Ampoules and diuretic tablets Furosemide: instructions for use, reviews for weight loss, price

Pharmacodynamics and pharmacokinetics

Furosemide - what is it?

Furosemide is a “loop” diuretic, that is, a diuretic that acts primarily on the thick segment of the ascending limb of the loop of Henle. It is fast-acting. The diuretic effect is pronounced, but short-lived.

How long does it take for Furosemide to work?

After oral administration, the drug begins to act within 20-30 minutes, after infusion into a vein - after 10-15 minutes.

Depending on the characteristics of the body, the effect when using the oral form of Furosemide can last for either 3-4 or 6 hours, while it is most powerfully manifested an hour or two after taking the tablet.

After introducing the solution into a vein, the effect reaches a maximum after half an hour and lasts for 2-8 hours (the more severe the kidney dysfunction , the longer the drug lasts).

Pharmacodynamics

The mechanism of action of the drug is associated with impaired reabsorption of chlorine and sodium ions in the tubules of the nephrons of the kidneys. In addition, Furosemide increases the excretion of magnesium, calcium, phosphates and bicarbonates.

The use of the drug in patients with heart failure leads to a decrease in preload on the heart muscle after 20 minutes.

The hemodynamic effect reaches its maximum severity by the 2nd hour of action of Furosemide, which is due to a decrease in the tone of the veins, a decrease in the volume of circulating blood, as well as the volume of fluid filling the intercellular spaces in organs and tissues.

Reduces blood pressure. The effect develops as a consequence:

reducing the reaction of the muscles of the vascular walls to a vasoconstrictor (provoking narrowing of blood vessels and a decrease in blood flow in them) effect;
decrease in BCC;
increasing the excretion of sodium chloride .

During the period of action of Furosemide, the excretion of Na+ ions increases significantly, but after the cessation of the effect of the drug, the rate of their excretion drops below the initial level (withdrawal or rebound syndrome). Due to this, when administered once a day, it does not have a significant effect on blood pressure and daily Na excretion.

The reason for this effect is the sharp activation of antinatriuretic components of neurohumoral regulation (in particular, renin-angiotensin) in response to massive diuresis.

The drug stimulates the sympathetic and arginine vasopressive systems, reduces the plasma concentration of atriopeptin, and causes vasoconstriction.

Pharmacokinetics

Absorption from the digestive tract is high, bioavailability (proportion of absorbed drug) when taken orally is from 60 to 70%. The binding rate to plasma proteins is 98%.

TSmax when taken orally - 1 hour, when infused into a vein - 0.5 hours.

Furosemide is able to cross the placenta and be excreted in breast milk.

The substance undergoes biotransformation in the liver. Metabolites are secreted into the lumen of the renal tubules.

T1/2 for the oral form of the drug - from one hour to one and a half hours, for parenteral - from half an hour to an hour.

From 60 to 70% of the dose taken orally is excreted by the kidneys, the rest - with feces. When administered into a vein, about 88% of furosemide and its metabolic products are excreted by the kidneys, and about 12% with feces.

Buy Furosemide solution intravenously and intramuscularly 1% 2ml No. 10 in pharmacies

Latin name Furosemide

Release form Solution for injection

Pack of 10 ampoules of 2 ml.

Pharmacological action Furosemide is a potent diuretic with a rapidly developing effect. It disrupts the reabsorption of sodium and chloride ions in the thick segment of the ascending loop of Henle. In addition, it increases the excretion of potassium, calcium, and magnesium ions.

Indications: edema syndrome of various origins, incl. for chronic heart failure stages IIB-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome; - pulmonary edema; – post-traumatic cerebral edema; – some forms of hypertensive crisis; – eclampsia; – premenstrual tension syndrome; – program of forced diuresis for barbiturate poisoning.

Contraindications – renal failure with anuria; – hepatic coma and precoma; – disorders of water-salt metabolism: hypokalemia, hyponatremia, hypovolemia (including with hypotension) or dehydration; – I and II trimesters of pregnancy; – hypersensitivity to sulfonamides.

