Furosemide-SOLOfarm - instructions for use, doses, side effects, contraindications

Pharmacodynamics:Furosemide is a fast-acting diuretic, which is a sulfonamide derivative. Furosemide blocks ion transport system Na⁺, TO⁺, CL in the thick segment of the ascending knee of the Henle loop, and therefore its saluretic effect depends on the drug entering the lumen of the renal tubules (due to the mechanism of anion transport). The diuretic effect of furosemide is associated with the inhibition of the reabsorption of sodium chloride in this section of the Henle loop. Secondary effects with respect to the increase in sodium excretion are:an increase in the amount of urine released (due to osmotically bound water) and an increase in potassium secretion in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. With repeated administration of furosemide, its diuretic activity does not decrease, as the drug interrupts the tubular-glomerular feedback in Macula densa (tubular structure closely connected with the juxtaglomerular complex). Furosemide causes dose-dependent stimulation of the renin-angiotensin-aldosterone system. With heart failure furosemide quickly reduces preload (by expanding the veins), reduces pulmonary artery pressure and the filling pressure of the left ventricle. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which this effect also requires sufficient preservation of kidney function.

The drug has antihypertensive effect, which is due to increased sodium excretion, hypovolemia (decrease in the volume of circulating blood) and a decreasethe response of the smooth muscles of the vessels to vasoconstrictor effects (due to the natriuretic effect furosemide reduces the response of blood vessels to catecholamines, whose concentration in patients with hypertension is increased).

A dose-dependent increase in diuresis and natriuresis is observed when taking furosemide at a dose of 10 mg to 100 mg (healthy volunteers). After intravenous administration of 20 mg of the drug, the diuretic effect develops after 15 minutes and lasts about 3 hours. The relationship between the intracanular concentrations of unbound (free) furosemide and its natriuretic effect is in the form of a sigmoid curve with a minimum effective furosemide excretion rate of about 10 μg / min. Therefore, prolonged infusion of furosemide is more effective than repeated bolus administration. In addition, when a certain bolus dose is exceeded, no significant increase in the effect is observed. When the tubular secretion of furosemide decreases or when the drug binds to the albumin located in the lumen of the tubules (for example, in a nephrotic syndrome), the effect of furosemide decreases.

Pharmacokinetics:

The volume of distribution of furosemide is 0.1-0.2 l / kg body weight and varies significantly depending on the underlying disease. Furosemide very strongly binds to blood plasma proteins (more than 98%), mainly with albumins.

Furosemide is excreted mainly unchanged and mainly through secretion in the proximal tubules. After intravenous administration of furosemide, 60-70% of the administered dose is excreted by this route. Glucuronated furosemide metabolites are 10-20% of the kidney-excreted drug. The remaining dose is secreted through the intestine, apparently by biliary secretion. The final half-life of furosemide after intravenous administration is approximately 1-1.5 hours.

Furosemide penetrates the placental barrier and is excreted in the mother's milk. Its concentration in the fetus and the newborn is the same as that of the mother.

Peculiarities of pharmacokinetics in individual patient groups

With renal failure, the excretion of furosemide slows down, and the half-life increases; with severe renal failure, the final half-life can increase to 24 hours.

In the nephrotic syndrome, a decrease in plasma protein concentrations leads to an increase in the concentrations of unbound furosemide (its free fraction), which increases the risk of developing an ototoxic effect. On the other hand, the diuretic effect of furosemide in these patients can be reduced by binding furosemide to albumin in the tubules and reducing the tubular secretion of furosemide.

With hemodialysis and peritoneal dialysis and permanent ambulatory peritoneal dialysis furosemide output is insignificant.

In liver failure, the half-life of furosemide is increased by 30-90%, mainly due to an increase in the volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly.

With heart failure, severe degree of arterial hypertension and in the elderly, excretion of furosemide slows down due to decreased kidney function.

