Furosemide: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: [[Diuretic]] | ||
*Dosage Forms: | *Dosage Forms:20, 40, 80 | ||
*Common Trade Names: Lasix | *Common Trade Names: Lasix | ||
*Approximately 50% bioavailability, so converting from oral to IV dose doubles oral dose<ref>Asare K. Management of Loop Diuretic Resistance in the Intensive Care Unit. Am J Health Syst Pharm. 2009;66(18):1635-1640.</ref> | |||
*Furosemide absorption may be reduced in decompensated [[CHF]]<ref>Vasko MR, Brown-Cartwright D, Knochel JP et al. Furosemide absorption is altered in decompensated congestive heart failure. Ann Intern Med. 1985; 102: 314–8.</ref> | |||
==Adult Dosing== | ==Adult Dosing== | ||
''40 mg [[furosemide]] = 20 mg [[torsemide]] = 1 mg [[bumetanide]] = 50 mg [[ethacrynic acid]]'' | |||
*[[Fluid overload]]: Typically 40 mg IV or normal PO dosage IV | |||
*[[hypertension]]: 10-40 mg PO QDAY-BID, max 600 mg/day | |||
*[[Hypercalcemia]]: 120 mg/day PO divided QDAY - TID | |||
*Continuous infusion may increase diuresis effect and minimize post-diuretic sodium retention and "diuretic braking"<ref>Pivac N, Rumboldt Z, Sardelic S et al. Diuretic effects of furosemide infusion versus bolus injection in congestive heart failure. Int J Clin Pharmacol Res. 1998; 18:121–8.</ref> | |||
**Start 0.1 mg/kg/hr, increase hourly to max of 0.75 mg/kg/hr<ref>Schuller D, Lynch JP, Fine D. Protocol-guided diuretic management: comparison of furosemide by continuous infusion and intermittent bolus. Crit Care Med. 1997; 25:1969–75.</ref> | |||
**Target > 1 mL/kg/hr | |||
**Monitor for ototoxicity | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Volume overload 0.5-2mg/kg/dose IV | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]:C | ||
*Lactation: | *Lactation: safety unknown | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult: no adjustment, contraindicated in anuria | ||
**Pediatric | **Pediatric: no adjustment, contraindicated in anuria | ||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult: not defined | ||
**Pediatric | **Pediatric: not defined | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*anuria | |||
*electrolyte imbalances | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*hypokalemia | |||
*metabolic alkalosis | |||
*hypovolemia | |||
*ototoxicity | |||
*hemolytic anemia | |||
*vasculitis | |||
*steven-johnson syndrome | |||
*pancreatitis | |||
*eosinophilia | |||
===Common=== | |||
*urinary frequency | |||
*dizziness | |||
*nausea/vomiting | |||
*weakness | |||
*muscle cramping | |||
*hypokalemia | |||
*hypomagnesemia | |||
*blurred vision | |||
*diarrhea | |||
*hyperglycemia | |||
*hyperuricemia | |||
*tinnitus | |||
==Pharmacology== | |||
*Half-life: 30-60 min | |||
*Metabolism: liver minimally | |||
*Excretion: urine | |||
*Mechanism of Action: inhibits loop of henle and proximal and distal convoluted tubule sodium and chloride resorption | |||
== | ==Indications by Condition== | ||
''The following table is automatically generated from disease/condition pages across WikEM.'' | |||
{{#ask:[[Has DrugName::Furosemide]] | |||
|?Has Indication=Indication | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|?Has Route=Route | |||
|?Has Population=Population | |||
|format=table | |||
|headers=plain | |||
|mainlabel=- | |||
|sort=Has Indication | |||
|limit=50 | |||
}} | |||
==See Also== | ==See Also== | ||
==References== | |||
<references/> | <references/> | ||
[[Category: | |||
[[Category:Pharmacology]] | |||
Latest revision as of 21:56, 20 March 2026
General
- Type: Diuretic
- Dosage Forms:20, 40, 80
- Common Trade Names: Lasix
- Approximately 50% bioavailability, so converting from oral to IV dose doubles oral dose[1]
- Furosemide absorption may be reduced in decompensated CHF[2]
Adult Dosing
40 mg furosemide = 20 mg torsemide = 1 mg bumetanide = 50 mg ethacrynic acid
- Fluid overload: Typically 40 mg IV or normal PO dosage IV
- hypertension: 10-40 mg PO QDAY-BID, max 600 mg/day
- Hypercalcemia: 120 mg/day PO divided QDAY - TID
- Continuous infusion may increase diuresis effect and minimize post-diuretic sodium retention and "diuretic braking"[3]
- Start 0.1 mg/kg/hr, increase hourly to max of 0.75 mg/kg/hr[4]
- Target > 1 mL/kg/hr
- Monitor for ototoxicity
Pediatric Dosing
- Volume overload 0.5-2mg/kg/dose IV
Special Populations
- Pregnancy Rating:C
- Lactation: safety unknown
- Renal Dosing
- Adult: no adjustment, contraindicated in anuria
- Pediatric: no adjustment, contraindicated in anuria
- Hepatic Dosing
- Adult: not defined
- Pediatric: not defined
Contraindications
- Allergy to class/drug
- anuria
- electrolyte imbalances
Adverse Reactions
Serious
- hypokalemia
- metabolic alkalosis
- hypovolemia
- ototoxicity
- hemolytic anemia
- vasculitis
- steven-johnson syndrome
- pancreatitis
- eosinophilia
Common
- urinary frequency
- dizziness
- nausea/vomiting
- weakness
- muscle cramping
- hypokalemia
- hypomagnesemia
- blurred vision
- diarrhea
- hyperglycemia
- hyperuricemia
- tinnitus
Pharmacology
- Half-life: 30-60 min
- Metabolism: liver minimally
- Excretion: urine
- Mechanism of Action: inhibits loop of henle and proximal and distal convoluted tubule sodium and chloride resorption
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Coarctation of the aorta | 1-2mg/kg IV | CHF management | IV | Pediatric |
| Congestive heart failure | Double home dose IV or up to 2.5x dose (e.g., if 40 mg PO daily → 40-100 mg IV) | Diuresis (hold if no fluid overload; give nitrates first) | IV | Adult |
| Hypermagnesemia | 20-40mg | Promote renal magnesium excretion | IV | Adult |
| Idiopathic intracranial hypertension | 20mg BID | Adjunctive diuresis | PO | Adult |
| Pulmonary edema | 20-40mg | Diuresis after nitroglycerin has been initiated | IV | Adult |
| Volume overload | 20-40mg IV bolus (diuretic-naive); or IV dose >= home oral daily dose | Loop diuretic, first-line for decongestion | IV | Adult |
See Also
References
- ↑ Asare K. Management of Loop Diuretic Resistance in the Intensive Care Unit. Am J Health Syst Pharm. 2009;66(18):1635-1640.
- ↑ Vasko MR, Brown-Cartwright D, Knochel JP et al. Furosemide absorption is altered in decompensated congestive heart failure. Ann Intern Med. 1985; 102: 314–8.
- ↑ Pivac N, Rumboldt Z, Sardelic S et al. Diuretic effects of furosemide infusion versus bolus injection in congestive heart failure. Int J Clin Pharmacol Res. 1998; 18:121–8.
- ↑ Schuller D, Lynch JP, Fine D. Protocol-guided diuretic management: comparison of furosemide by continuous infusion and intermittent bolus. Crit Care Med. 1997; 25:1969–75.