Use during pregnancy and breastfeeding Furosemide is contraindicated for use in the first and second trimesters of pregnancy. In the third trimester, its use is possible only under strict indications and for a short period. If it is necessary to use Furosemide during lactation, breastfeeding should be stopped due to the fact that furosemide is excreted in breast milk and suppresses lactation.

Special instructions The drug should be prescribed with caution in cases of severe cardiovascular insufficiency, long-term therapy with cardiac glycosides, as well as in elderly patients with severe atherosclerosis. Before starting treatment, serious disturbances in water and electrolyte balance should be compensated. Monitoring laboratory parameters During treatment, the level of electrolytes, carbonates, and urea should be regularly monitored (especially when using doses above 80 mg). Impact on the ability to drive vehicles and operate machinery The question of the possibility of engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions should be decided after assessing the patient’s individual reaction, due to a possible decrease in the ability to concentrate.

Composition 1 ml contains furosemide 10 mg

Method of administration and dosage Furosemide is prescribed intravenously and intramuscularly. For adults, the daily dose for parenteral administration is 40 - 60 - 120 mg (1 - 2 times a day). The maximum daily dose for adults is 240 mg. For children, the initial daily dose is 1 mg per kg of body weight, the maximum daily dose is 6 mg per kg of body weight.

Side effects From the water-electrolyte balance and acid-base balance: with long-term use or administration in high doses - hypovolemia, dehydration, hypokalemia, hyponatremia, hypochloremia, alkalosis; in some cases - hypocalcemia. From the cardiovascular system: arterial hypotension, heart rhythm disturbances. From the central nervous system: dizziness, muscle weakness, convulsions; in some cases, when using the drug in high doses in patients with severe impairment of renal excretory function - hearing impairment, vision impairment, paresthesia. From the digestive system: dry mouth; rarely - nausea, vomiting, diarrhea. Metabolism: transient hyperuricemia (with exacerbation of gout), increased levels of urea and creatinine; in some cases - hyperglycemia. Dermatological reactions: dermatitis. Other: in some cases - anaphylactic shock, changes in the peripheral blood picture.

Drug interactions When furosemide is used simultaneously with cardiac glycosides, the risk of developing glycoside intoxication increases, and when used in combination with corticosteroids, the risk of developing hypokalemia increases. With simultaneous use, Furosemide potentiates the effect of muscle relaxants. With the simultaneous use of Furosemide with aminoglycosides or cephalosporins and cisplatin, their concentration in the blood plasma may increase, which can lead to the development of nephro- and ototoxic effects. With simultaneous use, NSAIDs can reduce the diuretic effect of Furosemide. With the simultaneous use of Furosemide and antihypertensive drugs, the hypotensive effect is potentiated. When used simultaneously with Furosemide, the effect of hypoglycemic drugs and pressor amines may be weakened.

Overdose Symptoms: dehydration, decreased blood volume, arterial hypotension, water-electrolyte imbalance, hypokalemia and hypochloremic alkalosis caused by the diuretic effect. Treatment: carry out symptomatic therapy. There is no specific antidote.

Storage conditions The drug should be stored in a dry place, protected from light, at a temperature not exceeding 25°C.

Shelf life: 2 years.

Indications for use of Furosemide

Furosemide - what are these tablets for?

Tablets are prescribed for:

edema, the causes of which are kidney pathologies (including nephrotic syndrome ), stage II-III CHF or liver cirrhosis ;
manifested as pulmonary edema of acute heart failure ;
hypertensive crisis (as monotherapy or in combination with other drugs);
severe forms of arterial hypertension ;
cerebral edema;
hypercalcemia;
eclampsia.

The drug is also used for forced diuresis in case of poisoning with chemicals that are excreted from the body unchanged by the kidneys.

