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

"Loopback" diuretic; causes fast-acting, 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. Communication with blood plasma proteins - 98%.Penetrates through the placental barrier, stands out with 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 period of ogulation is 1-1.5 hours.

Indications:

Edema syndrome with heart failure II - III, liver cirrhosis, kidney disease (including nephrotic syndrome); arterial hypertension.

Contraindications:

Increased sensitivity to furosemide, acute renal failure with anuria (glomerular filtration value less than 3-5 ml / min), severe hepatic insufficiency, hepatic coma, urethral stenosis, acute glomerulonephritis, obstruction of the urinary tract by stone, precomatosis, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis, increased central venous pressure (> 10 mm Hg), idiopathic hypertrophic subaortic stenosis, arteries Ordering hypotension, acute infarkt myocardium, systemic lupus erythematosus, pancreatitis,violation of water-electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloraemia, hypocalcemia, hypomagnesemia), digitalis intoxication.

Carefully:

benign 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:

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 a break of 1-2 days.

With arterial hypertension, 20-40 mg is prescribed, in the absence of a sufficient reduction in blood pressure, other antihypertensive drugs must be added to the treatment.When furosemide is added to already prescribed antihypertensive drugs, their dose should be reduced by a factor of 2.

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

From the senses: a disturbance of sight and hearing.

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.

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, acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, 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, cisplatin. amphotericin B (due to competitive renal excretion).

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

Non-steroidal anti-inflammatory drugs, sucralfate, reduce 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 background of course treatment it is necessary to periodically monitor blood pressure, the content of electrolytes of blood plasma (incl. Na +, Ca2 +, K +, Mg2 +), CBS, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate treatment correction.

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 inappropriate 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 dosage regimen for patients with ascites against the background of cirrhosis of the liver should be carried out under stationary conditions (a violation of the water-electrolyte balance may lead to the development of the hepatic coma). This category of patients shows regular control over 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 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 level of glucose in the blood and urine is required.

In patients with unconsciousness, with prostate adenoma,narrowing of the ureters or hydronephrosis requires monitoring of urination, in connection with the possibility of acute retention of urine.

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:

For 10 or 25 tablets in a contour mesh package.

1.2 contourcell packs of 10 tablets or 2 contourcell packs of 25 tablets together with instructions for use are placed in a pack of cardboard.

Storage conditions:

List B. In a dry, the dark place at a temperature of no higher than 25 ° C.

Shelf life:

2 years. After the expiration date, the drug can not be used.

Terms of leave from pharmacies:On prescription

Registration number:LS-000488

Date of registration:18.11.2009

The owner of the registration certificate:PHARMSTANDART-TOMSKHIMFARM, OJSC PHARMSTANDART-TOMSKHIMFARM, OJSC Russia

Manufacturer: & nbsp

PHARMSTANDART-TOMSKHIMFARM, OJSC Russia

Information update date: & nbsp13.11.2015

Illustrated instructions

Instructions

Furosemide (Furosemide)