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

"Loopback" diuretic; causes a rapidly advancing, strong and short-term diuresis. It disrupts the reabsorption of sodium and chlorine ions in both the proximal and distal sections of the convoluted tubules and in the thick segment of the ascending part of the Henle loop. Furosemide has a pronounced diuretic, natriuretic, chlororetic effect. In addition, it increases the excretion of potassium, calcium, and magnesium ions.

Pharmacokinetics:

Absorption is high, the maximum concentration is noted in the blood plasma when ingested after 1 hour.

Bioavailability is 60-70%. The relative volume of the distribution is 0.2 l / kg.The connection with plasma proteins is 98%. Penetrates through the placental barrier, excreted in breast milk. Metabolised in the liver. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron.

60-70% is excreted by the kidneys, the rest - by the intestine. The half-life is 1 to 1.5 hours.

Indications:

Edema syndrome with heart failure IIB-III st., cirrhosis of the liver, kidney disease (including nephrotic syndrome); acute left ventricular failure (pulmonary edema).

Contraindications:

Increased sensitivity to furosemide, acute renal failure with anuria (glomerular filtration value less than 3-5 ml / min), severe hepatic insufficiency, hepatic coma, stenosis of the urethra, acute glomerulonephritis, obstruction of the urinary tract by stone, precomatitis states, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis, increased central venous pressure (> 10 mm Hg), idiopathic hypertrophic subaortic stenosis, sy dark lupus erythematosus, hypotension,acute myocardial infarction, pancreatitis, disturbance of water electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia), digitalis intoxication.

Carefully:

Benign prostatic hyperplasia, hypoproteinemia (risk of ototoxicity development), diabetes mellitus (decreased glucose tolerance), cerebral artery atherosclerosis, pregnancy (especially the first half, possible use according to vital indications), lactation period.

Dosing and Administration:

The dosage regimen is set individually, depending on the indications, the clinical situation, the age of the patient.

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

The drug is prescribed by mouth in the morning, before meals and the initial dose for adults is 20-40 mg (1/2 - 1 table).

With insufficient exposure, the dose is gradually increased to 80-160 mg per day (2-3 doses at intervals of 6 hours).

After reducing edema, the drug is prescribed in smaller doses with interruptions 1-2 days.

The initial single dose in children is 1 - 2 mg / kg, the maximum - 6 mg / kg.

Side effects:

From the cardiovascular system: excessive reduction in blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias.

From the side of the central 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.

On the part of the digestive system: 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.

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.

From the side of water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia,hyponatremia, hypochloraemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, a decrease in the volume of circulating blood.

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

Overdose:

Symptoms: depression of arterial pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias, acute renal failure with anuria, thrombosis, thromboembolism, drowsiness confusion, consciousness, flaccid paralysis, apathy.

Treatment: correction of water-salt balance and acid-base state (CBS), 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 - hypiglycemic agents, allopurinol.

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 digital intoxication due to hypokalemia increases.

Reduces renal clearance of lithium preparations and increases the likelihood of development of intoxication. Pressor amines and furosemide mutually reduce efficiency.

Non-steroidal anti-inflammatory drugs, sucralfate reduce the diuretic effect.

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.

Special instructions:

Against the backdrop of course treatment, it is necessary to periodically monitor blood pressure, the concentration of electrolytes in blood plasma (including sodium, calcium, potassium, magnesium), acid-base state, residual nitrogen, creatinine, uric acid, liver function and conduct, if necessary appropriate correction of treatment.

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.

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 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 this connection it is advisable to stop breastfeeding for the period of treatment.

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

In patients in an unconscious state, with enlarged prostate, narrowing of the ureter or hydronephrosis, requires monitoring of urine output, due to the possibility of acute urinary retention.

During the treatment period it is necessary to avoid practicing potentially dangerous activities requiring increased attention and speed of psychomotor reactions.

Form release / dosage:

Tablets of 40 mg.

Packaging:

10 tablets per contour cell pack.

For 50 tablets in a jar of polymer or a jar of glass dark glass. Each jar or 5 contour squares of 10 tablets together with instructions for use in a pack of cardboard

Storage conditions:

List B. In a dry, protected from light and inaccessible to children place.

Shelf life:

2 years.

Do not use after the date shown on the package.

Terms of leave from pharmacies:On prescription

Registration number:P N001295 / 01

Date of registration:20.03.2007

The owner of the registration certificate:DALHIMFARM, OJSC DALHIMFARM, OJSC Russia

Manufacturer: & nbsp

DALHIMFARM, OJSC Russia

Representation: & nbspDALHIMFARM, OJSCDALHIMFARM, OJSC

Information update date: & nbsp16.11.2015

Illustrated instructions

Instructions

Furosemide (Furosemide)