With elevated blood pressure developing against the background of chronic renal failure, furosemide is prescribed if the patient is contraindicated in thiazide diuretics , and also if Clcr does not exceed 30 ml per minute).

Indications for use of Furosemide in ampoules

The annotation for Furosemide in ampoules contains the same indications for use as for the tablet form of the drug.

When administered parenterally, the drug acts faster than when taken orally. Therefore, doctors, when asked “What is the solution for?”, answer that IV administration of Furosemide allows you to quickly reduce pressure (arterial, pulmonary artery, left ventricle) and preload on the heart, which is extremely important in emergency conditions (for example , in hypertensive crisis ).

In the case when the drug is prescribed for nephrotic syndrome , treatment of the underlying disease should come first.

Furosemide, solution

The dosage regimen is set by the doctor individually depending on the severity of water-electrolyte balance disorders, the magnitude of glomerular filtration, and the severity of the patient’s condition. During the use of the drug, water and electrolyte balance indicators should be adjusted taking into account diuresis and the dynamics of the patient’s general condition.

The drug (drug) Furosemide is prescribed intravenously only when oral administration is impractical or ineffective (for example, if absorption in the intestine is impaired) or if a quick effect is needed. If intravenous therapy is used, it is recommended to switch to oral drug therapy as quickly as possible.

To achieve optimal effectiveness and suppress counterregulation in general, preference is given to continuous infusion of the drug Furosemide compared to repeated bolus injections.

In cases where continuous infusion of Furosemide is not appropriate for further treatment after the administration of one or more bolus doses, a treatment regimen with low doses administered at short intervals (approximately 4 hours) is preferred over large bolus doses, which are administered at long intervals.

For adults, the recommended maximum daily dose of furosemide is 1500 mg.

For children, the recommended dose of Furosemide for parenteral administration is 1 mg/kg body weight, but the maximum daily dose should not exceed 20 mg.

Special Dosage Recommendations

Dosage for adults is based on the following recommendations.

Edema in chronic congestive heart failure

The recommended initial dose of the drug is from 20 mg to 50 mg per day. If necessary, the dose can be adjusted depending on the patient's therapeutic response. It is recommended to distribute the daily dose over 2 or 3 administrations.

Edema in acute congestive heart failure

The recommended initial dose of the drug is from 20 mg to 40 mg and is prescribed as a bolus injection. If necessary, the dose can be adjusted depending on the patient's therapeutic response.

Edema in chronic renal failure

The natriuretic effect of furosemide depends on a number of factors, including the severity of renal impairment and sodium balance. Thus, it is impossible to accurately predict the effectiveness of the dose. In patients with chronic renal failure, the dose should be titrated carefully to ensure gradual initial fluid loss. For adult patients, this means using a dose that results in a daily decrease in body weight of approximately 2 kg (approximately 280 mmol Na+).

When administered intravenously, the dose of furosemide can be determined as follows: treatment begins with a continuous infusion at a rate of 0.1 mg per 1 minute, then the infusion rate is increased every half hour depending on the patient's response.

In acute renal failure, before starting the use of furosemide, hypovolemia, hypotension and significant electrolyte and acid-base imbalance should be compensated.

It is recommended to switch from intravenous administration to oral administration as soon as possible.

The recommended starting dose is 40 mg and is given as an intravenous injection. If administration of this dose does not result in the desired increase in fluid output, furosemide can be given as a continuous infusion, starting with 50 mg to 100 mg of the drug administered over 1 hour.

Edema in liver diseases

The drug Furosemide is prescribed as an addition to therapy with aldosterone antagonists in cases where the use of aldosterone antagonists alone is not enough. To prevent complications such as orthostatic hypotension or electrolyte and acid-base imbalances, the dose should be titrated carefully to ensure gradual initial fluid loss. For adult patients, this means administering a dose that results in a daily decrease in body weight of approximately 0.5 kg. If administration is absolutely necessary, the initial single dose is 20–40 mg.

