Hydro-ren Special Precautions

Urinary output must be secured. Patients with partial obstruction of urinary outflow have an increased risk of developing acute retention and require careful monitoring. Where indicated, steps should be taken to correct hypotension or hypovolaemia before commencing therapy.
Careful monitoring is required in: Patients with hypotension.
Patients who are at risk from a pronounced fall in blood pressure.
Patients with latent diabetes or diabetes, as furosemide may cause hyperglycaemia and increased insulin requirement.
Patients with gout.
Patients with hepatorenal syndrome.
Patients with hypoproteinaemia e.g. associated with nephritic syndrome (the effect of furosemide may be weakened and its ototoxicity potentiated). Cautious dose titration is required.
Premature infants. Furosemide may cause nephrocalcinosis/nephrolithiasis; renal function must be monitored and renal ultrasonography performed.
Caution should be observed in patients with fluid and electrolyte imbalance and acid-base disturbances must be corrected. This may require temporary discontinuation of furosemide.
It is important to ensure that infusion rates do not exceed 4mg of Furosemide per minute. Tinnitus and deafness may occur if this rate is exceeded.
In patients who are at high risk of radiocontrast nephropathy, furosemide is not recommended for use as a diuretic as part of the preventative measures against radiocontrast-induced nephropathy.