Furosemide: indications for use

What helps tablets and injections Furosemide? Instructions for use reports that the medicine is a common diuretic drug to relieve swelling syndrome. This tool enhances the excretion of water from the body, as well as magnesium and calcium ions.

The main indications for Furosemide are: edema syndrome of various etiologies, eclampsia, pulmonary edema, hypercalcemia, cardiac asthma and some forms of hypertensive crisis.

Composition and form of release

The medication is available in the form of:

  • 40 mg tablets No. 50 (2 packs of 25 tablets or 5 packs of 10 tablets in a pack),
  • injection solution (2 ml ampoules, package No. 10).

Furosemide diuretic tablets contain 40 mg of the active substance, as well as potato starch, milk sugar, povidone, MCC, gelatin, talc, magnesium stearate, colloidal silicon dioxide.

In the composition of the solution for i / m and iv administration, the active substance is contained in a concentration of 10 mg / ml. Auxiliary components: sodium chloride, sodium hydroxide, water d / and. Instructions for use with a description of the technique are included in the box with the drug.

Description of the drug, release form

Furosemide is a diuretic drug designed to remove stagnant fluid in the body. It is used to reduce edema syndrome in pathologies of the renal, cardiovascular system. The drug is produced by pharmaceutical companies in tablet form and as a solution for injection.

For outpatient treatment, tablets are more suitable, each of which contains 40 mg of the active ingredient. Magnesium stearate, potato starch, lactose, povidone, talc, silicon dioxide are present as complementary substances in the composition. In a hospital, an injection solution is used. Each milliliter contains 10 mg of furosemide, in one ampoule - 2 ml. In addition, chloride and sodium hydroxide, purified water are present in the solution.

Furosemide has a pronounced diuretic effect. It promotes the removal of large amounts of water, but at the same time enhances the excretion of calcium and magnesium ions. Thanks to the use of the drug in cases of heart failure, there is a rapid decrease in the load on the heart muscle, provoked by the expansion of large veins.

With intravenous administration, the effect of the drug begins after 5-7 minutes, with intramuscular administration - after 15 minutes with oral administration - after about an hour. The diuretic effect of the drug is long, and ranges from three to eight hours.

Pharmachologic effect

The active component of the drug Furosemide, which causes a diuretic effect, promotes enhanced excretion of water with a simultaneous increase in the excretion of calcium and magnesium ions. When using Furosemide against a background of heart failure, a rapid decrease in preload on the heart occurs, caused by the expansion of large veins.

After intravenous administration, the action of Furosemide occurs quickly - after 5-10 minutes, after oral administration - on average after an hour. The duration of the diuretic effect from taking Furosemide is two to three hours, and with reduced kidney function, the effect of the drug can last up to eight hours.

The mechanism of action of the drug

Furosemide refers to loop diuretics. When used in standard doses, it inhibits the reverse absorption of sodium and chlorine in the thickened part of the Henle loop. Due to increased excretion of sodium ions, abundant release of water occurs.

The drug is absorbed quite quickly and almost completely.The highest concentration of the active ingredient in the blood is recorded one hour after application. When eating, the action slows down, but does not become smaller. Furosemide binds to plasma proteins by 96-97%.

In patients with renal failure, binding may decrease.

When taking the drug, negative side effects are rarely recorded.

The substance is partially excreted through the digestive system and the genitourinary system. Therefore, before use, it is necessary to verify the absence of pathological processes in these organs. In age-related patients, the onset of the therapeutic effect is much less.

Indications for use

The medicine is most often prescribed in the complex treatment of pathologies associated with abnormalities in the work of the heart and the entire vascular system. Against the background of such diseases, problems with blood supply to other organs develop. They suffer from a lack of oxygen and literally “starve”. Furosemide helps with the following pathologies diagnosed in the patient:

There is a myth that with regular use, the drug promotes weight loss. Since weight loss is achieved only by removing fluid, after stopping intake, lost kilograms go back. Drinking Furosemide for weight loss without medical advice is strictly prohibited.

Release form

The drug Furosemide goes on sale in two forms - for oral administration and injection:

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Furosemide - what are these pills from?

Tablets are prescribed for:

  • edema caused by kidney pathologies (including nephrotic syndrome), stage II-III heart failure or cirrhosis,
  • manifested in the form of pulmonary edema of acute heart failure,
  • hypertensive crisis (as a means of monotherapy or in combination with other drugs),
  • severe forms of arterial hypertension,
  • cerebral edema,
  • hypercalcemia,
  • eclampsia.

Also, the drug is used to conduct forced diuresis in case of poisoning with chemicals that are excreted from the body by the kidneys in unchanged form.

With increased blood pressure developing against the background of chronic renal failure, Furosemide is prescribed if thiazide diuretics are contraindicated in the patient, as well as if Clcr does not exceed 30 ml per minute).

Contraindications and limitations

Not all patients are allowed to take Furosemide. There are a number of contraindications in which treatment with this drug should not be:

  • Anuria combined with renal failure
  • severe liver disease,
  • postcomatose state

In addition, the drug is not prescribed for patients with previously identified allergic reactions to the components included in the composition, as well as for individual intolerance. It is forbidden to take the drug for children under 3 years old.

In addition to contraindications, the instructions for the drug indicate conditions in which treatment with Furosemide must be carried out under strict medical supervision. These deviations include:

  • myocardial infarction
  • arterial hypotension,

In the presence of such pathologies, a thorough examination is necessary before prescribing the drug. Treatment is carried out under the supervision of a doctor with regular monitoring of ECG and blood counts.

Pharmacological properties

Diuretic tablets "Furosemide", which helps the medicine for kidney diseases, intensely remove water and magnesium and calcium ions from the body. Thus, the diuretic effect of the active element is manifested. When using the remedy for heart failure, the load on the myocardium decreases.

This occurs as a result of the expansion of arteries and veins.The action of the drug is observed after 5 minutes with intravenous injection and after an hour when using tablets. The therapeutic effect lasts for 2-3 hours. If the kidney function deteriorates, the medication is effective for 6-8 hours.

Side effects and special instructions

Before using Furosemide, it is necessary to familiarize yourself with the possible negative reactions of the body to this drug. Against the background of therapy, the development of functional deviations in the operation of some systems is possible:

    Cardiovascular. Possible jumps in blood pressure, there is a risk of arrhythmias, anemia, sometimes there is a tendency to thrombosis.

If any of these symptoms appear during treatment with Furosemide, the medication should be discontinued and you should contact a medical institution to replace the drug or adjust the dose.

Depending on the indications, therapy with this drug should be accompanied by the use of drugs that replenish the loss of calcium, magnesium and potassium. In this case, Furosemide and Asparkam are prescribed at the same time, it is necessary to take these drugs with edema in combination.

What helps Furasemide in ampoules

In the annotation for Furosemide in ampoules, the same indications for use are given as for the tablet form of the drug.

With parenteral administration, the drug acts faster than when taken orally. Therefore, doctors to the question “What is the solution intended for?”, Answer that the introduction of furosemide iv allows you to quickly reduce pressure (arterial, in the pulmonary artery, in the left ventricle) and preload on the heart, which is extremely important in emergency conditions (for example with hypertensive crisis).

In the case when the drug is prescribed for nephrotic syndrome, treatment of the underlying disease should be in the first place.

The medicine "Furosemide": what helps

The medication is prescribed for various types of edematous syndrome. Indications for the use of the drug "Furosemide" include the following diseases and conditions:

  • heart asthma
  • excess calcium in the body
  • pulmonary edema,
  • hypertensive crisis,
  • heart failure
  • eclampsia
  • cerebral edema,
  • complicated arterial hypertension,
  • nephrotic syndrome
  • cirrhosis of the liver.

The drug is also used when performing forced diuresis.

Pharmacotherapeutic group

Highly active diuretics. Sulfonamides. PBX code: C03CA01.