Hypertensive crisis

The recommended starting dose of 20 mg to 40 mg is given as an intravenous bolus injection. If necessary, the dose can be adjusted depending on the patient's therapeutic response.

Support of forced diuresis in case of poisoning

The drug Furosemide is prescribed intravenously in addition to the administration of infusion of electrolyte solutions. The dose depends on the therapeutic response to furosemide. Loss of fluid and electrolytes should be regulated and initiated during treatment. In case of poisoning with acidic or alkaline substances, their elimination can be accelerated by alkalizing or acidifying the urine, respectively.

The recommended starting dose is 20 mg to 40 mg and is administered intravenously.

Special recommendations for use

Intravenous injection/infusion: If administered, furosemide is administered as a slow injection or infusion at a rate of no more than 4.0 mg per minute. For patients with severe liver dysfunction (serum creatinine more than 5 mg/dL), it is recommended to administer an infusion at a rate of no more than 2.5 mg per minute.

Intramuscular injection: Prescription of the drug by intramuscular injection should be limited to exceptional cases when oral and intravenous administration is inappropriate. It should be taken into account that the method of administering the drug by intramuscular injection is not indicated for the treatment of acute conditions such as pulmonary edema.

The drug infusion should not be carried out together with other drugs!

Drug Furosemide is a solution with a pH level of approximately 9, which does not have a buffer capacity. Thus, the active component may precipitate at pH values below 7. In the case of diluting a solution, care should be taken to ensure that the pH of the diluted solution ranges from slightly alkaline to neutral.

0.9% sodium chloride solution can be used as a solvent. It is recommended to use the diluted solution immediately after preparation.

Children

For children, the dose should be reduced according to body weight (see section "Method of administration and dosage").

Contraindications for Furosemide

The drug is not prescribed for:

intolerance to its components;
ARF, which is accompanied by anuria (if the GFR value does not exceed 3-5 ml/min.);
urethral stenosis;
severe liver failure;
hepatic coma;
hyperglycemic coma;
precomatose states;
obstruction of the urinary tract with stones;
decompensated stenosis of the mitral valve or aortic orifice;
conditions in which blood pressure in the right atrium exceeds 10 mmHg. Art.;
gout;
hyperuricemia;
myocardial infarction (in the acute stage);
arterial hypertension;
hypertrophic subaortic stenosis;
systemic lupus erythematosus;
disorders of water-salt metabolism (hypocalcemia, hypochloremia, hypomagnesemia, etc.);
pancreatitis;
digitalis intoxication (intoxication caused by taking cardiac glycosides).

Relative contraindications to the use of Furosemide:

benign prostatic hyperplasia (BPH);
diabetes;
hypoproteinemia (taking the drug increases the risk of developing ototoxicity);
obliterating cerebral atherosclerosis;
hepatorenal syndrome;
hypotension in patients at risk of ischemia (coronary, cerebral or other), which is associated with circulatory failure;
hypoproteinemia against the background of nephrotic syndrome (possible increased undesirable side effects of Furosemide (especially ototoxicity) and a decrease in its effectiveness).

Patients at risk should be under constant medical supervision. Violation of the blood sugar balance, hypovolemia or dehydration are grounds for reviewing the treatment regimen and, if necessary, temporarily discontinuing the drug.

Diuretics promote the removal of sodium from the body, therefore, in order to avoid the development of hyponatremia, before starting therapy and subsequently throughout the course of using Furosemide, it is necessary to monitor the level of sodium in the patient’s blood (especially in patients with cachexia , cirrhosis , as well as in the elderly).

The use of loop diuretics may cause sudden hypokalemia . Risk groups include:

aged people;
patients who are undernourished and/or taking multiple medications at the same time;
patients diagnosed with cirrhosis with ascites ;
patients with heart failure .

Hypokalemia increases the cardiotoxicity of digitalis (Digitalis) preparations and the risk of cardiac arrhythmias . In long QT syndrome (congenital or drug-induced), hypokalemia contributes to bradycardia or potentially life-threatening torsade de pointes (TdP ).