In premature and full-term children, excretion of furosemide can be slowed down, which depends on the degree of maturity of the kidneys, the metabolism of the drug in infants can also be slowed down, since their glucuric ability is inferior.In children, whose age after conception exceeds 33 weeks, the terminal half-life does not exceed 12 hours. In infants aged 2 months and older, the excretion of furosemide does not differ from that in adults.

Indications:

Edema syndrome with chronic heart failure; edematous syndrome in acute heart failure; edematous syndrome with chronic renal failure; acute renal failure, including those with pregnancy and burns (to maintain fluid excretion); edematous syndrome with nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease); edematous syndrome with liver diseases (if necessary in addition to treatment with aldosterone antagonists); hypertensive crisis; maintenance of forced diuresis in case of poisoning with chemical compounds, excreted kidneys in unchanged form.

Contraindications:

Hypersensitivity to the active substance or to any of the components of the drug; in patients with an allergy to sulfonamides (sulfanilamide antimicrobial agents or sulfonylureas), a "cross" allergy may develop furosemide; kidney failure in anuria, which does not respond to the administration of furosemide; hepatic precoma and coma; pronounced hypokalemia (see section "Side effect"); severe hyponatremia; hypovolemia (with or without arterial hypotension) or dehydration; marked abnormalities of urine outflow from any etiology (including unilateral urinary tract damage); pregnancy, the period of breastfeeding (see the section on "Application during pregnancy and during breastfeeding").

Carefully:

With arterial hypotension; at conditions in which excessive reduction in blood pressure is particularly dangerous (severe stenosis of the coronary and / or cerebral arteries); with acute myocardial infarction (increased risk of developing cardiogenic shock); with latent or manifest diabetes mellitus; with gout; with hepatorenal syndrome (that is, with functional renal failure associated with liver disease); with hypoproteinemia (for example, with nephrotic syndrome, when it is possible to reduce the diuretic effect and increase the risk of ototoxic action of furosemide,the choice of dose in such patients should be carried out with extreme caution); with partial obstruction of the urinary tract (prostatic hyperplasia, narrowing of the urethra); at increased risk of development of water-electrolyte balance disorders and acid-base state or in case of significant additional fluid losses (vomiting, diarrhea, profuse sweating) (monitoring of the water-electrolyte balance and acid-base state and, if necessary, correction of their disturbances up to the use of furosemide); with pancreatitis; with ventricular arrhythmias in the anamnesis; with systemic lupus erythematosus; in premature infants (the possibility of forming calcium-containing kidney stones (nephrolithiasis) and the deposition of calcium salts in the kidney parenchyma (nephrocalcinosis), so these children need regular monitoring of kidney function and ultrasound of the kidneys is required, while using risperidone in elderly patients with dementia (risk of increased mortality).

Pregnancy and lactation:

Furosemide penetrates the placental barrier, so it should not be used during pregnancy without strict medical indications. If, for vital reasons, the drug is used in pregnant women, careful monitoring of the condition and development of the fetus is necessary.

During the period of breastfeeding, the use of the drug is contraindicated. it can suppress lactation. If necessary, breast-feeding should be discontinued.

Dosing and Administration:

General recommendations

When using the drug, it is recommended to administer it at the lowest doses sufficient to achieve the necessary therapeutic effect.

The drug is administered intravenously and, in exceptional cases, intramuscularly (when its intravenous administration or ingestion is not possible). Intramuscular administration of the drug is not suitable for the treatment of acute conditions, such as pulmonary edema. Intravenous administration of the drug is carried out only when the intake of the drug inside is not possible or there is a violation of absorption of the drug in the small intestine, as well as when it is necessary to obtain the most rapid effect.At intravenous introduction of a preparation it is always recommended to pass as soon as possible on reception of a preparation inside.

