Fusix Dosage/Direction for Use

Tablet: In the treatment of edema, the usual initial dose is 40 mg once daily by mouth, adjusted as necessary according to response. Mild cases may response to 20 mg daily or 40 mg on alternate days. Some patients may require doses of 80 mg or more daily given as one or two doses daily, or intermittently. Severe cases may require gradual titration of the frusemide dosage up to 600 mg daily. If necessary further doses may be given, increasing by 20 mg increments and not give more often than every 2 hours.
For children, the usual dose by mouth is 1 to 3 mg per kg body-weight daily up to a maximum of 40 mg daily. In the treatment of hypertension, frusemide is given in doses of 40 to 80 mg daily, either alone, or in conjunction with other antihypertensive agents.
High-dose therapy: Patients who do not respond to a dose of 1 g probably require dialysis. If the response to either method of administration is satisfactory, the effective dose (of up to 1 g) may then be repeated every 24 hours. Dosage adjustments should subsequently be made according to the patient's response. Alternatively, treatment may be maintained by mouth; 500 mg should be given by mouth for each 250 mg required by injection.
In the treatment of chronic renal insufficiency, an initial dose of 250mg may be given by mouth, increased, if necessary in steps of 250mg every 4 to 6hours to a maximum of 1.5g in 24hours; in exceptional cases up to 2.0g in 24hours, may be given.
Dosage adjustments should subsequently be made according to the patient's response.
During treatment with these high-dose forms of frusemide therapy, careful laboratory control is essential. Fluid balance and electrolytes should be carefully controlled and, in particular, in patients with shock, measures should be taken to correct the blood pressure and circulating blood volume, before commencing this type of treatment. High dose frusemide therapy is contra-indicated in renal failure caused by nephrotoxic or hepatotoxic agents, and in renal failure associated with hepatic coma.
Injection: In an emergency or when oral therapy cannot be given, the equivalent of 20 to 50 mg of frusemide may be administered by intramuscular or slow intravenous injection as the sodium salt at a rate not exceeding 4 mg per minute. If necessary further doses may be given, increasing by 20 mg increments and not given more often than every 2 hours. If doses greater than 50 mg are required it is recommended that they be given by slow intravenous infusion. For pulmonary oedema, sources in the USA have recommended that if an initial slow intravenous injection of 40 mg (over 1 to 2 minutes) does not produce a satisfactory response within one hour, the dose may be increased to 80 mg given slowly intravenously.
For children, suggested doses by injection are 0.5 to 1.5 mg per kg daily up to a maximum of 20 mg daily, although doses of up to 6 mg per kg have been suggested.
ln the treatment of hypertension, frusemide is given in doses of 40 to 80 mg daily, either alone, or in conjunction with other antihypertensive agents.
High-dose therapy: In the management of oliguria in acute or chronic renal failure where the glomerular filtration rate is less than 20 ml per minute frusemide 250 mg diluted to 250 ml in a suitable diluent is infused over one hour. If urine output is insufficient within the next hour, this dose may be followed by 500 mg added to an appropriate infusion fluid, the total volume of which must be governed by the patient's state of hydration, and infused over approximately 2 hours. If a satisfactory urine output has still not been achieved within one hour of the end of the second infusion then a third dose of 1 g may be infused over approximately 4 hours. The rate of infusion should never exceed 4 mg per minute. ln oliguric or anuric patients with significant fluid overload, the injection may be given without dilution directly into the vein, using a constant-rate infusion pump with a micrometer screw-gauge adjustment; the rate of administration should still never exceed 4 mg per minute.
Patients who do not respond to a dose of 1 g probably require dialysis. If the response to either method of administration is satisfactory, the effective dose (of up to 1 g) may then be repeated every 24 hours.
Dosage adjustments should subsequently be made according to the patient's response. Alternatively, treatment may be maintained by mouth; 500 mg should be given by mouth for each 250 mg required by injection.
During treatment with these high-dose forms of frusemide therapy, careful laboratory control is essential. Fluid balance and electrolytes should be carefully controlled and, in particular, in patients with shock, measures should be taken to correct the blood pressure and circulating blood volume, before commencing this type of treatment. High dose frusemide therapy is contra-indicated in renal failure caused by nephrotoxic or hepatotoxic agents, and in renal failure associated with hepatic coma.