Lasix

Before taking furosemide,

• tell your doctor and pharmacist if you are allergic to furosemide, sulfonamide medications, any other medications, or any of the ingredients in furosemide tablets or solution. Ask your pharmacist or check the patient information for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: aminoglycoside antibiotics such as amikacin, gentamicin (Garamycin), or tobramycin (Bethkis, Tobi); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril, lisinopril (in Prinzide, in Zestoretic), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); angiotensin II receptor antagonists (ARB) such as azilsartan (Edarbi, Edarbyclor), candesartan (Atacand, in Atacand HCT), eprosartan (Teveten, in Teveten HCT), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, Benicar HCT), telmisartan (Micardis, in Micardis HCT), and valsartan (Diovan, in Diovan HCT, Exforge); aspirin and other salicylates; barbiturates such as phenobarbital and secobarbital (Seconal); corticosteroids such as betamethasone (Celestone), budesonide (Entocort), cortisone (Cortone), dexamethasone (Decadron, Dexpak, Dexasone, others), fludrocortisone (Floriner), hydrocortisone (Cortef, Hydrocortone), methylprednisolone (Medrol, Meprolone, others), prednisolone (Prelone, others), prednisone (Deltasone, Meticorten, Sterapred, others), and triamcinolone (Aristocort, Azmacort); cisplatin (Platinol); cyclosporine (Gengraf, Neoral, Sandimmune); digoxin (Lanoxin), ethacrynic acid (Edecrin); indomethacin (Indocin); laxatives; lithium (Lithobid); medications for diabetes, high blood pressure and pain; methotrexate (Trexall); probenecid (Probalan, Probenemid); and phenytoin (Dilantin, Phenytek). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• if you are taking sucralfate (Carafate), take it 2 hours before or after you take furosemide.
• tell your doctor if you have kidney disease. Your doctor may tell you not to take furosemide.
• tell your doctor if you have or have ever had any condition that stops your bladder from emptying completely, diabetes, gout, systemic lupus erythematosus (SLE, a chronic inflammatory condition), or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Do not breast-feed while taking this medicine. If you become pregnant while taking furosemide, call your doctor.
• if you are having surgery, tell the doctor that you are using furosemide.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Furosemide may make your skin sensitive to sunlight.
• you should know that furosemide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking furosemide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. Alcohol can add to these side effects.

GENERIC AVAILABLE: Yes

Yes

The principal signs and symptoms of overdose with LASIX are dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, and are extensions of its diuretic action.

The acute toxicity of LASIX has been determined in mice, rats and dogs. In all three, the oral LD50 exceeded 1000 mg/kg body weight, while the intravenous LD50 ranged from 300 to 680 mg/kg. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats.

The concentration of LASIX in biological fluids associated with toxicity or death is not known.

Treatment of overdosage is supportive and consists of replacement of excessive fluid and electrolyte losses. Serum electrolytes, carbon dioxide level and blood pressure should be determined frequently. Adequate drainage must be assured in patients with urinary bladder outlet obstruction (such as prostatic hypertrophy).

Hemodialysis does not accelerate furosemide elimination.

Furosemide is a prescription medication used to treat edema (tissue swelling) associated with congestive heart failure, cirrhosis of the liver, and kidney disease. It also treats high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• aminoglycoside antibiotics such as tobramycin (Nebcin, Tobi), gentamicin (Garamycin), or amikacin (Amikin)
• ethacrynic acid (Edecrin)
• aspirin (Ecotrin)
• bismuth subsalicylate (Pepto Bismol)
• succinylcholine (Anectine, Quelicin)
• lithium (Eskalith, Lithobid)
• angiotensin-converting enzyme (ACE) blockers such as
  • benazepril (Lotensin, Lotensin HCT)
  • captopril (Capoten, Capozide)
  • enalapril (Vasotec, Vaseretic)
  • fosinopril (Monopril, Monopril HCT)
  • lisinopril (Prinivil, Prinzide, Zestril, Zestoretic)
  • moexipril (Univasc, Uniretic)
  • quinapril (Accupril, Accuretic, Quinaretic)
  • ramipril (Altace)
  • trandolapril (Mavik, Tarka)
• angiotensin receptor II blockers such as
  • azilsartan (Edarbi)
  • candesartan (Atacand)
  • irbesartan (Avapro)
  • losartan (Cozaar)
  • olmesartan (Benicar)
  • telmisartan (Micardis, Twynsta)
  • valsartan (Diovan)
• diuretics such as
  • acetazolamide (Diamox)
  • amiloride (Midamor)
  • (Bumex)
  • chlorothiazide (Diuril)
  • chlorthalidone (Thalitone)
  • hydrochlorothiazide (Microzide, HCTZ)
  • metolazone (Zaroxolyn)
  • torsemide (Demadex)
  • triamterene (Dyrenium, Dyazide, Maxzide)
• beta blockers such as
  • metoprolol (Toprol XL, Lopressor)
  • carvedilol (Coreg)
  • bisoprolol (Zebeta)
  • betaxolol (Kerlone)
  • nebivolol (Bystolic)
  • propranolol (Inderal)
• calcium channel blockers such as
  • nifedipine (Adalat, Nifedical, Procardia)
  • amlodipine (Norvasc)
  • verapamil (Calan, Isoptin, Covera, Verelan)
  • diltiazem (Cardizem)
• sucralfate (Carafate)
• indomethacin (Indocin)