"Loop" diuretic. In usual therapeutic doses, it disrupts the reabsorption of sodium ions, chlorine in the thick segment of the ascending part of the Henle loop. Due to the increase in the release of sodium ions, secondary (indirectly osmotically bound by water) enhanced excretion of water and increased secretion of potassium ions in the distal part of the renal tubule occur. Furosemide has secondary effects due to the release of intrarenal mediators and redistribution of intrarenal blood flow. These effects increase the perfusion of the medullary layer of the kidneys. Furosemide has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscle to vasoconstrictor effects and as a result of a decrease in bcc. With heart failure, it quickly leads to a decrease in preload on the heart through the expansion of large veins. The diuretic effect is dose dependent. Against the background of the course of treatment, the weakening of the effect does not occur. Furosemide does not change the glomerular filtration rate and remains effective at a low glomerular filtration rate.

The onset of diuresis is observed within the first hour after oral administration of furosemide. The diuretic peak occurs in the first two hours after administration, and the duration of the diuretic effect is 6-8 hours.

Furosemide medicine: instructions for use

The treatment regimen is determined by a specialist depending on the clinical picture of the pathology. Tablets are taken in a volume of 20 to 80 mg per day. The dosage can be gradually increased, bringing the daily use of the drug to 0.6 g. The amount of the drug Furosemide for children is calculated on the basis of body weight of 1-2 mg per kg, not more than 6 mg per kg.

Instructions for the use of injections Furosemide

The volume of intramuscular or intravenous injection should not be higher than 0.04 g per day. Perhaps a double dose increase. Doctors recommend injecting the drug into a vein infectiously for 2 minutes. It is possible to inject injections into muscle tissue only when it is impossible to use tablets and intravenous injections.

In acute conditions, injections into the muscle are contraindicated.

Act

A powerful diuretic affects the ascending part of the Gengle loop (thick segment). A characteristic feature is a quick, but short-term diuretic effect.

While taking the pills, the diuretic effect appears after a third of an hour, after an intravenous injection - after 10-15 minutes. The maximum effect develops after 60 minutes, lasts three to four hours, rarely - up to six hours.

Furosemide not only removes excess fluid and stagnant urine, but also leaches chlorine and sodium salts. For this reason it’s important to carefully use a potent agent, for mild to moderate degrees of hypertension, renal pathologies, poisoning, use thiazide or osmotic diuretics. The optimal type of diuretic is selected by a urologist, nephrologist. In diseases of the heart and blood vessels, a consultation with a cardiologist is mandatory.

Diuretic Furosemide undergoes metabolism in the liver, the processed substance enters the renal tubules. After oral administration, up to 70% is excreted by the kidneys, 30% - with feces, with intravenous administration, the percentage ratio changes - 88 and 12%, respectively.

Indications for use

A diuretic is prescribed for the following pathologies and serious conditions:

  • hypertensive crisis,
  • swelling against the background of renal failure of the second and third degree, nephrotic syndrome, cirrhosis of the liver,
  • increased accumulation of calcium,
  • cerebral edema,
  • acute heart failure, accompanied by pulmonary edema,
  • eclampsia,
  • acute toxicosis in late pregnancy (only a short course prescribed by a doctor),
  • poisoning with pronounced signs of intoxication for the speedy removal of poisons.

Important:

  • during the course of therapy, a sharp decrease in potassium levels is possible. At risk are patients with cirrhosis of the liver, heart failure, taking a large amount of various drugs,
  • you need to regularly (once a week) take a blood test to monitor the level of potassium in the elderly, with a poor diet. The first ionogram is required 7 days after taking the first diuretic tablet,
  • against the background of hypokalemia, bradycardia, cardiac arrhythmia, and life-threatening pirouette tachycardia develop. These points should be taken into account by the doctor choosing the optimal diuretic for patients at risk.

Instructions for use and dosage

How to take furosemide? Loop diuretics show many side effects. Exceeding a single or daily dosage of the drug Furosemide is fraught with complications. You can take pills with the permission of your doctor. Injections in severe conditions are carried out only by paramedics.

Tablets

With moderate pathologies, half or an entire tablet of Furosemide is prescribed twice a day. In severe condition, the norm is increased to two or three units of the drug, the frequency of use is 1 or 2 times a day.

Furosemide in combination with drugs that lower blood pressure is prescribed to patients with high blood pressure in patients with chronic renal failure. The rate of loop diuretic per day is from 20 to 120 mg.

Injections

The best option for using a powerful diuretic is intravenous administration, always slow, for one to two minutes. With pulmonary edema, IM is prohibited, in most cases a diuretic solution is injected into a vein.

At a dosage of Furosemide above 80 ml, droppers are prescribed. In case of poisoning, hypertensive crisis, the initial dose is from 20 to 40 mg. The maximum daily norm of the active substance is 600 mg (in exceptional cases).

Doctors recommend transferring the patient as soon as possible from the parenteral method of administration (injection, infusion) to the oral (tablets).

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Likely side effects

Depending on the individual characteristics of the body, negative manifestations of varying severity are possible:

  • oliguria, hematuria, acute urinary retention,
  • a sharp decrease in blood pressure, arrhythmia, collapse, tachycardia,
  • visual and hearing impairment,
  • aplastic anemia, leukopenia, thrombocytopenia,
  • hyperglycemia, increased cholesterol, glucosuria, excessive production of urine,
  • various types of allergic reactions, photosensitivity, anaphylactic shock, urticaria,
  • constipation, exacerbation of pancreatitis, cholestatic jaundice, nausea, dry mouth, diarrhea,
  • increased risk of thrombosis, metabolic acidosis, dehydration,
  • muscle weakness, confusion, apathy, headaches, lethargy, dizziness,
  • thrombophlebitis (with intravenous administration).

Overdose

The optimal norm for each type of pathology cannot be exceeded. The optimal dosage is prescribed by the doctor. Excess furosemide negatively affects the body. It's important to know: the drug does not have a specific antidote, in case of violation of the rules it is quite difficult to return the indicators to normal.

Overdose Signs:

  • dehydration,
  • shock,
  • thrombosis,
  • arrhythmia,
  • a sharp decrease in blood pressure,
  • collapse,
  • thromboembolism
  • drowsiness,
  • flaccid paralysis,
  • confusion,
  • acute renal failure, a sharp decrease in the volume of excreted urine,
  • hypovolemia (decrease in circulating blood volume).

What to do: call an ambulance for urgent measures to restore the water-salt balance, heart disorders, reduce fluid deficiency.

Cost and storage conditions

Furosemide is an effective and cheap diuretic. The cost of tablets and solution for injection varies slightly depending on the manufacturer.

Average Furosemide Price:

  • tablets, packaging No. 20 - from 25 to 45 rubles,
  • tablets, packaging No. 50 - from 30 to 65 rubles,
  • ampoules 1% solution, packaging No. 10 - from 30 to 85 rubles.

The cost of the drug Lasix - 10 ampoules - 350 rubles, 50 capsules - 460 rubles.

The diuretic should be placed in a dark place. Room temperature - no more than + 25C.

Use an open ampoule immediately. The room should not be damp. Keep diuretic away from children.

How long does furosemide act?

After oral administration, the drug begins to act in 20-30 minutes, after infusion into a vein - after 10-15 minutes.

Depending on the characteristics of the body, the effect when using the oral form of Furosemide can persist for 3-4 or 6 hours, while it is most potent after one or two hours after taking the pill.

After the solution is injected into a vein, the effect reaches a maximum after half an hour and lasts for 2-8 hours (the more pronounced kidney dysfunction, the longer the drug acts).

Pharmacodynamics

The mechanism of action of the drug is associated with a violation of reabsorption in the tubules of the nephrons of the kidneys of ions of chlorine and sodium. In addition, furosemide increases the excretion of magnesium, calcium, phosphates and bicarbonates.

Use of the drug in patients with fromheart failure leads to a decrease in preload on the heart muscle after 20 minutes.

