Furosemide

Undiluted direct IV injections may be administered at a rate of 20 to 40 mg per minute; for high doses (eg, ≥160 mg), consider a short-term infusion at a maximum rate of administration of 4 mg/minute; rapid administration increases the risk of ototoxicity due to the high concentrations achieved in a short period of time

Contraindications:

Hypersensitivity to furosemide or any component of the formulation; anuria

Interactions:

Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Cardiac Glycosides: Loop Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Risk C: Monitor therapy

Ceftizoxime: Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime. Risk C: Monitor therapy

Desmopressin: May enhance the hyponatremic effect of Loop Diuretics. Risk X: Avoid combination

Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider therapy modification

Pregnancy and Lactation:

Furosemide crosses the placenta, Monitor fetal growth if used during pregnancy

Furosemide is present in breast milk, caution be used if administered to a breastfeeding woman

Warning and Precaution:

• Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension
• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met
• Cirrhosis: In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy; correct electrolyte and acid/base imbalances prior to initiation when hepatic coma is present. Supplemental potassium or an aldosterone antagonist, when appropriate, may reduce risk of hypokalemia and metabolic alkalosis. Close monitoring warranted, especially with initiation of therapy.
• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.
• Prostatic hyperplasia/urinary stricture: May cause urinary retention due to increased urine production, especially upon initiation of therapy.
• Systemic lupus erythematosus: May cause systemic lupus erythematosus exacerbation or activation.

Adverse Reactions:

Cardiovascular: Necrotizing angiitis, orthostatic hypotension, thrombophlebitis

Dermatologic: Acute generalized exanthematous pustulosis, bulla (hemorrhagic), bullous pemphigoid, erythema multiforme, exfoliative dermatitis, lichenoid eruption, pruritus, skin photosensitivity, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Glycosuria, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hypovolemia, increased serum cholesterol, increased serum triglycerides

Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, oral irritation, pancreatitis, vomiting

Genitourinary: Bladder spasm

Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, hemolytic anemia

Hepatic: Hepatic encephalopathy, increased liver enzymes, intrahepatic cholestatic jaundice

Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, nonimmune anaphylaxis

Immunologic: Drug reaction with eosinophilia and systemic symptoms

Nervous system: Dizziness, headache, paresthesia, restlessness, vertigo

Neuromuscular & skeletal: Asthenia, muscle spasm

Ophthalmic: Blurred vision, xanthopsia

Renal: Acute kidney injury, calcium nephrolithiasis (pediatric patients), interstitial nephritis (allergic)

Storage:

Store below 30 and protect from freezing.