This is not a complete list of furosemide drug interactions. Ask your doctor or pharmacist for more information.

General

Edema

• Careful etiologic diagnosis should precede the use of any diuretic.e

• Hospitalization of the patient during initiation of therapy is advisable, especially for patients with hepatic cirrhosis and ascites or chronic renal failure.133 e

• In prolonged diuretic therapy, intermittent use of the drug (e.g., on 2–4 consecutive days each week) may be advisable.e

• For the management of fluid retention (e.g., edema) associated with heart failure, experts state that diuretics should be administered at a dosage sufficient to achieve optimal volume status and relieve congestion without inducing an excessively rapid reduction in intravascular volume, which could result in hypotension, renal dysfunction, or both.524

Hypertension

• Monitor BP carefully, especially during initial therapy.133

• If added to regimen of a patient receiving another antihypertensive agent, reduce dosage of preexisting therapy by at least 50% initially to avoid severe hypotension; additional dosage adjustment may be required.133

Administration

Administer orally, IV, or IM.133 150

Oral Administration

Administer orally once (preferably in the morning)e or twice daily .133

For ease of administration and maximum dosage flexibility in children, consider use of oral solution preparation.151

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

IV administration may be used in emergency clinical circumstances when a rapid onset of diuresis is desired, or in patients unable to take oral medication or those with impaired GI absorption; replace with oral therapy as soon as possible.133 150 e

Consider the potential risks, when using large parenteral doses; monitor patient closely.105 107

For IV infusion, dilute in 5% dextrose, 0.9% sodium chloride, or lactated Ringer’s injection and adjust pH to >5.5.150 e

For direct IV injection, administer slowly over a period of 1–2 minutes.150 e

If high-dose parenteral furosemide therapy is necessary, the manufacturer recommends that the drug be administered as a controlled infusion at a rate not exceeding 4 mg/minute in adults.150 e

Dosage

Individualize dosage according to patient’s requirements and response; titrate dosage to gain maximum therapeutic effect while using the lowest possible effective dosage.e (See Boxed Warning.)

Pediatric Patients

2 mg/kg administered as a single dose.103 104 105 107 108 133 If necessary, increase in increments of 1 or 2 mg/kg every 6–8 hours103 104 105 107 108 to a maximum of 6 mg/kg.103 133 Generally not necessary to exceed individual doses of 4 mg/kg or a dosing frequency of once or twice daily.104 Use minimum effective dosage for maintenance therapy.133

1 mg/kg administered as a single IM or IV injection.103 104 105 106 107 108 150 If necessary for resistant forms of edema, the initial dose may be increased by 1 mg/kg103 104 105 108 no more often than every 2 hours until the desired effect has been obtained or up to a maximum dosage of 6 mg/kg.103 Adequate response usually is obtained with individual parenteral doses of 1 mg/kg.104 105 107 108

1 mg/kg administered as a single IM or IV injection.103 104 105 106 107 108 150 If necessary for resistant forms of edema, the initial dose may be increased by 1 mg/kg103 104 105 108 no more often than every 2 hours until the desired effect has been obtained or up to a maximum dosage of 6 mg/kg.103 Adequate response generally obtained with 1 mg/kg.104 105 107 108