The hemodynamic effect reaches its maximum severity by the 2nd hour of the action of Furosemide, which is due to a decrease in venous tone, a decrease in bcc (volume of circulating blood), as well as the volume of fluid filling the intercellular spaces in organs and tissues.

Lowers blood pressure. The effect develops as a result:

  • reducing the reaction of the muscles of the vascular walls to the vasoconstrictor (provoking vasoconstriction and a decrease in blood flow in them) effect,
  • decreasing bcc,
  • increased excretion sodium chloride.

During the period of action of Furosemide, the excretion of Na + ions increases significantly, however, after the cessation of the action of the drug, the rate of their excretion drops below the initial level (“withdrawal” or “rebound” syndrome). Due to this, once a day, it does not have a significant effect on blood pressure and daily Na excretion.

The cause of this effect is the sharp activation of antinatriuretic links of neurohumoral regulation (in particular, renin-angiotensin) in response to massive diuresis.

The drug stimulates the sympathetic and arginine-vasopressive systems, reduces the plasma concentration of atriopeptin, and causes vasoconstriction.

Pharmacokinetics

Absorption from the digestive tract - high, bioavailability (proportion of absorbed drug) when taken orally - from 60 to 70%. The plasma protein binding rate is 98%.

TSmax when taken per os - 1 hour, when injected into a vein - 0.5 hours.

Furosemide is able to cross the placenta and excreted in breast milk.

Biotransformation of a substance undergoes in the liver. Metabolites are secreted into the lumen of the tubules of the kidneys.

T1 / 2 for the oral form of the drug - from one hour to one and a half hours, for parenteral - from half an hour to an hour.

From 60 to 70% of the oral dose is excreted by the kidneys, the rest - with feces. When introduced into the vein by the kidneys, about 88% of furosemide and its metabolic products are excreted, with feces - about 12%.

Instructions for the use of injections "Furosemide"

The volume of intramuscular or intravenous injection should not be higher than 0.04 g per day. Perhaps a double dose increase. Doctors recommend injecting the drug into a vein infectiously for 2 minutes. It is possible to inject injections into muscle tissue only when it is impossible to use tablets and intravenous injections.

Reviews about Furosemide

Furasemide is one of the most effective diuretics for quick and short action. Doctors' reviews confirm the fact that the drug plays a key role in the treatment of edematous syndrome in patients with heart failure, since loop diuretics most effectively block the reabsorption of Na + ions in the upstream segment of the Henle loop.

At the same time, Furosemide remains active even in patients with chronic renal failure (including at the terminal stage of the disease).

However, the use of short-acting loop diuretics can cause irreversible damage to the renal tubules, especially in cases where the drug is prescribed in a high dose.

A parallel increase in the delivery of Na + ions to the distal parts of the nephron, where loop diuretics no longer work, leads to sodium overload and structural damage to these parts of the nephron with the development of hyperplasia and hypertrophy.

In addition, after the completion of the drug’s action, Na + reabsorption increases significantly and, as a result, the “rebound” effect develops, which manifests itself in an increase in post-diuretic reabsorption.

The reviews that patients leave allow us to conclude that the medicine is good for edema and is indispensable for hypertensive patients. The disadvantages of the drug, as a rule, are called side effects, contraindications and the fact that it is addictive.

Another category of reviews are reviews of Furosemide for weight loss.

Despite the fact that the drug really allows you to quickly reduce weight by 3-5 kg, it is not recommended to use it for weight loss either by doctors or by losing weight. This is due to the fact that the drug does not remove excess fat, but only removes water (and with it the substances necessary for the body to function normally).

Thus, given that Furosemide is a very powerful tool, it can only be used taking into account contraindications, not exceeding the prescribed dose and only under the supervision of a doctor (especially during pregnancy). Also, you should not take it for other purposes (for example, with cystitis).

When treating with diuretics, the question is very important - with what to drink the drug Furosemide. Instructions for use explain that it is optimal to supplement therapy with the use of potassium-rich foods or with potassium supplements.

Dosage

Tablets should be taken on an empty stomach, without chewing and drinking plenty of fluids. When prescribing Furosemide, it is recommended to use its lowest dose, sufficient to achieve the desired effect. The maximum daily dose for adults is 1500 mg. The initial single dose in children is determined based on 1-2 mg / kg body weight / day with a possible increase in dose to a maximum of 6 mg / kg / day, provided that the drug is taken no more than 6 hours later. The duration of treatment is determined by the doctor individually, depending from the testimony.

Adult Dosing Schedule

Edema syndrome in chronic heart failure

The initial dose is 20-80 mg / day. The required dose is selected depending on the diuretic response. It is recommended to divide the daily dose into 2-3 doses.

Edema syndrome in chronic renal failure

In patients with chronic renal failure, a careful selection of the dose is required, by gradually increasing the dose so that fluid loss occurs gradually (at the beginning of treatment, fluid loss is possible up to about 2 kg of body weight / day). The recommended initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients on hemodialysis, usually the maintenance dose is 250-1500 mg / day.

Edema with nephrotic syndrome

The initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The daily dose can be taken at one time or divided into several doses.

Edema syndrome in liver disease

Furosemide is prescribed in addition to treatment with aldosterone antagonists in case of their insufficient effectiveness. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or impaired electrolyte or acid-base conditions, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss up to about 0.5 kg body weight / day is possible). The initial dose is 20-80 mg / day.

Furosemide Sofarma can be used in monotherapy or in combination with other antihypertensive drugs. The usual maintenance dose is a dose of 20-40 mg / day. When furosemide is added to already prescribed drugs, their dose should be reduced by 2 times. With arterial hypertension in combination with chronic renal failure, higher doses of the drug may be required.

Side effects

From the cardiovascular system: a marked decrease in blood pressure, collapse, tachycardia, arrhythmias, a tendency to thrombosis, a decrease in the volume of circulating blood.

From the central nervous system: dizziness, headache, muscle weakness, spasms of the calf muscles (tetany), paresthesia, apathy, adynamia, weakness, lethargy, drowsiness, confusion.

From the senses: impaired vision and hearing, tinnitus.

From the digestive system: anorexia, dry mucous membrane of the oral cavity, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation), hepatic encephalopathy.

From the genitourinary system: oliguria, acute urinary retention (in patients with benign prostatic hyperplasia), interstitial nephritis, hematuria, decreased potency.

From the endocrine system: a decrease in glucose tolerance, a manifestation of latent diabetes mellitus.

Allergic reactions: purpura, urticaria, exfoliative dermatitis, exudative erythema multiforme, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock, Stevens-Johnson syndrome, bullous pemphigrolis pemphigrolis, toxic.

From the hemopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia.

On the part of water-electrolyte metabolism: hypovolemia, dihydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.

Laboratory indicators: hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalciuria, increased activity of hepatic transaminases, eosinophilia.

Drug interaction

With simultaneous use with phenobarbital and phenytoin, the effect of furosemide decreases.

Increases the concentration and risk of nephro- and ototoxic effects of cephalosporins, chloramphenicol, ethacrylic acid, cisplatin, amphotericin B (due to competitive renal excretion).

With the simultaneous use of aminoglycosides with furosemide, there is a slowdown in the elimination of aminoglycosides and an increase in the risk of developing their ototoxic and nephrotoxic effects. For this reason, the use of this combination of drugs should be avoided unless it is necessary for health reasons, and in this case, correction (reduction) of the maintenance doses of aminoglycosides is required.

Increases the effectiveness of diazoxide and theophylline, reduces hypoglycemic agents, allopurinol.

Medicines blocking tubular secretion increase the concentration of furosemide in blood serum. Medicines with a nephrotoxic effect - when combined with furosemide, the risk of developing their nephrotoxic effect increases.

GCS and carbenoxolone when combined with furosemide increase the risk of hypokalemia.

With simultaneous use with cardiac glycosides, the risk of developing digitalis intoxication increases against the background of water-electrolyte disturbances (hypokalemia or hypomagnesemia).