In this regard, it is recommended to determine the level of potassium in the patient’s blood as often as possible. The first ionogram should be done within a week after the start of the course.

In diabetics, sugar levels must be systematically monitored throughout the course of treatment.

Additional Information

The drug is not a doping, but it is often used to remove prohibited substances from the body, and also as a means of losing weight in sports where the athlete’s weight is important. In this regard, Furosemide is equated to doping drugs and cannot be used in athletes.

Furosemide

During the course of treatment, it is necessary to periodically monitor blood pressure, plasma electrolyte content (including Na, Ca, K, Mg), acid-base status, residual nitrogen, creatinine, uric acid, liver function and, if necessary, carry out appropriate correction of treatment (with a higher frequency in patients with frequent vomiting and against the background of parenterally administered fluids). Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to furosemide. In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit the consumption of table salt.

To prevent hypokalemia, it is recommended to simultaneously administer potassium supplements and potassium-sparing diuretics (primarily spironolactone), as well as adhere to a diet rich in potassium.

An increased risk of developing fluid and electrolyte imbalances is observed in patients with renal failure.

The selection of a dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in a hospital setting (disturbances in water and electrolyte balance can lead to the development of hepatic coma). This category of patients requires regular monitoring of the content of electrolytes in the blood plasma.

If azotemia and oliguria appear or worsen in patients with severe progressive kidney disease, it is recommended to suspend treatment.

It is excreted in milk in women during lactation, and therefore it is advisable to stop feeding.

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

In unconscious patients with prostate adenoma, narrowing of the ureters or hydronephrosis, monitoring of urination is necessary due to the possibility of acute urinary retention. Furosemide is 98% bound to plasma proteins, mainly albumin. Penetrates the placental barrier and is excreted in breast milk.

Metabolized in the liver to form 4-chloro-5-sulfamoylanthranilic acid. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron. The half-life (T½) of furosemide after intravenous administration ranges from 0.5 to 1 hour.

Excreted predominantly (88%) by the kidneys unchanged and in the form of metabolites; with feces - 12%. Clearance -1.5-3 ml/min/kg.

Side effects of Furosemide

The following side effects may occur while using the drug:

cardiovascular disorders , including orthostatic hypotension , arterial hypotension , arrhythmias , tachycardia , collapse ;
dysfunctions of the nervous system , manifested by dizziness, muscle weakness, headache, tetany , apathy , adynamia , paresthesia , drowsiness, lethargy, weakness, confusion;
dysfunction of the sensory organs (in particular hearing and vision impairment);
disorders of the digestive system, including dry mouth, anorexia , cholestatic jaundice , diarrhea/constipation, nausea, vomiting, exacerbation of pancreatitis ;
disorders of the urogenital tract, including oliguria , interstitial nephritis , acute urinary retention (with BPH), hematuria , impotence ;
hypersensitivity reactions, including exfoliative dermatitis , urticaria , purpura , necrotizing angiitis , vasculitis , erythema multiforme , chills, pruritus, photosensitivity, fever , anaphylactic shock ;
disorders of the hematopoietic organ system, including aplastic anemia , thrombocytopenia , leukopenia , agranulocytosis ;
disorders of water-salt metabolism, including dehydration and, as a consequence, an increased risk of thrombosis/thromboembolism , hypovolemia , hypomagnesemia , hypochloremia , hypokalemia , hypocalcemia , hyponatremia , metabolic acidosis ;
changes in laboratory parameters, including hypercholesterolemia , hyperglycemia , glucosuria , hyperuricemia .

When Furosemide is administered intravenously, thrombophlebitis , and in newborn infants, renal calcification .

Instructions for use of Furosemide

How to take Furosemide for edema?

Diuretic tablets are taken orally. The doctor selects the dose individually depending on the indications and characteristics of the course of the disease.