Initially, 0.5–2 mg/kg given once or twice daily.149 Increase as necessary up to a maximum of 6 mg/kg daily.149

Adults

20–80 mg given as a single dose, preferably in the morning.133 e If needed, repeat same dose 6–8 hours later or increase dose by 20- to 40-mg increments and give no sooner than 6–8 hours after last dose until desired diuretic response (including weight loss) is obtained.133 e May titrate carefully up to 600 mg daily in severe cases.133

The effective dose may be given once or twice daily thereafter, or, in some cases, by intermittent administration on 2–4 consecutive days each week.133 e Dosage may be reduced for maintenance therapy.e

For management of fluid retention (e.g., edema) associated with heart failure, some experts recommend initiating furosemide at a low dosage (e.g., 20–40 mg once or twice daily) and increasing dosage (maximum 600 mg daily) until urine output increases and weight decreases, generally by 0.5–1 kg daily.524

20–40 mg given as a single IM or IV injection.150 e If needed, repeat same dose 2 hours later or increase dose by 20-mg increments and give no sooner than every 2 hours until the desired diuretic response is obtained.150 Effective dosages may then be given once or twice daily.150

40 mg given as a single IV injection.150 If needed, an 80-mg dose may be given 1 hour after the initial dose.150

40 mg twice daily.133 If desired BP not attained, consider adding other antihypertensive agents.133

Some experts recommend usual dosage range of 10–40 mg twice daily.500

Prescribing Limits

Pediatric Patients

Maximum of 6 mg/kg.103 133

Maximum of 6 mg/kg in infants and children; do not exceed 1 mg/kg daily in premature infants.150

Maximum 6 mg/kg daily.149

Adults

Maximum of 600 mg daily.133 524

Special Populations

Renal Impairment

Higher doses may be required for patients with acute or chronic renal failure.e

Absorption

Bioavailability

Mean oral bioavailability of furosemide from commercially available tablets and oral solution is 64% and 60%, respectively.133

Commercially available tablets and oral solution are bioequivalent.133

Onset

Following oral administration, onset of diuresis occurs within 30 minutes to 1 hour; maximal effect after 1–2 hours.133 e

Following IV administration, diuresis occurs within 5 minutes and peaks within 20–60 minutes.150 e

Onset of diuresis after IM administration occurs somewhat later than after IV administration.150

Maximum hypotensive effect may not be apparent until after several days of therapy.e

Duration

Diuretic effect persists 6–8 hours following oral administration and approximately 2 hours following IV administration.133 150 e

Food

Food does not appear to affect diuretic effect.e

Special Populations

In patients with severely impaired renal function, the diuretic response may be prolonged.e

Distribution

Extent

Crosses the placenta and is distributed into milk.e

Plasma Protein Binding

Approximately 95% bound to plasma proteins (mainly albumin) in both normal and azotemic patients.133 e

Elimination

Metabolism

Metabolized in the liver to the defurfurylated derivative, 4-chloro-5-sulfamoylanthranilic acid.e

Elimination Route

Rapidly excreted in urine by glomerular filtration and by secretion from the proximal tubule.e

Approximately 50% of an oral dose and 80% of an IV or IM dose are excreted in urine within 24 hours; 69–97% of these amounts is excreted in the first 4 hours.150 e The remainder of the drug is eliminated by nonrenal mechanisms including degradation in the liver and excretion of unchanged drug in the feces.e

Half-life

Biphasic;e terminal half-life is approximately 2 hours.133

Special Populations

Hepatic or renal impairment prolongs the elimination half-life of the drug.e

In patients with marked renal impairment without liver disease, nonrenal clearance is increased to the extent that up to 98% of the drug is cleared within 24 hours.e

Not removed by hemodialysis.133

Furosemide belongs to a group of medicines called loop diuretics (also known as water pills). Furosemide is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. It works by acting on the kidneys to increase the flow of urine.

Furosemide is also used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

This medicine is available only with your doctor's prescription.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of furosemide in children. However, premature babies are more likely to have unwanted effects on the kidney, which may require caution in patients receiving furosemide.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of furosemide in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving furosemide.