Enhances neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).

NSAIDs (including indomethacin and acetylsalicylic acid) in combination with furosemide can cause a temporary decrease in creatinine clearance and an increase in serum potassium and reduce the diuretic and antihypertensive effect of furosemide. In patients with hypovolemia and dehydration (including those taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may enhance the toxic effect of salicylates (due to competitive renal excretion).

Sucralfate reduces the absorption of furosemide and weakens its effect (these drugs should be taken with an interval of at least 2 hours).

Combined use with carbamazepine may increase the risk of hyponartemia.

Antihypertensive drugs, diuretics or other drugs that can lower blood pressure, when combined with furosemide, can lead to a more pronounced antihypertensive effect.

The appointment of ACE inhibitors to patients previously treated with furosemide may lead to an excessive decrease in blood pressure with impaired renal function, and in some cases to the development of acute renal failure, therefore, three days before the start of treatment with AIF inhibitors or an increase in their dose, it is recommended to cancel furosemide, or reduction in its dose.

Probenecid, methotrexate and other drugs that are secreted in the renal tubules, like furosemide, can reduce the effect of furosemide (the same pathway for renal secretion), on the other hand, furosemide can lead to a decrease in kidney excretion of these drugs.

Lithium salts - under the influence of furosemide, lithium excretion decreases, due to which the serum concentration of lithium increases and the risk of developing toxic effects of lithium, including its damaging effect on the heart and nervous system, increases. Therefore, using this combination requires monitoring of serum lithium concentrations.

The concomitant use of cyclosporin A and furosemide increases the risk of developing gouty arthritis due to hyperuricemia caused by furosemide and cyclosporin disturbance in the excretion of urates at night.

Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce effectiveness.

X-ray contrast agents - in patients with a high risk of developing nephropathy for the administration of radiopaque drugs that received furosemide, there was a higher incidence of renal dysfunction compared to patients with a high risk of nephropathy for the administration of radiopaque drugs that received only intravenous hydration before the administration of the radiopaque drug.

Special instructions

Before starting therapy with Furosemide Sofarma, the presence of pronounced violations of the outflow of urine should be excluded, patients with partial impairment of the outflow of urine need careful monitoring. Against the background of the course of treatment, it is necessary to periodically monitor blood pressure, the content of blood plasma electrolytes (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate treatment correction.

The use of furosemide slows the excretion of uric acid, which can provoke an exacerbation of the course of gout.

Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to furosemide.

In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is impractical to limit the intake of table salt. For the prevention of hypokalemia, the simultaneous administration of potassium and potassium-sparing diuretics is recommended, as well as a diet rich in potassium. The dosage regimen for patients with ascites against cirrhosis of the liver should be selected under stationary conditions (disturbances in the water-electrolyte balance can lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.

With the appearance or intensification of azotemia and oliguria in patients with severe progressive kidney disease, it is recommended to suspend treatment.

In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of the level of glucose concentration in the blood and urine is required.

In patients in an unconscious state, with benign prostatic hyperplasia, narrowing of the ureters or hydronephrosis, urination control is necessary due to the possibility of acute urinary retention.

The drug contains lactose monohydrate, so patients with rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

The composition of the drug includes wheat starch in an amount that is safe for use in patients with celiac disease (celiac enteropathy).

Patients with an allergy to wheat (other than celiac disease) should not use this medication.

Influence on the ability to drive vehicles and control mechanisms

During the treatment with Furosemide Sofarma, one should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving and working with mechanisms).

Contraindications to Furosemide

The drug is not prescribed for:

  • intolerance of its components,
  • ARF, which is accompanied by anuria (if the GFR value does not exceed 3-5 ml / min.),
  • urethral stenosis,
  • severe liver failure,
  • hepatic coma,
  • hyperglycemic coma,
  • precomatous conditions
  • urinary tract obstruction with calculus,
  • decompensated stenosis of the mitral valve or aortic orifice,
  • conditions in which blood pressure in the right atrium exceeds 10 mm RT. Art.,
  • gout,
  • hyperuricemia,
  • myocardial infarction (in the acute stage)
  • arterial hypertension,
  • hypertrophic subaortic stenosis,
  • systemic lupus erythematosus,
  • violations of water-salt metabolism (hypocalcemia, hypochloremia, hypomagnesemia, etc.),
  • pancreatitis,
  • digital intoxication (intoxication caused by taking cardiac glycosides).

Relative contraindications to the use of furosemide:

  • benign prostatic hyperplasia(BPH)
  • diabetes,
  • hypoproteinemia (when taking the drug, the risk of developing ototoxicity increases),
  • cerebral atherosclerosis obliterans,
  • hepatorenal syndrome,
  • hypotension in patients with a risk of ischemia (coronary, cerebral or otherwise), which is associated with circulatory failure,
  • hypoproteinemia on the background nephrotic syndrome (Perhaps an increase in undesirable side effects of Furosemide (especially ototoxicity) and a decrease in its effectiveness).

Patients at risk should be under the constant supervision of a doctor. Violation of the CRR, hypovolemia or dehydration is the basis for reviewing the treatment regimen and, if necessary, temporarily discontinuing the drug.

Diureticscontribute to the excretion of sodium from the body, therefore, to avoid development hyponatremia Before starting therapy and subsequently throughout the course of the use of Furosemide, it is necessary to control the level of sodium in the patient’s blood (especially in patients with cachexia, cirrhosisas well as elderly people).

Application loop diuretics may cause sudden hypokalemia. The risk group includes:

  • aged people,
  • patients who are not receiving adequate nutrition and / or taking several drugs at the same time,
  • patients diagnosed cirrhosis with ascites,
  • patients with heart failure.

Hypokalemiaraises digitalis cardiotoxicity (Digitalis) and risk cardiac arrhythmias. AtQT interval prolongation syndrome (congenital or caused by the use of drugs) hypokalemia contributes to bradycardiaor potentially life threatening pirouette tachycardia.

In this regard, it is recommended to determine the level of potassium in the blood of the patient as often as possible. The first ionogram should be done within a week after the start of the course.

In diabetics, the level of sugar must be systematically monitored throughout the course of treatment.

Pregnancy and lactation

Furosemide crosses the placental barrier, so it should not be prescribed during pregnancy. If it is necessary to prescribe Furosemide Sofarma during pregnancy, the ratio of the benefits of using the drug for the mother to the risk to the fetus should be assessed. Excreted in breast milk. If treatment with the drug is necessary, breastfeeding must be discontinued.

With impaired renal function

Edema syndrome in chronic renal failure

In patients with chronic renal failure, a careful selection of the dose is required, by gradually increasing the dose so that fluid loss occurs gradually (at the beginning of treatment, fluid loss is possible up to about 2 kg of body weight / day). The recommended initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients on hemodialysis, usually the maintenance dose is 250-1500 mg / day.

Edema with nephrotic syndrome

The initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The daily dose can be taken at one time or divided into several doses.

How to take furosemide for edema?

Diuretic pills taken orally. The doctor selects the dose individually, depending on the indications and characteristics of the course of the disease.

An adult with edema that develops against the background of pathologies of the liver, kidneys or heart is prescribed to take ½-1 tablet / day, if the condition is assessed as moderate. In severe cases, the doctor may recommend taking 2-3 tablets. 1. R. / day or 3-4 tab. in 2 doses.

Furosemide Slimming

Some women use the properties of the drug to reduce weight. Taking Furosemide tablets (Furosemide Sofarma) really allows you to get rid of several kilograms, but this weight loss can hardly be called weight loss, since the drug does not remove excess fat in problem areas, but only removes water from the body.

Instructions for use of Furosemide in ampoules

The preferred method of administration of the solution is slow intravenous injection (performed within 1-2 minutes).

The drug is injected into the muscle in exceptional cases when an oral or intravenous route of administration is not possible. Contraindications for intramuscular administration of furosemide are acute conditions (e.g. pulmonary edema).