When administered intravenously, the drug should be administered slowly. The rate of intravenous administration should not exceed 4 mg / min. In patients with severe renal failure (with a serum creatinine concentration ≥ 5 mg / dl), it is recommended that the intravenous dose rate of the drug does not exceed 2.5 mg / min. To achieve optimal efficiency and suppression of counterregulation (activation of renin-angiotensin and antinatriuretic neurohumoral regulating units), prolonged intravenous infusion of the drug is more preferable than its repeated intravenous bolus administration. If after one or more bolus intravenous injections in acute conditions there is no possibility for a continuous intravenous infusion, it is more preferable to administer low doses at short intervals between administrations (approximately 4 hours) than intravenous bolus administration of higher doses with longer time intervals between the introductions.

The solution for parenteral administration has a pH of about 9 and does not have buffer properties. At pH below 7, the active ingredient may fall into the sediment, so when diluting the drug, it is necessary to strive for the pH of the resulting solution to be from neutral to slightly alkaline. For dilution, 0.9% sodium chloride solution can be used. A diluted solution of the drug should be used, but the possibilities, immediately after preparation.

The recommended maximum daily dose for intravenous administration in adults is 1500 mg and in children 20 mg.

The duration of treatment in children and adults is determined by the doctor individually, depending on the indications.

Special recommendations on the dosing regimen

Children

In children, the dose should be reduced in accordance with the body weight. In children, the recommended dose for parenteral administration is 1 mg / kg / body weight per day, but not more than 20 mg / day.

Adults

Edema syndrome with liver diseases

The drug is used in addition to treatment with aldosterone antagonists in case of their insufficient effectiveness. To prevent the development of complications,such as inappropriate regulation orthostatic circulation disturbances vodnoelektrolitnogo balance or acid-base status, careful selection of the dose is required so that the fluid loss occurs gradually (at the beginning of treatment available fluid loss of about 0.5 kg body weight per day). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.

Edema Syndrome in Chronic Renal Failure

The sodium reaction to the drug depends on several factors, including the severity of renal failure and the sodium content in the blood, so the effect of the dose can not be exactly predictable. In patients with chronic renal failure require careful dose selection by its gradual rise so that the fluid loss occurs gradually (at the beginning of treatment available fluid loss up to about 2 liters per day, which can be up to 280 mmole Na⁺ per day). In patients on hemodialysis, the usual maintenance dose is 250-1500 mg / day orally.

With intravenous administration, the dose of the drug can be determined as follows: treatment is started with intravenous drip administration at a rate of 0.1 mg / min,then gradually increase the rate of administration every 30 minutes, depending on the therapeutic effect.

Acute renal failure (to maintain the excretion of fluid)

Before the beginning of treatment with the drug, hypovolemia, arterial hypotension and significant violations of the water-electrolyte balance and / or acid-base condition should be eliminated. It is recommended that the patient is transferred from the intravenous drug to the tablets as soon as possible (the dose of the tablets depends on the selected dose for intravenous administration).

The recommended initial dose for intravenous administration is 40 mg. If, after its administration, the necessary diuretic effect is not achieved, the drug can be administered as a continuous intravenous infusion, starting at a rate of 50-100 mg / hr.

Edema with nephrotic syndrome

The recommended initial dose is 20-40 mg per day. The necessary dose is selected depending on the diuretic effect. The daily dose can be administered once or divided into several administrations (see subsection "Pharmacokinetics" and section "Special instructions").

Edema Syndrome in Chronic Heart Failure

The recommended initial dose is 20-80 mg per day. The necessary dose is selected depending on the diuretic response. It is recommended that the daily dose be divided into 2-3 injections.

Edema in acute heart failure

The recommended initial dose of the drug is 20-40 mg as an intravenous bolus. If necessary, the dose of the drug can be adjusted depending on the therapeutic effect.

Hypertensive crisis

The recommended initial dose is 20-40 mg by intravenous bolus administration. The dose can be adjusted depending on the effect.

