemia (with the possible aggravation of gout), hyperglycemia.
Allergic reactions: purpura, urticaria, exfoliative dermatitis, erythema multiforme exudative, vasculitis, necrotizing vasculitis, pruritus, chills, fever, photosensitivity, anaphylactic shock.
Other: for optional IV injections - thrombophlebitis, renal calcinosis in preterm infants.
Acute glomerulonephritis, stenosis of the urethra, obstruction of urinary tract stones, acute renal failure with anuria, hypokalemia, alkalosis, precomatose state, severe hepatic failure, hepatic coma and precoma, diabetic coma, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (greater than 10 mm Hg), hypotension, acute myocardial infarction, pancreatitis, impaired water-electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, chloropenia, hypocalcemia, hypomagnesemia), digitalis toxicity, increased sensitivity to furosemide.
Using during pregnancy and breastfeeding
In pregnancy, the use of Furosemid is only possible within a short time only, when the intended use of therapy to the mother justifies the potential risk to the fetus.
As furosemide may be excreted in breast milk and to suppress lactation, if necessary use during lactation, a breastfeeding should be discontinued.
Category effects on the fetus by FDA - C.
With careful use Furosemid with prostatic hyperplasia, SLE, hypoproteinemia (risk of ototoxicity), diabetes (impaired glucose tolerance), stenosing atherosclerosis of cerebral arteries on the background of long-term therapy cardiac glycosides, elderly patients with severe atherosclerosis, pregnancy (especially first half), during lactation.
Before the treatment by Furosemid it should be compensated for electrolyte disturbances. During treatment with furosemide it is necessary to control blood pressure, electrolytes and glucose in the blood serum, liver and kidney function.
For the prevention of hypokalemia there is expedient to combine furosemide with potassium-sparing diuretics. With the simultaneous administration of furosemide and hypoglycemic agents it may be require dose adjustment of the latter.
There is not recommended to mix a solution of furosemide in the same syringe with any other drugs.
Furosemid drug interactions
Aminoglycosides, ethacrynic acid and cisplatin increases ototoxicity of this medication (especially when impaired renal function). Furosemide increases the danger of kidney damage with amphotericin B. if prescribed high doses of salicylates increases the risk of salicylism (competitive renal excretion), cardiac glycosides - hypokalemia and related arrhythmias, corticosteroids - an electrolyte imbalance. Furosemid reduces muscle relaxant activity of tubocurarine, potentiates the effect of succinylcholine. This drug reduces the renal clearance (and increases the likelihood of intoxication) lithium. Under the influence of furosemide increases the effect of ACE inhibitors and antihypertensive agents, warfarin, diazoxide, theophylline, attenuated - antidiabetic drugs, norepinephrine. Sucralfate and indomethacin (by inhibiting the synthesis of PG, the level of violations of plasma renin and aldosterone excretion) reduce the effectiveness of Furosemid. Probenecid increases the concentration of this medicine in serum (blocking excretion).
Furosemid in case of emergency / overdose
Symptoms: hypovolemia, dehydration, haemoconcentration expressed hypotension, reduction of BCC, collapse, shock, cardiac arrhythmias and conduction (including AV block, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.
Treatment: correction of water and electrolyte balance and acid-base balance, supplementation of BCC, symptomatic therapy, the maintenance of vital functions. The specific antidote is unknown.