Given the clinical condition of the patient, it is recommended to transfer from the parenteral to the oral route of administration of Furosemide as soon as possible.

The question of the duration of treatment is decided taking into account the nature of the disease and the severity of symptoms. The manufacturer recommends using the lowest possible dose at which the therapeutic effect will be maintained.

At edematous syndrome in adults and adolescents over 15 years of age, treatment begins with the introduction of 20-40 mg of Furosemide into the vein (in exceptional cases, into the muscle).

In the absence of a diuretic effect, the drug is continued to be administered every 2 hours in a dose increased by 50%. Treatment according to this scheme is continued until adequate diuresis is achieved.

A dose in excess of 80 mg should be injected into a vein by drip. The rate of administration should not be more than 4 mg / min. The maximum permissible dose is 600 mg / day.

In case of poisoning, in order to maintain forced diuresis, the patient should be administered from 20 to 40 mg of the drug, after dissolving the necessary dose in the electrolyte infusion solution. Further treatment is carried out depending on the volume of diuresis. Compulsory is the recovery of salts and fluids lost by the body.

Initial dose for hypertensive crisis- 20-40 mg.In the future, it is adjusted taking into account the clinical response.

Drug interaction

The combined use of the drug "Furosemide" and other drugs can cause negative reactions of the body. The combination of a medication with hypoglycemic drugs, cephalosporins, aminoglycosides, indomethacin, NSAIDs, insulin is unacceptable. You can not take the drug together with digitoxin, astemizole, digoxin, ACE inhibitors, cisplatin, colestyramine, cisapride, phenytoin, colestipol, lithium carbonate.

Interaction

Furosemide increases concentration and toxicity (in particular, oto- and nephrotoxicity) Ethacrylic acid,Aminoglycosides, Cephalosporins, Cisplatin, Chloramphenicol, Amphotericin B.

Enhances therapeutic efficacy Theophylline and Dazoxidereduces efficiency Allopurina and hypoglycemic drugs.

Reduces the rate of renal excretion of Li + drugs from the blood, thereby increasing the likelihood of intoxication by them.

Enhances caused by non-depolarizing muscle relaxants (peripheral relaxants) neuromuscular blockade and action antihypertensive drugsweakens the action non-depolarizing relaxants.

In combination with pressor amines, a mutual decrease in the effectiveness of drugs is noted, with Amphotericin B and corticosteroids - increased risk of development hypokalemia.

Use in conjunction with cardiac glycosides(SG) can provoke the development of toxic effects inherent in the latter due to a decrease in the level of potassium in the blood (for low and high polar hypertension) and an increase in the half-life (for low polar hypertension).

Blocking tubular secretion drugs increase the serum concentration of furosemide.

Sucralfat and NSAIDs reduce the diuretic effect of the drug due to suppression of Pg synthesis, changes in plasma concentration renin and highlight aldosterone.

The use of high doses salicylates during treatment with the drug increases the risk of their toxicity, due to competitive renal excretion of drugs.

The Furosemide solution introduced into the vein has a slightly alkaline reaction, therefore it is contraindicated in mixing with drugs whose pH is lower than 5.5.

Opinions of patients and doctors

The medicine "Furosemide", reviews of experts confirm this fact, is a key tool for the treatment of edematous syndrome in people with heart failure. It is a fast-acting drug. Patients say that in addition to helping with edema and hypertension, the drug has side effects and is addictive (it is undesirable to use it for a long time).

Many women use the drug "Furosemide" for weight loss. This tool allows you to quickly get rid of 3 - 5 kg of excess weight. However, doctors do not recommend taking the drug for weight loss, since it does not break down excess fat, but removes water and other necessary substances. Women claim that when taking more than 2 capsules per week, side effects and addiction appear.

On the forums you can meet the question: Which is better - "Lasix" or "Furosemide"? Pharmacists explain that the drugs are identical, and their choice depends on price and availability.

Not recommended combinations for solution

The introduction of furosemide into a vein within 24 hours after chloral hydrate may provoke:

  • nausea
  • flushing
  • anxiety,
  • increased sweating,
  • increase in blood pressure,
  • tachycardia.

Application of furosemide with ototoxic drugs (e.g. with aminoglycosides) may cause irreversible hearing impairment. Such a combination can be used only for health reasons.

Why is Furosemide prescribed?

Furosemide effectively helps with the occurrence of congestion, both in the large and in the small circles of blood circulation, if the cause of the pathology is associated with heart failure.In addition, the effect of the drug helps to cope with such conditions as:

  1. Chronic cardiovascular insufficiency of the II and III degree, cirrhosis of the liver, chronic renal failure.
  2. Pulmonary edema and brain, peripheral edema.
  3. Hypertensive crisis, hypertension.
  4. Nephrotic syndrome.
  5. Eclampsia (the most severe form of late toxicosis of pregnant women).

A course of treatment with Furosemide tablets is prescribed in the presence of pathologically high levels in the blood serum of calcium, potassium and sodium, with premenstrual tension syndrome, and stabilization of the condition in severe heart failure.

Intravenous administration is indicated:

  • with cerebral edema,
  • for emergency care for hypertensive crisis,
  • as part of the symptomatic treatment of patients with severe forms of arterial hypertension,
  • with edema caused by acute heart failure, chronic renal failure,
  • as part of symptomatic therapy for patients with nephrotic syndrome (the primary task is the treatment of the underlying disease),
  • in chronic liver diseases accompanied by edematous syndrome,
  • patients with coronary insufficiency in the presence of edema,
  • to maintain forced diuresis (poisoning with toxins, chemical compounds that are excreted together with urine unchanged).

Side effect

Withsides of the cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased circulating blood volume.

From the nervous system: dizziness, headache, muscle weakness, spasms of the calf muscles (tetany), apathy, adynamia, weakness, lethargy, drowsiness, confusion.

From the senses: visual and hearing impairment (hearing loss and tinnitus, usually short-term, occur in rare cases, especially in patients with renal failure, hypoproteinemia (for example, with nephrotic syndrome)).

From the digestive system: hepatic encephalopathy in patients with hepatic cell insufficiency, increased transaminases, anorexia, dry mouth, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation).

From the genitourinary system: oliguria, acute urinary retention (in patients with prostate adenoma), muscle spasm, bladder spasm, interstitial nephritis, hematuria, decreased potency.

Allergic reactions: urticaria, eosinophilia, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitization, anaphylactic and / or anaphylactoid reactions, purpura, paresthesia (burning, pain), bullous syndrome (bullous), bullous syndrome (bullous) Stevens-Johnson, toxic epidermal necrolysis.

From the hemopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.

From the water-electrolyte exchange: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.

Influence on laboratory indicators: hyperglycemia, increased cholesterol, low density lipoproteins (when taking large doses of the drug), hyperuricemia, glucosuria, hypercalciuria, increased levels of creatinine in the blood.

If adverse reactions occur, reduce the dose or cancel the drug, and consult a doctor.

How to replace furosemide?

Furosemide analogs in tablets: Furosemide Sofarma, Lasix.

Analogs of the parenteral form of the drug: Furosemide-Darnitsa, Furosemide vial, Lasix.

Drugs that belong to the same pharmacological subgroup with Furosemide: Bufenox, Britomar, Diuver, Trigrim, Torasemide.

Similar drugs

If Furosemide is intolerant, the attending physician will choose the appropriate replacement for the drug. To date, pharmaceutical companies produce a fairly large number of diuretics, which in action are similar to those described. The most common analogues are:

No. p / pNameActive componentManufacturerCost in rubles
1TorasemidetorasemideVertex, NORTH STAR CJSC, Russia100-120
2DiuvertorasemidePliva Hrvatsk, Croatia300-350
3TrigrimtorasemidePolpharma, Poland170-220
4Veroshpiron spironolactoneGideon Richter OJSC, Hungary80-100

All of the listed drugs have a good diuretic effect and can be prescribed for the treatment of edema syndrome, arterial hypertension and other pathologies associated with the accumulation of a large amount of fluid in the body. However, self-treatment with such drugs is strictly prohibited. Incorrectly selected dosage or frequency of use can lead to severe and often irreversible consequences for the body.