Maintenance of forced diuresis in poisoning

The drug is used in addition to intravenous infusion of electrolyte solutions. The recommended initial dose for intravenous administration is 20-40 mg. The dose depends on the reaction to the drug. Before and during treatment, the drug should be monitored and restored for fluid and electrolyte losses. In case of poisoning with substances with an acidic or alkaline reaction, their excretion can be accelerated by additional alkalinization or an increase in the acidity of the urine, respectively.

Side effects:

Frequency of occurrence of unwanted reactions / adverse events (HP / AE) is obtained from literature and clinical studies. If the frequency of occurrence for the same HP / A in the literature and data from clinical trials varied, the highest incidence of HP / AH was indicated. The following gradations of the frequency of occurrence of HP / AH by classification CIOMS (Council of International Medical Scientific Organizations): very often (≥ 10%), often (≥ 1%, <10%), infrequently (≥ 0.1%, <1%), rarely (≥ 0.01%, <0 , 1%), very rarely (<0.01%), the frequency is unknown (can not be calculated from available data).

Disorders from the metabolism and nutrition

Often:

- Violations of the water-electrolyte balance, including those with clinical symptoms. Symptoms that indicate the development of violations of water electrolyte balance can be headache, convulsions, tetany, muscle weakness, heart rhythm disturbances and dyspeptic disorders. Such violations can develop either gradually (for a long time) or quickly (for a very short time, for example, in the case of high doses of furosemide in patients with normal renal function).Factors contributing to the development of violations of water-electrolyte balance are the main diseases (for example, cirrhosis of the liver or heart failure); concomitant therapy with means that change the water-electrolyte balance; malnutrition and drinking regimen; vomiting, diarrhea, profuse sweating;

- Dehydration and hypovolemia, especially in elderly patients, which can lead to hemoconcentration with a tendency to develop thrombosis (see subsection "Vascular disorders" below);

- Increase in the concentration of creatinine in the blood;

- Increase in the concentration of triglycerides in the blood serum.

Often: hyponatremia, hypochloraemia, hypokalemia, increased cholesterol concentration in the blood, increased uric acid concentration in the blood and the development of an attack of gout.

Infrequent: decreased tolerance to glucose. Possible manifestation of latent diabetes mellitus (see section "Special instructions").

Frequency unknown: hypocalcemia, hypomagnesemia, increased urea concentration in the blood, metabolic alkalosis, Barter's pseudosyndrome with incorrect and / or prolonged use of furosemide.

Vascular disorders

Very often (for intravenous infusion): lowering blood pressure (BP), including orthostatic hypotension.

Rarely: vasculitis.

Frequency unknown: thrombosis.

Disorders from the kidneys and urinary tract

Often: increase the volume of urine.

Rarely: tubulointerstitial nephritis.

The frequency is unknown: an increase in the content of sodium and chloride in the urine; urinary retention (in patients with partial obstruction of the urinary tract, see section "Special instructions"); nephrocalcinosis / nephrolithiasis in premature infants (see section "Special instructions"); kidney failure (see section "Interaction with other drugs").

Disorders from the digestive system

Infrequently: nausea.

Rarely: vomiting, diarrhea.

Very rarely: acute pancreatitis.

Disturbances from the liver and bile ducts

Very rarely: cholestasis, increased activity of "liver" transaminases.

Hearing disorders and labyrinthine disorders

Infrequent: hearing impairment, usually transient, especially in patients with renal insufficiency, hypoproteinemia (eg, with nephrotic syndrome) and / or too fast intravenous administration of furosemide.There have been reported cases of deafness, sometimes irreversible, after taking furosemide by mouth or intravenously.

Rarely: noise in the ears.

Disturbances from the skin and subcutaneous tissues

Infrequent: itchy skin, hives, rash, bullous dermatitis, erythema multiforme, pemphigoid, exfoliative dermatitis, purpura, photosensitization reactions.

The frequency is unknown: Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, DRESS-syndrome: drug rash with eosinophilia and systemic symptoms.

Immune system disorders

Rarely: severe anaphylactic or anaphylactoid reactions until the development of anaphylactic shock.

