Furosemide belongs to the class of medications called diuretics. It is used to treat edema (fluid retention) that occurs with congestive heart failure and disorders of the liver, kidney, and lung. It is also used to control mild to moderate high blood pressure. It may be used in combination with other medications to treat more severe high blood pressure. Furosemide works by increasing the amount of urine produced and excreted, and by removing excessive water (edema) from the body. The tablet form begins to work within an hour of being taken and usually lasts for 4 to 6 hours. The injectable form begins to work within ½ hour and lasts approximately 2 hours. Absorption: 60–67% absorbed after oral administration (↓ in acute HF and in renal failure); also absorbed from IM sites. Metabolism and Excretion: Minimally metabolized by liver, some nonhepatic metabolism, some renal excretion as unchanged drug. TIME/ACTION PROFILE (diuretic effect)CNS: blurred vision, dizziness, headache, vertigo EENT: hearing loss, tinnitus CV: hypotension GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, ↑ liver enzymes, nausea, pancreatitis, vomiting GU: ↑ BUN, excessive urination, nephrocalcinosis Derm: Edema PO: (Adults) 20–80 mg/day as a single dose initially, may repeat in 6–8 hr; may ↑ dose by 20–40 mg q 6–8 hr until desired response. Distribution: Crosses placenta, enters breast milk. Maintenance doses may be given once or twice daily (doses up to 2.5 g/day have been used in patients with HF or renal disease). Hypertension– 40 twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response; Hypercalcemia– 120 mg/day in 1–3 doses. PO: (Children 1 mo): 2 mg/kg as a single dose; may be ↑ by 1–2 mg/kg q 6–8 hr (maximum dose = 6 mg/kg). IM: IV: (Adults) 20–40 mg, may repeat in 1–2 hr and ↑ by 20 mg every 1–2 hr until response is obtained, maintenance dose may be given q 6–12 hr; Continuous infusion– Bolus 0.1 mg/kg followed by 0.1 mg/kg/hr, double q 2 hr to a maximum of 0.4 mg/kg/hr. IM: IV: Children 1–2 mg/kg/dose q 6–12 hr; Continuous infusion– 0.05 mg/kg/hr, titrate to clinical effect. Hypertension PO: (Adults) 40 twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response. Tablets: 20 mg, 40 mg, 80 mg, 500 mg Cost: Generic: 20 mg $6.50/100, 40 mg $7.11/100, 80 mg $10.83/100Oral solution (10 mg/m L–orange flavor, 8 mg/m L–pineapple–peach flavor): 8 mg/m L, 10 mg/m LCost: Generic: 10 mg/m L $10.40/60 m LSolution for injection: 10 mg/m LLab Test Considerations: Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. May cause ↓ serum sodium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, creatinine, and uric acid levels.furosemide is a sample topic from the Davis's Drug Guide.
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