Which is better - Lasix or Furosemide?

Lasix - This is one of the trade names for furosemide. The drug is manufactured by the Indian company Sanofi India Ltd. and, like its analogue, it has two dosage forms: one percent solution d / and tablets of 40 mg.

Thus, when choosing one or another means, one should be guided by subjective sensations. The advantage of Furosemide is its lower price.

Precautionary measures

In the presence of ascites without peripheral edema, it is recommended to use furosemide in doses that provide additional diuresis in the amount of not more than 700-900 ml per day in order to avoid the development of oliguria, azotemia and disturbances in electrolyte metabolism.

Long-term use can lead to the appearance of weakness, fatigue, lowering blood pressure and cardiac output, and excessive diuresis during myocardial infarction with congestion in the pulmonary circulation can contribute to the development of cardiogenic shock.

In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is impractical to limit the intake of table salt. For the prevention of hypokalemia, the simultaneous administration of potassium and potassium-sparing diuretics is recommended, as well as a diet rich in potassium. Increased diuresis is the cause of dehydration and hypovolemia, which can lead to arterial thrombosis, especially in elderly patients. All patients receiving furosemide should be monitored for signs of electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia): dry mouth, thirst, weakness, drowsiness, muscle pain, muscle spasms, muscle weakness, arterial hypotension, oliguria, oliguria arrhythmia, gastrointestinal disorders.

Accidental use of the drug can lead to hypovolemia, dehydration. In case of hepatocellular insufficiency, treatment should be carried out with caution, under the strict control of electrolytes, taking into account the risk of hepatic encephalopathy. If necessary, discontinue treatment immediately.

Taking furosemide in case of partial urinary tract obstruction can lead to urinary retention. Careful monitoring of diuresis should be ensured, especially at the beginning of treatment with furosemide.

Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitization to furosemide.

When using thiazide diuretics, there have been cases of photosensitivity reactions. In case of photosensitivity reactions, it is recommended to cancel furosemide. If necessary, it is recommended to protect exposed skin exposed to sunlight or ultraviolet radiation from artificial sources.

Since the drug contains lactose, its use is not recommended for patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.

In the treatment with furosemide, careful monitoring and dose adjustment is required in the following cases:

in patients at risk of cerebral, coronary ischemia or other ischemia associated with circulatory failure,

in patients with hepatorenal syndrome (renal failure associated with severe liver disease),

in patients with hypoproteinemia in the case of nephrotic syndrome: a possible decrease in the effect of furosemide and potentiation of side effects, especially ototoxicity.

An increase in urine output may cause or worsen urinary retention in patients with urinary tract obstruction.

Treatment with furosemide can lead to a transient increase in creatinine, cholesterol, triglycerides.

There have been several cases of kidney stones in preterm infants receiving high doses of furosemide injections due to the development of hypercalciuria.

Sodium, It is necessary to control the level of sodium before starting therapy and regular monitoring of it in the future. Diuretic treatment can trigger hyponatremia. Lowering the level of sodium in the blood at first is asymptomatic, regular monitoring should be more frequent in patients at risk: the elderly, cachexia (malnutrition) or cirrhosis.

Potassium When using loop diuretics, a decrease in the level of sodium with hypokalemia is possible. Risk of sudden hypokalemia (

What is the danger of furosemide?

Application diuretics for weight loss can cause serious health problems, since removing water, these drugs also upset the balance of electrolytes in the body. one of the most common side effects ishypokalemia.

Potassium deficiency in turn leads to muscle cramps, weakness, visual impairment, sweating, loss of appetite, nausea, and dizziness.

A very dangerous side effect is arrhythmia. Conducted SOLVD studies have shown that treatment loop diuretics accompanied by increased mortality among patients. At the same time, both the indicators of general and cardiovascular mortality and the number of sudden deaths increase.

Another hazard that uncontrolled use may entail diureticfor weight loss, is a violation of the kidneys. Moreover, it may take more than one month to restore kidney function and the lymphatic system.

Furosemide and Asparkam for weight loss

Since one of the side effects of furosemide is hypokalemia, it is very important during the period of use of this drug to adhere to a certain diet (available in the form of the use of products with a high content of potassium) or additionally take medicines that can minimize the inherent diuretics side effects.

As a rule, Furosemide is recommended to be taken in combination with Asparkam (Panangin). WhatAsparkam? This is a drug that is used as an additional source of potassium and magnesium. The medicine has a harmless composition, which eliminates the likelihood of its unwanted interaction with Furosemide.

Recommendations on how to drink with Asparkam diuretics, can only give a doctor. Tablets Asparkama, according to the manufacturer’s instructions, take 3-6 pieces per day, dividing the specified dose into three doses.

Dosage and administration

Furosemide tablets are taken orally, without biting, immediately swallowing, drinking with a small amount of water. The dose of the drug is determined by the doctor individually for each patient, depending on body weight, severity of edema, the presence of concomitant diseases.

The drug is prescribed in the minimum effective dosage, starting with 20 mg per day for an adult. With insufficient mild therapeutic effect, the dose of the drug is gradually increased, the maximum daily dose for an adult is 1.5 g. An interval of at least 6 hours should be maintained between doses of the drug.

If necessary, treatment with Furosemide can be combined with antihypertensive drugs.

Patients with chronic renal failure require an individual and careful selection of the dose of the drug. Treatment is carried out under the supervision of a doctor in a minimally effective dosage.

Use of the drug during pregnancy and lactation

In the first trimester of pregnancy, Furosemide tablets are not prescribed for women, since at this stage the internal organs of the fetus are formed and the effect of drugs on the mother's body is undesirable.

In the 2nd and 3rd trimesters of pregnancy, Furosemide can be prescribed to patients only if there are serious indications. The doctor carefully assesses the possible risks to the fetus with the ratio of benefits to the mother. The drug easily penetrates the placental barrier, but in the course of clinical trials there was no teratogenic or embryotoxic effect of Furosemide on the child.

The drug is excreted in breast milk and can penetrate the body of a child. If necessary, therapy with the drug Furosemide to a nursing mother should stop lactation, so as not to harm the baby.

Can I drink furosemide during pregnancy?

When asked whether pregnant women can take diuretics, most doctors answer that for treatment gestosis and preeclampsia modern medicine offers much safer methods.

That is, Furosemide during pregnancy can be used only as an ambulance, as short a course as possible and only if the woman is under strict medical supervision.

According to the FDA classification, the drug belongs to category C.

Despite all the contraindications, on forums, women quite often leave reviews about the use of Furosemide during pregnancy.

In almost all of them, it is noted that the drug really quickly removed excess fluid from the body, but also caused unpleasant side effects (for example, leg cramps).

Therefore, all mothers are unanimous in their opinion - Furosemide can be taken only on strict indications and only in an uncontested situation.

Vacation and storage conditions

Furosemide is sold from pharmacies by prescription. Keep the package with tablets in a place protected from children, away from moisture, at a temperature not exceeding 25 degrees. The shelf life of the drug is indicated on the package and is 4 years from the date of manufacture. Do not use the drug at the expiration date.

Pharmacological effects

The mechanism of the effect of the drug composition on the body is:

  • violation of the reabsorption of ions of elements such as sodium and chlorine, which contributes to enhanced excretion of fluid and increased secretion of potassium ions in the distal part of the renal tubule,
  • increased excretion of calcium and magnesium ions,
  • the release of mediators in the kidneys and the improvement of blood circulation in these organs,
  • stabilization of heart failure due to a decrease in preload on the heart due to the expansion of large veins,
  • the provision of hypotensive effects.

The therapeutic effect is observed after 5-10 minutes, if the drug is used in the form of a solution for intravenous injection. In the case of the use of a tablet composition, the therapeutic effect is achieved within the first hour.

