Furosemide - instructions for use, dose, side effects, contraindications

High-speed diuretic with pronounced diuretic effect. Disrupts the reabsorption of sodium, chlorine ions in the thick segment of the ascending loop of Henle. Furosemide has a pronounced diuretic, natriuretic, chlororetic effect. In addition, it increases the excretion of potassium, calcium, and magnesium ions.

With heart failure quickly leads to a decrease in preload on the heart through the expansion of large veins. Has hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of the smooth muscles of the vessels to vasoconstrictor effects, and as a result of a decrease in the volume of circulating blood.

With intravenous administration of furosemide develops in 15-20 minutes and reaches a maximum at the end of the first hour; diuretic effect lasts for 3 hours, with reduced renal function - up to 8 hours.

During the period of action, excretion of sodium ions increases significantly, but after its termination, the rate of excretion decreases below the initial level ("rebound" or "cancel" syndrome). The phenomenon is caused by a sharp activation of the renin-angiotensin and other antinatriuretic neurohumoral regulating units in response to a massive diuresis

Pharmacokinetics:

The time to reach the maximum concentration at intravenous administration - 30 minutes. The relative volume of the distribution is 0.2 l / kg. Furosemide 98% bind to plasma proteins, mainly with albumins. Penetrates through the placental barrier, excreted in breast milk.

Metabolised in the liver with the formation of 4-chloro-5-sulfamoyl-anthranilic acid. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron. The half-life of furosemide after intravenous administration is 0.5 to 1 hour.

It is excreted mainly (88%) by the kidneys in unchanged form and in the form of metabolites; with feces - 12%. Clearance - 1.5-3 ml / min / kg.

Indications:

edematous syndrome of various genesis (with chronic heart failure, liver cirrhosis (syndrome of portal hypertension);
edematous syndrome of renal genesis (with nephrotic syndrome in the foreground is the treatment of the underlying disease);
acute heart failure, especially with pulmonary edema (used in combination with other medical interventions);
edema of the brain;
edema with burns;
severe forms of hypertension;
hypertensive crisis;
to maintain forced diuresis in poisoning.

Contraindications:

Hypersensitivity to furosemide, acute glomerulonephritis, acute renal failure with anuria (glomerular filtration value less than 3-5 ml / min), severe hepatic insufficiency, hepatic coma and precoma, stenosis of the urethra, obstruction of the urinary tract by stone, precomatitis, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis,elevated central venous pressure (above 10 mm Hg), idiopathic hypertrophic subaortic stenosis, hypotension, acute myocardial infarction, systemic lupus erythematosus, pancreatitis, disruption of water-electrolyte metabolism and acid-base balance (hypokalaemia, alkalosis, hypovolemia, hyponatremia , hypochloraemia, hypocalcemia, hypomagnesemia), digitalis intoxication.

Carefully:

hyperplasia of the prostate, hypoproteinemia (risk of development of ototoxicity), diabetes mellitus (decreased glucose tolerance), stenosing cerebral arteriosclerosis, pregnancy (especially the first half, possible use for life indications), lactation period.

Dosing and Administration:

Furosemide Assign intravenously (slowly struyno), if impossible - intramuscularly (efficacy is much lower) for 7-10 days or more. Parenteral administration is advisable to perform in urgent situations, or with a pronounced edematous syndrome.

The drug is administered in doses of 20 to 60 mg 1-2 times a day; in the absence of a diuretic response every 2 hours, injected in an increased 50% dose until an adequate diuresis is achieved.

The average daily dose for intravenous administration in children - 0.5-1.5 mg / kg, the maximum - 20 mg.Patients with reduced glomerular filtration and low diuretic response are prescribed in large doses - 1-1.5 g.

After the onset of the desired effect, they switch to taking the drug inside.

Side effects:

From the cardiovascular system: lowering blood pressure, collapse, tachycardia, arrhythmia, a decrease in the volume of circulating blood, thrombophlebitis.

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

From the sense organs: visual and hearing impairments.