An adult with edema that has developed against the background of pathologies of the liver, kidneys or heart is prescribed to take ½-1 tablet/day if the condition is assessed as moderate. In severe cases, the doctor may recommend taking 2-3 tablets. 1.r./day or 3-4 tablets. in 2 doses.

How to lower blood pressure with Furosemide?

To reduce high blood pressure in patients with chronic renal failure, the drug is used in combination with antagonists of the renin-angiotensin system. The recommended dose varies from 20 to 120 mg/day. (½-3 tablets/day). The medicine is taken in one or two doses.

Furosemide for weight loss

Some women use the properties of the drug for weight loss. Taking Furosemide tablets (Furosemide Sopharma) really allows you to get rid of several kilograms, but this weight loss can hardly be called weight loss, since the drug does not remove excess fat in problem areas, but only removes water from the body.

Instructions for use of Furosemide in ampoules

The preferred method of administering the solution is a slow intravenous injection (performed over 1-2 minutes).

The drug is administered into the muscle in exceptional cases when oral or intravenous administration is not possible. Contraindications for intramuscular administration of Furosemide are acute conditions (for example, pulmonary edema ).

Taking into account the clinical condition of the patient, it is recommended to transfer Furosemide from parenteral to oral administration as soon as possible.

The question of the duration of treatment is decided taking into account the nature of the disease and the severity of symptoms. The manufacturer recommends using the lowest possible dose at which the therapeutic effect will be maintained.

For edematous syndrome in adults and adolescents over 15 years of age, treatment begins with the injection of 20-40 mg of Furosemide into a vein (in exceptional cases, into a muscle).

In the absence of a diuretic effect, the drug is continued to be administered every 2 hours at a dose increased by 50%. Treatment according to this regimen is continued until adequate diuresis is achieved.

A dose exceeding 80 mg should be administered into a vein by drip. The rate of administration should not be more than 4 mg/min. The maximum permissible dose is 600 mg/day.

In case of poisoning, to maintain forced diuresis, the patient should be administered from 20 to 40 mg of the drug, having previously dissolved the required dose in an infusion solution of electrolytes. Further treatment is carried out depending on the volume of diuresis. It is mandatory to replace the salts and fluids lost by the body.

The initial dose for hypertensive crisis is 20-40 mg. It is subsequently adjusted based on clinical response.

Furosemide injections and tablets: instructions for use in children

In pediatrics, the dose is selected depending on the patient’s weight. Furosemide tablets are given to a child at a rate of 1-2 mg/kg/day. The dose can be taken in one dose or divided into two doses.

Only the attending physician can answer questions about how often you can take the drug in a given case, as well as how long the course of treatment will be. The only clear recommendations are as to what to take Furosemide with: in addition to diuretics, you should definitely take potassium supplements.

The medicine is administered intravenously to children under 15 years of age at a dose of 0.5-1.5 mg/kg/day.

Furosemide tablets: what are they used for in veterinary medicine?

Why is Furasemide Sopharma used in veterinary medicine? In veterinary practice, Furosemide and similar drugs are used as part of complex therapy for the treatment of heart pathologies in dogs.

The use of diuretics allows you to remove fluid that accumulates around the lungs, abdominal or chest cavity, thereby reducing the load on the heart.

For dogs, the dosage of Furosemide depends on the weight of the animal. As a rule, the drug is given 2 times a day at a rate of 2 mg/kg. As an addition to treatment, it is recommended to give your dog bananas daily (one per day) to compensate for potassium losses.

Furosemide, solution 10 mg/ml, ampoules 2 ml, 10 pcs.

General recommendations

When using the drug Furosemide, it is recommended to administer it in the smallest doses sufficient to achieve the required therapeutic effect. The dose is selected individually.