The main active substance of the drug is represented by the eponymous element - furosemide.The drug is available in the form of tablets, solutions for injection and granules for the preparation of suspensions for oral administration. The latter, as a rule, are prescribed for the treatment of children and today are not on sale.

As for the tablet form, one tablet contains about 40 mg of furosemide. On sale there is a drug in cardboard packages of 25 and 50 tablets.

Side effects

Furosemide is characterized not only by the achievement of a quick therapeutic effect, but also by a number of possible side effects. Most often, during treatment, patients are faced with:

  • nausea and vomiting
  • redness of the skin,
  • diarrhea or constipation
  • itchy skin
  • arterial hypotension,
  • interstitial jade
  • tinnitus, hearing loss, which are reversible,
  • dizziness, drowsiness, confusion,
  • the development of a depressive state,
  • muscle weakness
  • tachycardia, arrhythmia,
  • increased risk of thrombosis,
  • headaches
  • muscle cramps located on the calves of the legs,
  • anorexia
  • acute urinary retention in those patients who were diagnosed with benign prostatic hyperplasia,
  • decreased potency
  • chills and fever
  • the development of anaphylactic shock,
  • toxic epidermal necrolysis,
  • leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia,
  • hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia.

When observing the listed side effects, it is recommended that the daily dosage be adjusted in the direction of decreasing the amount of the drug taken.

Compatibility

With the addition of Furosemide with cephalosporins, aminoglycosides, chloramphenicol, ethacrylic acid, cisplatin, amphotericin B, an increase in concentration and an increase in the risk of developing nephro- and ototoxic actions of the latter are possible. With the simultaneous use of diazoxide and theophylline, an increase in their effectiveness is observed, and with the appointment of hypoglycemic drugs and allopurinol, a decrease.

With caution, the use of amphotericin B should be prescribed, because as a result of complex treatment, the patient runs the risk of experiencing hypokalemia. But methods of cardiac glycosides in combination with Furosemide may be accompanied by an increased risk of digital intoxication.

The use of a combination of furosemide with such medicinal compositions as gentamicin, cephalosporin and other analogues with nephrotoxic effects should be excluded. Drinking alcohol during treatment with Furosemide is strongly not recommended.

Furosemide analogues

Loop diuretic. It disrupts the reabsorption of sodium ions, chlorine in the thick segment of the ascending part of the Henle loop. In addition, it increases the excretion of potassium, calcium, magnesium ions.

The diuretic effect develops 3-4 minutes after iv administration and lasts 1-2 hours, after oral administration - after 20-30 minutes, lasts up to 4 hours.

With iv administration, it causes dilatation of peripheral veins, reduces preload, lowers the filling pressure of the left ventricle and the pressure in the pulmonary artery. Lowers blood pressure.

After oral administration, absorption is 60-70%. In severe kidney disease or chronic heart failure, the degree of absorption decreases. The volume of distribution is 0.1 l / kg. Binding to plasma proteins (mainly with albumin) - 95-99%.

Metabolized in the liver. It is excreted by the kidneys - 88%, with bile - 12%. The half-life in patients with normal renal and hepatic function is 0.5-1.5 hours. With anuria, the half-life can increase to 1.5-2.

5 hours, with combined renal and liver failure - up to 11-20 hours

Edematous syndrome of various origins, including with chronic heart failure of II B-III stages, cirrhosis of the liver (portal hypertension syndrome), nephrotic syndrome.Pulmonary edema, cardiac asthma, cerebral edema, some forms of hypertensive crisis, eclampsia, for conducting forced diuresis.

Set individually, depending on the indications, clinical situation, age of the patient.

During treatment, the dosage regimen is adjusted depending on the magnitude of the diuretic response and the dynamics of the patient's condition.

When administered, the initial dose for adults is 20-80 mg / day, then, if necessary, the dose is gradually increased to 600 mg / day. For children, a single dose is 1-2 mg / kg.

  • Maximum doses: when taken orally for children, 6 mg / kg.
  • Side effect

With iv (jet) or i / m administration, the dose for adults is 20-40 mg 1 time / day, in some cases 2 times / day. For children, the initial daily dose for parenteral use is 1 mg / kg.

From the side of metabolism: possible hypovolemia, hypokalemia, hyponatremia, hypochloremia, hypokalemic metabolic alkalosis (as a result of these disorders - arterial hypotension, dizziness, dry mouth, thirst, arrhythmia, muscle weakness, cramps), hyperuricemia (with possible exacerbation of gout, gout).

From the digestive system: nausea, vomiting, diarrhea are possible. Allergic reactions: skin rashes, dermatitis are possible.

From the central nervous system and peripheral nervous system: when used in high doses in patients with severe impaired renal excretory function in some cases - deafness, visual impairment, paresthesia.

  1. Contraindications
  2. Acute glomerulonephritis, acute renal failure with anuria, hypokalemia, alkalosis, precomatous conditions, hepatic coma, diabetic coma, hypersensitivity to furosemide.
  3. Pregnancy and lactation

In pregnancy, the use of furosemide is possible only for a short time and only if the intended benefit to the mother outweighs the possible risk to the fetus. Since furosemide can be excreted in breast milk, as well as inhibit lactation, if necessary, use during lactation, breastfeeding should be discontinued.

It is used with caution in severe cardiovascular failure, against the background of prolonged therapy with cardiac glycosides, as well as in elderly patients with severe atherosclerosis. Before treatment, electrolyte disturbances should be compensated.

During treatment with furosemide, it is necessary to control blood pressure, serum electrolytes and glucose, and liver and kidney function. To prevent hypokalemia, it is advisable to combine furosemide with potassium-sparing diuretics. With the simultaneous use of furosemide and hypoglycemic drugs, dose adjustment of the latter may be required.

It is not recommended to mix furosemide solution in one syringe with any other drugs.

  • Influence on the ability to drive vehicles and control mechanisms
  • Furosemide in the form of a solution for injection and tablets is included in the List of Essential Drugs.
  • Drug interaction

When using furosemide, it is impossible to exclude the possibility of a decrease in the ability to concentrate, which is important for people driving vehicles and working with mechanisms.

With the simultaneous use of furosemide with corticosteroids, antihypertensive drugs, amphotericin B, the risk of developing hypokalemia increases, with non-depolarizing muscle relaxants, their effects increase, with lithium preparations, their effects increase due to an increase in blood lithium concentration, with allopurinol, oral hypoglycemic agents, their insulin decreases effects, with aminoglycosides - increased nephrotoxic and ototoxic effects, with cisplatin - increased ototoxic effects. With the simultaneous use of furosemide with digoxin, the toxicity of digoxin increases, associated with exacerbation of hypokalemia.

Instructions for the drug furosemide, analogues, prices in pharmacies of Simferopol

Indications for use of the drug Furosemide:

Edematous syndrome in chronic heart failure II-III art., Cirrhosis of the liver, kidney disease (including

against the background of nephrotic syndrome), acute heart failure (pulmonary edema), cerebral edema, hypertensive crisis (alone or in combination with others.

hypotensive drugs), arterial hypertension (severe course), hypercalcemia, forced diuresis in case of poisoning by chemical compounds excreted by the kidneys unchanged, eclampsia.

  • Active substance, group:
  • Furosemide (Furosemide), Diuretic
  • Dosage form:
  • granules for suspension for oral administration for children, solution for intravenous and intramuscular administration, tablets
  • Contraindications:

Hypersensitivity to Furosemide, acute renal failure with anuria (glomerular filtration less than 3-5 ml / min), severe liver failure, hepatic coma and precoma, urethral stenosis, acute glomerulonephritis, obstruction of the urinary tract with stone, precomatous states, hyperglycemic coma, hyperglycemia , gout, decompensated mitral or aortic stenosis, GOKMP, increased central venous pressure (over 10 mmHg), arterial hypotension, acute myocardial infarction, pa Creative, disruption of water-electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia), digitalis intoxication.