The frequency is unknown: weighting of the flow or exacerbation of systemic lupus erythematosus. Disturbances from the nervous system

Often: hepatic encephalopathy in patients with hepatocellular insufficiency (see section "Contraindications").

Rarely: paresthesia.

The frequency is unknown: dizziness, syncope (fainting) or loss of consciousness, headache.

Violations of the blood and lymphatic system

Often: hemoconcentration.

Infrequent: thrombocytopenia.

Rarely: leukopenia, eosinophilia.

Very rarely: agranulocytosis, aplastic anemia or hemolytic anemia.

Disturbances from the musculoskeletal system and connective tissue

The frequency is unknown: there have been cases of rhabdomyolysis, often associated with severe hypokalemia (see "Contraindications").

Congenital, hereditary and genetic disorders

The frequency is unknown: an increased risk of non-transmission of the ductus arteriosus when furosemide is introduced to premature infants during the first weeks of life.

General disorders and disorders at the site of administration

Rarely: fever.

The frequency is unknown: after intramuscular injection, a local reaction in the form of pain is possible. Since some adverse reactions (such as a change in the blood picture, severe anaphylactic or anaphylactoid reactions, severe skin allergic reactions) may, under certain conditions, threaten the life of patients, then any side effects should immediately be reported to the doctor.

Overdose:

The clinical picture of acute or chronic overdose of the drug depends mainly on the degreeand the consequences of fluid loss and electrolytes; overdose may be manifested by hypovolemia, dehydration, hemoconcentration, cardiac rhythm disturbances and conduction (including atrioventricular block and ventricular fibrillation). Symptoms of these disorders are a marked decrease in blood pressure, progressing until the development of shock, acute renal failure, thrombosis, delirious condition, flaccid paralysis, apathy and confusion.

The treatment is aimed at correction of clinically significant violations of water-electrolyte balance and acid-base state under the control of the content of electrolytes in blood serum, acid-base indexes, hematocrit, and prevention or therapy of possible serious complications developing against the background of these disorders.

Interaction:

Unsupported combinations

Chloral hydrate - an intravenous infusion of furosemide for a 24-hour period after the application of chloral hydrate can lead to hyperemia of the skin, excessive sweating, anxiety, nausea, increased blood pressure and tachycardia.Therefore, the use of furosemide simultaneously with chloral hydrate is not recommended.

Aminoglycosides - a delay in excretion of aminoglycosides by the kidneys when they are used simultaneously with furosemide and an increased risk of development of ototoxic and nephrotoxic action of aminoglycosides. For this reason, use of this combination of drugs should be avoided, except when necessary for vital signs, in which case correction (reduction) of maintenance doses of aminoglycosides is required.

Combinations, when using which care should be taken

Ototoxic drugs - furosemide potentiates their ototoxicity. Since this can lead to irreversible damage to the hearing organ, such drugs can be used simultaneously with furosemide only under strict medical conditions.

Cisplatin - with simultaneous application with furosemide, there is a risk of developing an ototoxic effect. In addition, it is possible to increase the nephrotoxic effect of cisplatin in the application of furosemide to perform forced diuresis during treatment with cisplatin, if furosemide is not used in low doses (for example, 40 mg in patients with normal renal function) and in combination with sufficient hydration of the patient.

Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists - the use of ACE inhibitors or angiotensin II receptor antagonists in patients previously treated with furosemide may lead to an excessive decrease in 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 or increasing the dose of ACE inhibitors or angiotensin II receptor antagonists, it is recommended that furosemide be canceled or its dose reduced. Lithium salts - under the influence of furosemide, lithium removal decreases, which increases the lithium content in serum, which increases the risk of its toxic effect, including its damaging effects on the heart and nervous system. Therefore, when this combination is used, monitoring of lithium content in serum is required.

Risperidone - caution should be exercised, carefully weighing the risk-benefit ratio, before using a combination of risperidone with furosemide or other strong diuretics due to the fact that there was an increase in mortality in elderly patients with dementia who were treated simultaneously with risperidone and furosemide.

