Furosemide Kabi

Furosemide

Oedema &/or ascites caused by cardiac or hepatic diseases; oedema caused by renal diseases (in case of nephrotic syndrome, treatment of the underlying disease is essential); pulmonary oedema (eg, in case of acute heart failure); hypertensive crisis (in addition to other therapeutic measures).

Slow IV. Max rate: 4 mg/min. Adult & adolescent >15 yr Initially 20-40 mg (1 or 2 amp) IV. If large doses are required, give dose by 20-mg increments not more often than every 2 hr. Max daily dose: 1,500 mg. Childn <15 yr 0.5-1 mg/kg daily up to a max daily dose of 20 mg. Severe renal impairment (serum creatinine >5 mg/dL) Recommended infusion rate: 2.5 mg/min should not be exceeded. Elderly Initially 20 mg/day, increasing gradually until required response is achieved. Oedema associated to chronic & acute CHF Adult Initially 20-40 mg daily; given in 2 or 3 individual doses per day for chronic CHF, & as a bolus for acute CHF. Oedema associated w/ renal disease Adult Initially 20-40 mg daily. Dialyzed patient Usual maintenance dose: 250-1,500 mg daily. Hypertensive crisis (in addition to other therapeutic measures) Adult Initially 20-40 mg IV bolus inj. Pulmonary oedema (in acute heart failure) Adult Initially 40 mg IV. If required, another 20-40 mg after 30-60 min.

Hypersensitivity to furosemide & to sulphonamides (eg, sulfonylureas or antibiotics of sulphonamide group). Patients w/ renal failure w/ oligoanuria not responding to furosemide. Renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents. Patients in pre-comatose & comatose state associated w/ hepatic encephalopathy. Patients w/ severe hypokalaemia, severe hyponatraemia, hypovolaemia w/ or w/o hypotension or dehydration. Lactation.

Careful monitoring in patients w/ partial obstruction of urinary outflow; hypotension or at increased risk from pronounced fall in BP; manifest or latent DM or variation of glycaemia (regular monitoring of blood glucose levels necessary); gout & hyperuricaemia (regular monitoring of uric acid levels in serum necessary); hepatic disease or hepatorenal syndrome; hypoproteinaemia; co-administration w/ lithium salts; acute porphyria. NSAIDs may antagonise the diuretic effect of furosemide & other diuretics. Use of NSAIDs w/ diuretics may increase the risk of nephrotoxicity. Cautious dose titration is required in electrolyte variations (eg, hypokalaemia, hyponatraemia); fluid variations, dehydration, blood vol reduction w/ circulatory collapse & possibility of thrombosis & embolism, particularly in elderly, w/ excessive use; ototoxicity (if administered faster than 4 mg/mL); administration of high dosages; administration in progressive & severe renal disease; administration w/ sorbitol; administration in lupus erythematosus; medication that prolong the QT interval; premature infants. Symptomatic hypotension leading to dizziness, fainting or loss of consciousness can occur. Perform regular monitoring of serum Na, K & creatinine. Hypovolaemia or dehydration as well as any significant electrolyte or acid-base disturbances must be corrected. Cases of photosensitivity reactions. May interfere w/ doping tests. Concomitant use w/ risperidone. May impair ability to drive or operate dangerous machinery. Pregnancy.

Hypovolaemia & dehydration; severe fluid depletion may lead to haemoconcentration w/ a tendency for thromboses to develop; decreased glucose tolerance; disturbance in electrolyte & water balance (hypokalaemia, hyponatraemia, metabolic alkalosis); K depletion may occur; hyponatraemia; hypocalcaemia; hypomagnesaemia; increased uric acid levels & gout attacks; tinnitus aurium; reduction in BP; intrahepatic cholestasis, cholestatic jaundice, hepatic ischaemia, increase in hepatic transaminases; may exacerbate or reveal acute retention of urine symptoms, vasculitis, glycosuria, transitory increase of blood creatinine & urea levels; nephrolithiasis & nephrocalcinosis in premature infants.

Reduced excretion of lithium. Increased mortality in elderly patients w/ dementia concomitantly receiving risperidone. Risk of arrhythmias w/ drugs that prolong QT interval or produce hypokalaemia eg, class I & class III antiarrhythmics (eg, quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, ibutilide, dofetilide); cardiac glycosides (digoxin); antipsychotics (eg, sultopride, phenothiazines, benzamide, butyrophenones); other neuroleptics (pimozide); other miscellaneous substances (eg, bepridil, cisapride, erythromycin, halofantrine, sparfloxacine, pentamidine, quinolone). Increased K loss w/ amphotericin B, glucocorticoids, carbenoxolone, tetracosactide, laxatives, liquorice. Increased risk of hyponatraemia w/ carbamazepine or aminoglutethimide. Risk of induced acute renal failure in cases of pre-existing hypovolaemia & reduced diuretic, natriuretic & antihypertensive effect of furosemide w/ NSAIDs. When co-administered w/ high doses of salicylates, predisposition for salicylic toxicity may be increased. Potentiated hypotensive effects &/or renal effects of ACE inhibitors & AIIA. Potentiated effect of other antihypertensives (eg, other diuretics, β-blocker). Potential for additive hypotensive effect w/ amifostine, baclofen or α-blocker. Increased risk of postural hypotension w/ TCAs (eg, imipramine, nortriptyline, amitriptyline) or antipsychotic agents. May attenuate effects of antidiabetic agents. IV administration of furosemide in a 24-hr period prior to chloral hydrate administration may lead to flush, hyperhidrosis, anxiety, nausea, increase in BP & tachycardia. Blood levels of furosemide & of fibric acid derivates (eg, clofibrate & fenofibrate) may be increased during concurrent administration. Concomitant administration of furosemide & iodinated contrast media may increase the risk of contrast media associated acute renal failure. Increased blood levels of metformin. Reduced bioavailability w/ colestyramine & colestipol. May intensify nephrotoxic effects of nephrotoxic drugs (eg, cephaloridine, cephalothin, ceftazidime, polymyxins, aminoglycosides, organoplatins, immunosuppressants, foscarnet, pentamidine). Risk of renal impairment w/ cephalosporins. Risk of ototoxicity w/ cisplatin. May intensify ototoxicity of aminoglycosides (eg, kanamycin, gentamicin, tobramycin). In small doses of furosemide, potentiated neuromuscular blockade of competitive neuromuscular blocker (curare-type muscle relaxants like atracurium & tubocurarine) & depolarising neuromuscular blocker (like succinylcholine); in high doses, antagonism of neuromuscular blockade. Synergistic effect w/ K-sparing diuretics. Decreased clearance of theophylline. Increased risk of dehydration, hyponatraemia & hypokalaemia w/ thiazides. Reduced effect w/ probenecid, methotrexate, other drugs that undergo significant renal tubular secretion. Attenuated effect w/ anticonvulsants (eg, phenytoin, phenobarb). Attenuated effect of pressor amines. Increased risk of gouty arthritis secondary to furosemide-induced hyperuricemia & insufficient renal excretion of urates associated to ciclosporin.

Diuretics

C03CA01 - furosemide ; Belongs to the class of high-ceiling sulfonamide diuretics.

P₁S₁S₃