From the gastrointestinal tract, liver: 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), interstitial nephritis, hematuria, impotence, kidney calcification in premature infants.

Allergic reactions: purpura, urticaria, exfoliation dermatitis, erythema multiforme, vasculitis, necrotizing angiitis, itching, chills, fever, photosensitivity, anaphylactic shock.

From the hematopoiesis: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.

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

Laboratory indicators: hyperglycemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalciuria.

Overdose:

Symptoms: decreased blood pressure, collapse, shock, hypovolemia, dehydration,

hemoconcentration, arrhythmias (incl. AV blockade, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.

Treatment: correction of water-salt balance and acid-base state, replenishment of circulating blood volume, symptomatic treatment. There is no specific antidote.

Interaction:

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

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

Pressor amines and furosemide mutually reduce efficiency.

Drugs that block tubular secretion, increase the concentration of furosemide in serum.

With the simultaneous use of glucocorticosteroids, amphotericin B increases the risk of hypokalemia, with cardiac glycosides - the risk of developing digitalis intoxication due to hypokalemia (for high and low-polarity) and T1 / 2 prolongation (for low-polarity) increases. Reduces renal clearance of lithium preparations and increases the likelihood of development of intoxication.

Non-steroidal anti-inflammatory drugs, sucralfate reduce diuretic effect due to inhibition of synthesis Pg, disturbance of plasma renin level and aldosterone clearance.

Strengthens the hypotensive effect of antihypertensive drugs, neuromuscular blockade of depolarizing muscle relaxants (succinylcholine) and weakens the effect of nondepolarizing muscle relaxants (tubocurarine).

Simultaneous reception of large doses of salicylates against furosemide therapy increases the risk of their toxicity (due to competitive renal excretion).

Intravenously administered furosemide has a slightly alkaline reaction, so it can not be mixed with drugs with a pH of less than 5.5.

Special instructions:

Against the background of course treatment, it is necessary to periodically monitor blood pressure, the content of plasma electrolytes (incl. Na, Ca, K, Mg), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate correction of treatment (with a higher multiplicity in patients with frequent vomiting and against parenteral fluids).

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

Patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit the intake of table salt.

For the prevention of hypokalemia, the simultaneous administration of potassium and potassium-sparing diuretics (primarily spironolactone) is recommended, as well as adherence to a diet rich in potassium.

Increased risk of development of violations of water-electrolyte balance is observed in patients with renal insufficiency.

Selection of the dosing regimen for patients with ascites against the background of cirrhosis of the liver should be done in a stationary setting (violations of the water-electrolyte balance may lead to the development of the hepatic coma). This category of patients shows regular monitoring of the content of plasma electrolytes.

When azotemia and oliguria appear or increase in patients with severe progressive kidney disease, it is recommended to suspend treatment.

It is allocated with milk in women during lactation, in connection with which it is advisable to stop feeding.

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

In patients with unconsciousness, with prostatic adenoma, narrowing of the ureters or hydronephrosis, control of urinary excretion is necessary, in connection with the possibility of acute urinary retention.

Form release / dosage:

Solution for injection, 20 mg / 2 ml.

Packaging:

2 ml per ampoule of glass.

10 ampoules together with a knife or scarifier for opening ampoules and instructions for medical use in a cardboard box.

Storage conditions:In the dark place at a temperature of no higher than 25 degrees.

Shelf life:2 years

Terms of leave from pharmacies:On prescription

Registration number: N015090 / 01

Date of registration:17.07.2009

The owner of the registration certificate:BORISOVSKIY FACTORY OF MEDPREPARATES, OJSC BORISOVSKIY FACTORY OF MEDPREPARATES, OJSC Republic of Belarus

Manufacturer: & nbsp

BORISOVSKIY FACTORY OF MEDPREPARATES, OJSC Republic of Belarus

Representation: & nbspBORISOVSKIY FACTORY OF MEDPREPARATES, OJSCBORISOVSKIY FACTORY OF MEDPREPARATES, OJSC

Information update date: & nbsp13.11.2015

Illustrated instructions

Instructions

Furosemide (Furosemide)