Levothyroxine - furosemide in high doses can inhibit the binding of thyroid hormones to carrier proteins and, thus, lead to an initial transient increase in the content of free thyroid hormones, and then, in general, to a decrease in the total level of thyroid hormones. When this combination is used, thyroid hormone levels should be monitored.

Interactions that should be taken into account

Cardiac glycosides, drugs that cause lengthening of the interval QT - in the case of development of violations of water-electrolyte balance (hypokalemia or hypomagnesemia) with furosemide, the toxic effect of cardiac glycosides and agents that cause lengthening of the interval QT (the risk of heart rhythm disturbances increases).

Glucocorticosteroids, carbenoxolone, licorice preparations in large quantities and prolonged use of laxatives - when combined with furosemide increase the risk of hypokalemia.

Medicines with nephrotoxic action - when combined with furosemide, the risk of developing their nephrotoxic effect increases.

High doses of some cephalosporins (excreted mainly by the kidneys) - in combination with furosemide, the risk of nephrotoxic effect of cephalosporins increases.

Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, including acetylsalicylic acid, can reduce the diuretic effect of furosemide. In patients with hypovolemia and dehydration (including those taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide can increase the toxicity of salicylates.

Phenytoin is a decrease in the diuretic effect of furosemide.

Hypotensive drugs, diuretics or other means that can reduce blood pressure - when combined with furosemide, a more pronounced decrease in blood pressure is possible.

Probenecid, methotrexate or other drugs that, like furosemide, excreted in the renal tubules, can reduce the effects of furosemide (the same pathway of renal excretion); on the other hand, furosemide can lead to a decrease in the excretion of these drugs by the kidneys. All this increases the risk of side effects of both furosemide and the concomitantly taking with them the above medications.

Hypoglycemic agents (and for oral administration, and insulin), pressor amines (epinephrine, norepinephrine) - weakening effects when combined with furosemide. Theophylline, diazoxin, curare-like muscle relaxants - enhancing effects when combined with furosemide.

Sucralfate - decrease in absorption of furosemide with joint ingestion (does not belong to this dosage form) and weakening of its effect (furosemide ingestion and sucralfate should be taken at intervals of not less than two hours). Cyclosporin A - when combined with furosemide, the risk of developing gouty arthritis due to furosemide-induced hyperuricemia and impaired excretion of urate by the kidneys under the influence of cyclosporine increases.

Radiopaque substances - in patients with a high risk of developing nephropathy for the introduction of radiopaque preparations that received furosemide, there was a higher incidence of renal dysfunction after the administration of radiocontrast preparations, compared with patients at high risk of developing radiocontrast-induced nephropathy who received only intravenous fluids (hydration) prior to administration of the radiopaque drug.

The intravenous drug is slightly alkaline, so it should not be mixed with drugs with a pH of less than 5.5.

Special instructions:

Before the beginning of treatment with the drug, one should exclude the presence of pronounced violations of the outflow of urine, including one-sided ones.

Patients with a partial disturbance of urinary outflow need careful monitoring, especially at the beginning of treatment with the drug.

During treatment with the drug requires regular monitoring of sodium, potassium and serum creatinine concentrations; especially close monitoring should be carried out in patients with a high risk of water-electrolyte balance disorders in cases of additional fluid loss and electrolytes (eg, due to vomiting, diarrhea, or intense sweating).

Before and during treatment, the drug should be monitored and, in case of occurrence, eliminated gynovolemia or dehydration, as well as clinically significant disturbances of the water-electrolyte balance and / or acid-base state, which may require a short-term cessation of treatment with the drug.

When treating the drug is always advisable to eat foods rich in potassium (lean meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). In some cases, the intake of potassium preparations or the intake of potassium-sparing drugs may be indicated.

Patients with hypoproteinemia, for example, associated with nephrotic syndrome, require a cautious change in the dose of the drug (possibly reducing the effectiveness of furosemide and increasing its ototoxicity).

