Hydro-ren

Furosemide

Oedema & hypertensive crises; acute or chronic renal failure.

Initially 20-50 mg by slow IV (not to exceed rate of 4 mg/min) or IM. Increase dose by 20 mg increments & not more often than every 2 hr if larger doses are required. Doses >50 mg may be given by slow IV infusion. Max daily dose: 1,500 mg. Severe renal impairment (serum creatinine >5 mg/dL) Not to exceed infusion rate of 2.5 mg/min. Childn 0.5-1.5 mg/kg daily up to max total dose: 20 mg daily.

Hypersensitivity to furosemide or sulphonamides. Hypovolaemia, dehydration, anuria. Severe hypokalaemia or hyponatraemia. Comatose or pre-comatose states associated w/ hepatic encephalopathy. Renal failure w/ anuria not responding to furosemide. Renal failure due to nephrotoxic or hepatotoxic drug poisoning; or associated w/ hepatic coma. Lactation.

IM administration is not suitable for acute conditions eg, pulmonary oedema. Not recommended in patients at high risk of radiocontrast nephropathy. Carefully monitor patients w/ partial obstruction of urinary outflow; hypotension; risk of pronounced fall in BP; latent diabetes or diabetes; gout; hepatorenal syndrome; hypoproteinaemia eg, associated w/ nephritic syndrome. Correct acid-base disturbances & fluid & electrolyte imbalance. Pregnancy. Women should not breastfeed during treatment. Premature infants.

Fluid & electrolyte imbalance. Visual disturbances, blurred vision, cardiac rhythm disturbances, hypotension, orthostatic hypotension, nausea, vomiting, diarrhea, dry mouth, hepatic encephalopathy, skin & mucous membrane reactions, asthenia, malaise, fever, local reactions.

May increase toxicity of drugs inducing QT interval prolongation syndrome eg, amisulpride, atomoxetine, pimozide, sotalol, sertindole. Increased risk of hypokalaemia w/ β₂ sympathomimetics (large doses), theophylline, corticosteroids, liquorice, carbenoxolone, laxatives (prolonged use), reboxetine, or amphotericin. May attenuate effect of antidiabetics & pressor amines. Effect may be reduced w/ probenecid & methotrexate. May decrease renal elimination of probenecid & methotrexate. Increased toxic effects of digoxin & other digitalis glycosides. May increase cardiac toxicity of anti-arrhythmic drugs (eg, amiodarone, disopyramide, flecainide, quinidine & sotalol) & may antagonise effects of lidocaine & mexiletine. Possible marked fall in BP & renal function deterioration w/ ACE inhibitors or angiotensin II receptor antagonists. May increase serum lithium levels. Avoid concomitant use w/ risperidone in elderly w/ dementia. Certain NSAIDs (including indomethacin, ketorolac, acetylsalicylic acid) may decrease effectiveness & may cause acute renal failure in cases of preexisting hypovolaemia or dehydration. May increase salicylate toxicity. May potentiate nephrotoxicity & ototoxicity of aminoglycosides & other ototoxic drugs. Increased risk of ototoxicity w/ vancomycin or polymyxins (colistin). Renal function impairment may develop w/ high doses of certain cephalosporins eg, cephaloridine. Risk of ototoxicity w/ cisplatin. Increased risk of gouty arthritis w/ ciclosporin. Effectiveness may be decreased w/ phenytoin. May increase risk of hyponatraemia w/ carbamazepine. May cause Na retention & increased risk of developing hypokalaemia w/ corticosteroids. Bolus doses may induce flushing, sweating, tachycardia & BP variations w/ chloral hydrate/triclofos. May affect response to neuromuscular blocking agents.

Diuretics

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