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

Composition:1 ml of the solution contains active substance furosemide - 10 mg;
auxiliary substances: sodium hydroxide, sodium chloride, water for injection.

Description:

Transparent colorless or slightly yellowish liquid.

Pharmacotherapeutic group:diuretic

ATX: & nbsp

C.03.C.A.01 Furosemide

Pharmacodynamics:

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 ("ricochet" or "cancellation"). The phenomenon is caused by a sharp activation of the renin-angiotensin and other antinatriuretic neurohumoral regulating units in response to massive diuresis.

Pharmacokinetics:

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

Metabolized in the liver to form 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.Bioavailability is 60-70%.

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:

Edema syndrome of various genesis (with chronic heart failure, cirrhosis of the liver (syndrome of portal hypertension), edematous syndrome of renal genesis (in the nephrotic syndrome in the foreground is the treatment of the underlying disease), acute heart failure, especially with swelling of the lungs (used in combination with other therapeutic measures), cerebral edema, severe forms of arterial hypertension, hypertensive crisis, conducting forced diuresis with poisoning by chemical compounds that are excreted points in unchanged form.

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, increased central venous pressure (> 10 mm Hg), idiopathic hypertrophic subaortal stenosis, arterial hypotension, acute myocardial infarction, pancreatitis, disturbance of water-electrolyte metabolism and acid-base balance (hypokalemia, alkalosis, hypovolemia , hyponatremia, hypochloraemia, hypocalcemia, hypomagnesemia), digitalis intoxication.

Carefully:

systemic lupus erythematosus, prostatic hyperplasia, hypoproteinemia (risk of ototoxicity development), diabetes mellitus (decrease in glucose tolerance), stenosing cerebral arteries atherosclerosis, pregnancy (especially the first half, possible use for life indications), lactation period.

Dosing and Administration:

Furosemide prescribe intravenously (slowly struyno), with the impossibility of intramuscular (effectiveness 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 is 0.5-1.5 mg / kg body weight, the maximum - 6 mg. Patients with reduced glomerular filtration and low diuretic response are prescribed in large doses of -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 (BP), collapse, tachycardia, arrhythmia, a decrease in the volume of circulating blood, thrombophlebitis, orthostatic hypotension.

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, exfoliative 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, glycosuria, hypercalciuria.

Overdose:

Symptoms: decreased blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including atrioventricular block, 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 the volume of circulating blood, 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-polar) and elongation of the half-life (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 the diuretic effect due to inhibition of prostaglandin synthesis, renin level in the blood plasma and aldosterone removal.

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 electrolytes of blood plasma, acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate correction of treatment (with higher multiplicity in patients with frequent vomiting and in the background parenterally administered 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 adenoma of the prostate gland, narrowing of the ureters or hydronephrosis, control of urinary excretion is necessary, in connection with the possibility of acute retention of urine.

Form release / dosage:

Solution for intravenous and intramuscular injection of 10 mg / ml.

Packaging:

Packaging: 2 ml in ampoules, nested 10 pieces together with the instruction for application and scarifier ampoule or a disc cutting ceramic in a pack of cardboard.

If there are fracture rings or break points on the ampoule, the ampoule scarifier or ceramic cutting disc is not put into the pack.

Storage conditions:

List B. In a place protected from light and inaccessible to children at a temperature of 8 to 15 ° C.

Shelf life:2 years.

Do not use the product after the expiration date indicated on the package!

Terms of leave from pharmacies:On prescription

Registration number:LSR-010208/08

Date of registration:10.03.2009

The owner of the registration certificate:EXPERIMENTAL FACTORY ГНЦЛС, ООО EXPERIMENTAL FACTORY ГНЦЛС, ООО Ukraine

Manufacturer: & nbsp

EXPERIMENTAL FACTORY ГНЦЛС, ООО Ukraine

Information update date: & nbsp13.11.2015

Illustrated instructions

Instructions

Furosemide (Furosemide)