Preterm infants require regular monitoring of kidney function and ultrasound of the kidneys (the possibility of nephrolithiasis and nephrocalcinosis).

Most of the deaths were observed in elderly patients with dementia who were simultaneously treated with risperidone and furosemide, compared with patients receiving or only furosemide, or only risperidone. The pathophysiological mechanism of this effect is not established. The simultaneous use of risperidone with other diuretics (mainly with low doses of thiazide diuretics) was not associated with an increase in mortality in elderly patients with dementia. In elderly patients with dementia, caution should be exercised, carefully weighing the benefit-risk ratio, applying furosemide and risperidone Simultaneously. Since dehydration is a common risk factor for increasing mortality, when deciding to use this combination in elderly patients with dementia, patients should be dehydrated. Possible weighting of the flow or exacerbation of systemic lupus erythematosus. The choice of dosage regimen for patients with ascites on the background of liver cirrhosis should be performed in a hospital (violations of water-electrolyte balance may lead to the development of hepatic coma).

Compatibility Guidelines

The drug should not be mixed in the same syringe with other medicines.

Emergency measures in the development of anaphylactic shock

As a rule, the following measures are recommended:

At the first signs (severe weakness, cold sweat, nausea, cyanosis) stop the injection, leaving the needle in the vein. Along with other usual urgent measures, it is necessary to ensure a low position of the head and trunk and maintain airway patency.

Urgent medication (recommendations for dosage are calculated for an adult patient with normal body weight, in the treatment of children, the dosage should be reduced in proportion to the body weight).

Immediate intravenous injection of epinephrine (adrenaline): after diluting 1 ml of a standard solution of epinephrine 1: 1000 to 10 ml, 1 ml of the resulting solution (0.1 mg of epinephrine) is slowly introduced at the beginning under the control of the heart rate, blood pressure and heart rate. If necessary, the introduction of epinephrine can be continued by intravenous infusion. Simultaneously with the introduction of epinephrine, intravenous glucocorticosteroids (250-1000 mg of methylprednisolone or prednisolone) are produced, which can be repeated if necessary. In addition to these measures, intravenous infusion of plasma substitutes and / or electrolytic solutions is performed to replenish the volume of circulating blood.If necessary: artificial respiration, inhalation with oxygen, antihistamines facilities.

Effect on the ability to drive transp. cf. and fur:

Some side effects (eg, a significant reduction in blood pressure) can impair the ability to concentrate and reduce the speed of psychomotor reactions, which can be dangerous when driving vehicles or when engaging in other potentially hazardous activities. Especially it refers to the period of starting treatment or increasing the dose of the drug, as well as to the cases of simultaneous use of antihypertensive drugs or alcohol.

In such cases, it is not recommended to drive vehicles or engage in potentially hazardous activities.

Form release / dosage:

Solution for intravenous and intramuscular injection 10 mg / ml.

Packaging:

2 ml per ampoule of colored glass.

5 or 10 vials in blisters of polyvinyl chloride or polyethylene terephthalate film with a polymer film or lacquered aluminum foil or a polymer film without an aluminum foil and lacquer or in the form of cardboard with cells for stacking ampoules.

1 the contour cellular packaging made of cardboard or form with 10 ampoules or blisters 2 or shapes from a cardboard of 5 ampoules with instruction but application and lancet ampulnam or without pricking ampoule is placed in a pile of cardboard.

Storage conditions:

Store at a temperature not exceeding 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiration date!

Terms of leave from pharmacies:On prescription

Registration number:LP-004603

Date of registration:20.12.2017

Expiration Date:20.12.2022

The owner of the registration certificate:GROTEKS, LLC GROTEKS, LLC Russia

Manufacturer: & nbsp

GROTEKS, LLC Russia

Information update date: & nbsp24.01.2018

Illustrated instructions

Instructions

Furosemide-SOLOfarm (Furosemide-SOLOpharm)