Pregnancy

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Desmopressin

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aceclofenac
• Acemetacin
• Amikacin
• Amtolmetin Guacil
• Arsenic Trioxide
• Aspirin
• Bepridil
• Bromfenac
• Bufexamac
• Celecoxib
• Chloral Hydrate
• Choline Salicylate
• Cisplatin
• Clonixin
• Dasabuvir
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Digitoxin
• Dipyrone
• Dofetilide
• Droperidol
• Droxicam
• Ethacrynic Acid
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Foscarnet
• Gentamicin
• Ibuprofen
• Indomethacin
• Kanamycin
• Ketanserin
• Ketoprofen
• Ketorolac
• Levomethadyl
• Lithium
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Metolazone
• Morniflumate
• Nabumetone
• Naproxen
• Neomycin
• Nepafenac
• Netilmicin
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Phenylbutazone
• Piketoprofen
• Piroxicam
• Proglumetacin
• Propyphenazone
• Proquazone
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sotalol
• Streptomycin
• Sulindac
• Tenoxicam
• Tiaprofenic Acid
• Tobramycin
• Tolfenamic Acid
• Tolmetin
• Valdecoxib
• Vasopressin

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alacepril
• Aliskiren
• Benazepril
• Captopril
• Carbamazepine
• Cephaloridine
• Cholestyramine
• Cilazapril
• Clofibrate
• Colestipol
• Cyclosporine
• Delapril
• Dibekacin
• Enalapril
• Enalaprilat
• Fludrocortisone
• Fosinopril
• Germanium
• Ginseng
• Gossypol
• Imidapril
• Licorice
• Lisinopril
• Moexipril
• Pancuronium
• Pentopril
• Perindopril
• Quinapril
• Ramipril
• Spirapril
• Temocapril
• Trandolapril
• Tubocurarine
• Vecuronium
• Zofenopril

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy to sulfa drugs (e.g., sulfamethoxazole, sulfasalazine, sulfisoxazole, Azulfidine®, Bactrim®, Gantrisin®, or Septra®) or
• Anemia or
• Bladder problem with urinating or
• Dehydration or
• Diabetes mellitus or
• Gout or
• Hearing problems or
• Hyperuricemia (high uric acid in the blood) or
• Hypocalcemia (low calcium in the blood) or
• Hypochloremic alkalosis (low chlorine in the blood) or
• Hypokalemia (low potassium in the blood) or
• Hypomagnesemia (low magnesium in the blood) or
• Hyponatremia (low sodium in the blood) or
• Hypotension (low blood pressure) or
• Hypovolemia (low blood volume) or
• Liver disease, severe (e.g., cirrhosis) or
• Systemic lupus erythematosus (SLE) or
• Tinnitus (ringing in the ears) or
• Trouble urinating (caused by bladder emptying disorders, enlarged prostate, narrow urethra)—Use with caution. May make these conditions worse.

• Anuria (not able to pass urine)—Should not be used in patients with this condition. .

• Hypoproteinemia (low protein in the blood) from a kidney problem or
• Radiocontrast nephropathy (kidney problem)—May cause side effects to become worse.

• Kidney disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• If you have an allergy to furosemide or any other part of Lasix (furosemide tablets).
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you are not able to pass urine.
• If you are taking any of these drugs: Chloral hydrate, ethacrynic acid, or lithium.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take Lasix with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Hard stools (constipation).
• Loose stools (diarrhea).
• Dizziness.
• Upset stomach or throwing up.
• Headache.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

• Store at room temperature.
• Protect from light.
• Store in a dry place. Do not store in a bathroom.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.

Lasix is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.

You should not use Lasix if you are allergic to furosemide, or:

• if you are unable to urinate.

To make sure Lasix is safe for you, tell your doctor if you have:

• kidney disease;

• enlarged prostate, bladder obstruction or other urination problems;

• cirrhosiss or other liver disease;

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

• high cholesterol or triglycerides (a type of fat in the blood);

• gout;

• lupus;

• diabetes; or

• sulfa drug allergy.

Tell your doctor if you have an MRI (magnetic resonance imaging) or any type of scan using a radioactive dye that is injected into your veins. Both contrast dyes and furosemide can harm your kidneys.

It is not known whether Lasix will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Furosemide can pass into breast milk and may harm a nursing baby. This medicine may also slow breast milk production. Tell your doctor if you are breast-feeding a baby.