With caution. Prostate hyperplasia, SLE, hypoproteinemia (the risk of developing ototoxicity), diabetes mellitus (decreased glucose tolerance), stenotic atherosclerosis of the cerebral arteries, pregnancy (especially the first half, it can be used for health reasons), lactation.

Dosage and administration:

In / in (rarely IM), the parenteral administration of Furosemide is advisable in cases where it is not possible to take it inside - in urgent situations or with a pronounced edematous syndrome.

Edematous syndrome: the initial dose of Furosemide is 40 mg. In / in the introduction is carried out for 1-2 minutes, in the absence of a diuretic response every 2 hours is administered in a dose increased by 50% until adequate diuresis is achieved.

The average daily dose for iv administration in children is 0.5-1.5 mg / kg, the maximum is 6 mg / kg. Patients with reduced glomerular filtration and a low diuretic response are prescribed in large doses - 1-1.5 g of Furosemide.

The maximum single dose is 2 g.

Inside, in the morning, before meals, the average single initial dose of Furosemide is 20-80 mg, in the absence of a diuretic response, the dose is increased by 20-40 mg every 6-8 hours until an adequate diuretic response is obtained. A single dose, if necessary, can be increased to 600 mg or more (required with a decrease in glomerular filtration and hypoproteinemia).

In case of arterial hypertension, 20-40 mg is prescribed; in the absence of a sufficient decrease in blood pressure, other hypotensive drugs should be added to treatment. When furosemide is added to already prescribed antihypertensive drugs, their dose should be reduced by 2 times.

The initial single dose of Furosemide in children is 2 mg / kg, the maximum is 6 mg / kg.

Pharmachologic effect:

"Loop" diuretic, causes rapidly advancing, strong and short-term diuresis. It has natriuretic and chloruretic effects, increases the excretion of K +, Ca2 +, Mg2 +.

Penetrating into the lumen of the renal tubule in the thick segment of the ascending knee of the Henle loop, it blocks the reabsorption of Na + and Cl-.

Due to the increase in Na + release, secondary (indirectly osmotically bound by water) enhanced water excretion and increased K + secretion in the distal part of the renal tubule occur. At the same time, the excretion of Ca2 + and Mg2 + increases.

It has secondary effects due to the release of intrarenal mediators and redistribution of intrarenal blood flow. Against the background of course treatment with Furosemide, there is no attenuation of the effect.

With HF, it quickly leads to a decrease in preload on the heart through the expansion of large veins. It has a hypotensive effect due to an increase in the excretion of NaCl and a decrease in the reaction of vascular smooth muscle to vasoconstrictive effects and as a result of a decrease in bcc.

The action of furosemide after iv administration occurs in 5-10 minutes, after oral administration - after 30-60 minutes, the maximum effect - after 1-2 hours, the duration of the effect is 2-3 hours (with reduced renal function - up to 8 hours) .

During the period of action of Furosemide, the excretion of Na + increases significantly, however, after its termination, the excretion rate decreases below the initial level (“rebound” syndrome, or “withdrawal”). The phenomenon is due to the sharp activation of renin-angiotensin, etc.

antinatriuretic neurohumoral regulation links in response to massive diuresis, stimulates arginine-vasopressive and sympathetic systems. Reduces the level of atrial natriuretic factor in plasma, causes vasoconstriction.

Due to the phenomenon of "rebound" when taken 1 time per day, it may not have a significant effect on the daily excretion of Na + and blood pressure.

  1. Side effects:
  2. From the CCC side: decrease in blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decrease in bcc.
  3. From the side of the nervous system: dizziness, headache, myasthenia gravis, cramps of the calf muscles (tetany), paresthesia, apathy, adynamia, weakness, lethargy, drowsiness, confusion.
  4. From the senses: impaired vision and hearing.
  5. From the digestive system: loss of appetite, dry mouth, thirst, nausea, vomiting, constipation or diarrhea, cholestatic jaundice, pancreatitis (exacerbation).
  6. From the genitourinary system: oliguria, acute urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, decreased potency.
  7. Allergic reactions to the components of Furosemide: purpura, urticaria, exfoliative dermatitis, erythema multiforme exudative, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock.
  8. From the hemopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.
  9. On the part of water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.
  10. Laboratory indicators: hyperglycemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalciuria.
  11. With the on / in the introduction of Furosemide (optional) - thrombophlebitis, renal calcification in premature infants.

An overdose of furosemide. Symptoms: decreased blood pressure, collapse, shock, hypovolemia, dehydration, blood concentration, arrhythmias (including AV block, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.

Treatment: correction of water-salt balance and CBS, replenishment of BCC, symptomatic treatment. There is no specific antidote.

Special instructions:

Against the background of course treatment with Furosemide, it is necessary to periodically monitor blood pressure, plasma electrolyte concentration (including Na +, Ca2 +, K +, Mg2 +), CBS, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate treatment correction ( with greater frequency in patients with frequent vomiting and against the background of parenteral fluids).

  • Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to furosemide.
  • In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is impractical to limit the intake of table salt.
  • For the prevention of hypokalemia, the simultaneous administration of K + and potassium-sparing diuretics (primarily spironolactone) is recommended, as well as a diet rich in K +.
  • An increased risk of developing water-electrolyte imbalance is observed in patients with renal failure.

The dosage regimen for patients with ascites against cirrhosis of the liver should be selected under stationary conditions (disturbances in the water-electrolyte balance can lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.

  1. When azotemia and oliguria appear or intensify in patients with severe progressive kidney disease, it is recommended to suspend treatment with Furosemide.
  2. It is excreted in milk in women during lactation, in connection with which it is advisable to stop feeding.
  3. In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of the concentration of glucose in the blood and urine is required.
  4. In patients in an unconscious state, with hypertrophy of the prostate gland, narrowing of the ureters or hydronephrosis, monitoring of urination is necessary due to the possibility of acute urinary retention.
  5. During treatment with Furosemide, one should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.
  6. Interaction:
  7. Increases the concentration and risk of nephro- and ototoxic effects of cephalosporins, aminoglycosides, chloramphenicol, ethacrylic acid, cisplatin, amphotericin B (due to competitive renal excretion).
  8. The use of furosemide increases the effectiveness of diazoxide and theophylline, reduces hypoglycemic drugs, allopurinol.
  9. Reduces renal clearance of Li + drugs and increases the likelihood of intoxication.
  10. Enhances the hypotensive effect of antihypertensive drugs, neuromuscular blockade caused by depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).
  11. Pressor amines and furosemide mutually reduce effectiveness.
  12. Drugs that block tubular secretion increase the concentration of furosemide in blood serum.
  13. With the simultaneous use of Furosemide with GCS, amphotericin B, the risk of developing hypokalemia increases, with cardiac glycosides, the risk of developing digitalis intoxication due to hypokalemia (for high and low polar cardiac glycosides) and T1 / 2 elongation (for low polar) increases.
  14. NSAIDs, sucralfate reduce the diuretic effect due to inhibition of Pg synthesis, changes in plasma renin concentration and the release of aldosterone.
  15. Taking salicylates in large doses during therapy with Furosemide increases the risk of toxicity (due to competitive renal excretion).

The iv furosemide administered has a slightly alkaline reaction, therefore it cannot be mixed with drugs with a pH of less than 5.5.

Analogs:

Apo-Furosemide, Diusemide, Difurex, Kinex, Lasix, Novo-Semid, Tasek, Tasimayd, Uriks, Florix, Fruksiks, Frusemid, Furozemix, Furon, Furorese, Furosemide Lannacher, Furosemide Nikomed Furidem Furos-Furos Daroumid Furos-Furos Daroumid Furos-Furos-Furome Milve, Furosemide-N.S., Furosemide-Ratiopharm, Furosemide-Ros, Furosemide-Teva, Furosemide-Ferein, Fursemid.

Watch the video: How Does Furosemide Work? Understanding Loop Diuretics (February 2020).