Furosemiade " Lasix " : Commonly used drugs in Emergency & ICU

Furosemiade " Lasix " 

Trade names: Apo-Furosemide, Lasix

          Drug class: Loop diuretics

Pregnancy: (Category C/ D if used in pregnancy-induced hypertension.]

         Therapeutic actions

§ Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

      Indications

•       Edema associated with CHF, cirrhosis, renal disease (oral, IV)

•       Acute pulmonary edema (IV)

•       Hypertension (oral)

Contraindications/cautions

•       Contraindications: allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.

•       Use cautiously with SLE, gout, diabetes mellitus.

          Dose

§  by mouth, oedema, initially 40 mg in the morning; maintenance 20–40 mg daily, increased in resistant oedema to 80 mg daily or more;

§  CHILD 1–3 mg/kg daily, max. 40 mg daily

Oliguria, initially 250 mg daily; if necessary larger doses, increasing in steps of 250 mg, may be given every 4–6 hours to a max. Of a single dose of 2 g (rarely used)

§  By intramuscular injection or slow intravenous injection, initially 20–50 mg; CHILD 0.5–1.5 mg/kg to a max. daily dose of 20 mg

§  By intravenous infusion (by syringe pump if necessary), in oliguria, initially 250 mg over 1 hour (rate not exceeding 4 mg/minute), if satisfactory urine output not obtained in the subsequent hour further 500 mg over 2 hours, then if no satisfactory response within subsequent hour, further 1 g over 4 hours, if no response obtained dialysis probably required; effective dose (up to 1 g) can be repeated every 24 hours

Adverse effects

•       CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss

•       GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice

•       CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis

•       Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances

•       GU: Polyuria, nocturia, glycosuria, urinary bladder spasm

•       Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme

•       Other: Muscle cramps and muscle spasms

Clinically important interactions

•       Drug-drug

§  Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance)

§  Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin

§  Decreased absorption of furosemide with phenytoin

§  Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs

§  Decreased GI absorption with charcoal

    Nursing Considerations

•       Administer with food or milk to prevent GI upset.

•       Reduce dosage if given with other antihypertensive; readjust dosages gradually as BP responds.

•       Give early in the day so that increased urination will not disturb sleep.

•       Avoid IV use if oral use is at all possible.

•       Do not mix parenteral solution with highly acidic solutions with pH below 3.5.

•       Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.

•       Discard diluted solution after 24 h.

•       Refrigerate oral solution.

•       Measure and record weight to monitor fluid changes.

•       Arrange to monitor serum electrolytes, hydration, and liver function.

•       Arrange for potassium-rich diet or supplemental potassium as needed.

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