With simultaneous use with phenobarbital and phenytoin, the action of furosemide is reduced.
Increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, cisplatin, amphotericin B (due to competitive renal excretion).
With the simultaneous use of aminoglycosides with furosemide, aminoglycoside excretion slows down and the risk of developing their ototoxic and nephrotoxic action increases. For this reason, use of such a combination of drugs should be avoided, except when necessary for life indications, in which case correction (reduction) of aminoglycoside doses is required.
Increases the effectiveness of diazoxide and theophylline, reduces - hypoglycemic agents (oral antidiabetics, insulin), allopurinol. Medicines with nephrotoxic action - when combined with furosemide, the risk of developing their nephrotoxic effect increases. Glucocorticosteroids, corticotropin and amphotericin B lead to loss of potassium. When combined with furosemide, this can lead to a serious decrease in plasma potassium levels. Carbenoksolon, nicotine, beta2-sympathomimetics in high doses, prolonged use of laxatives, reboxetine may increase the risk of hypokalemia.
With simultaneous use with cardiac glycosides, the risk of developing digitalis intoxication against a background of water-electrolyte disorders (hypokalemia or hypomagnesemia) that cause the syndrome of an elongated interval QT.
Strengthens the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of nondepolarizing muscle relaxants (tubocurarine).
Non-steroidal anti-inflammatory drugs (NSAIDs) (including indomethadine and acetylsalicylic acid) in combination with furosemide maycause a temporary decrease in creatinine clearance and an increase in serum potassium content and reduce the diuretic and antihypertensive effects of furosemide. In patients with hypovolemia and dehydration (including furosemide), NSAIDs can cause acute renal failure. Furosemide can enhance the toxic effect of salicylates (due to competitive renal excretion).
Sucralfate reduces the absorption of furosemide and weakens its effect (these preparations should be taken at intervals of not less than 2 hours).
Combination with carbamazepine may increase the risk of hyponatremia, and with corticosteroids, on the contrary, can cause sodium retention. Hypotensive drugs, diuretics or other means that can reduce blood pressure when combined with furosemide can lead to a more pronounced antihypertensive effect.
The use of angiotensin-converting enzyme (ACE) angiotensin inhibitors or angiotensin II receptor antagonists in patients previously treated with furosemide may result in excessive lowering of 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 ACE inhibitors or angiotensin II receptor antagonists, or increasing their dose, it is recommended that furosemide be withdrawn or reduced.
Probenecid, methotrexate and other medications, which, like furosemide, are secreted in the renal tubules, can reduce the action of furosemide (the same pathway of kidney secretion), on the other hand furosemide can lead to a decrease in the excretion of these drugs by the kidneys. Simultaneous use with metolazonom (thiazide diuretic) can cause increased diuresis.
Lithium salts - under the influence of furosemide, lithium excretion decreases, which increases the serum concentration of lithium and increases the risk of its toxic effects, including damaging effects on the heart and nervous system. Therefore, when using this combination, control of serum lithium concentrations is required.
Simultaneous administration of cyclosporin A and furosemide increases the risk of gouty arthritis due to hyperuricemia,caused by furosemide and violation of cyclosporin excretion of urate by the kidneys.
Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce efficiency.
Radiopaque substances - in patients with a high risk of developing nephropathy for the introduction of radiopaque preparations that received furosemide, a higher incidence of renal dysfunction was observed compared to patients at high risk of developing nephropathy for the introduction of radiopaque preparations that received only intravenous hydration prior to the administration of the radiopaque preparation.
The use of diuretics is considered potentially dangerous when used simultaneously with risperidone. In placebo-controlled trials with risperidone, encompassing elderly patients with dementia, a higher mortality was observed in patients treated simultaneously with furosemide and risperidone compared to patients treated with only furosemide or only risperidone, therefore special caution is required when using furosemide simultaneously with risperidone in such patients.
As a combined or concomitant treatment, such therapy can only be used after an assessment of the benefit / risk ratio.
There are no reports of increased mortality among patients taking other diuretics (mainly thiazide diuretics, at low doses) as concomitant treatment with risperidone.
Patients who are prescribed cholestyramine. Use this medication at least 1 hour after taking furosemide.