The drug Furosemide is administered intravenously (slowly in a stream), if impossible - intramuscularly (the effectiveness is much lower) for 7-10 days or more. Intramuscular administration of the drug is not suitable for the treatment of acute conditions such as pulmonary edema. Intravenous administration of the drug Furosemide is carried out only when taking the drug orally is impossible or there is a malabsorption of the drug in the small intestine, as well as if it is necessary to obtain the fastest possible effect. When administering Furosemide intravenously, it is always recommended to switch to taking Furosemide orally as soon as possible.

When administered intravenously, Furosemide should be administered slowly. The rate of intravenous administration should not exceed 4 mg/min. In patients with severe renal impairment (serum creatinine concentration ≥ 5 mg/dL), it is recommended that the rate of intravenous administration of Furosemide not exceed 2.5 mg/min. To achieve optimal effectiveness and suppress counterregulation (activation of the renin-angiotensin and antinagriuretic neurohumoral regulation links), prolonged intravenous infusion of the drug Furosemide is preferable to its repeated intravenous bolus administration. If a continuous intravenous infusion is not possible after one or more intravenous bolus administrations in an acute setting, then administering low doses with short intervals between administrations (approximately 4 hours) is preferable to intravenous bolus administration of higher doses at longer intervals. between injections.

The solution for parenteral administration has a pH of about 9 and does not have buffering properties. At a pH below 7, the active substance may precipitate, therefore, when diluting the drug Furosemide, it is necessary to strive to ensure that the pH value of the resulting solution is from neutral to slightly alkaline. For dilution, you can use 0.9% sodium chloride solution. A diluted solution of Furosemide should be used, if possible, immediately after preparation.

The drug is administered in doses of 20-60 mg 1-2 times a day; in the absence of a diuretic response, a dose increased by 50% is administered every 2 hours until adequate diuresis is achieved.

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 dosage recommendations

Children

In children, the dose should be reduced according to 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 in liver diseases

Furosemide is used in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation, disturbances in water-electrolyte balance or acid-base status, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of body weight is possible 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 natriuretic response to Furosemide depends on several factors, including the severity of renal impairment and blood sodium levels, so the dose effect cannot be accurately predicted. In patients with chronic renal failure, careful dose selection is required by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of approximately 2 liters per day is possible, which can amount to up to 280 mmol Na + per day). In patients on hemodialysis, the usual maintenance dose is 250-1500 mg/day orally.

When administered intravenously, the dose of Furosemide can be determined as follows: treatment begins with intravenous drip administration at a rate of 0.1 mg per minute, and then gradually increases the rate of administration every 30 minutes, depending on the therapeutic effect.

Acute renal failure (to maintain fluid excretion)

Before starting treatment with Furosemide, hypovolemia, arterial hypotension and significant disturbances in water-electrolyte balance and/or acid-base status must be eliminated. It is recommended that the patient, as soon as possible, be switched from intravenous administration of the drug Furosemide to taking Furosemide tablets (the dose of Furosemide tablets depends on the selected dose for intravenous administration).

The recommended starting dose for intravenous administration is 40 mg. If after its administration the required diuretic effect is not achieved, then Furosemide can be administered as a continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.

Edema in nephrotic syndrome

The recommended starting dose is 20-40 mg per day. The required dose is selected depending on the diuretic effect. The daily dose can be administered once or divided into several administrations.

Edema syndrome in chronic heart failure

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

Edema syndrome in acute heart failure

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

Hypertensive crisis, cerebral edema

The recommended starting dose is 20-40 mg by intravenous bolus. The dose may be adjusted depending on the effect.

Maintaining forced diuresis during poisoning

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

Overdose

Symptoms of Furosemide overdose:

a sharp drop in blood pressure;
hypovolemia;
dehydration;
collapse;
hemoconcentration;
shock;
arrhythmias (including atrioventricular block and ventricular fibrillation);
thrombosis;
thromboembolism;
confusion;
drowsiness;
acute renal failure with anuria ;
apathy;
flaccid paralysis

To normalize the patient’s condition, measures are prescribed aimed at correcting CSR and water-salt metabolism, replenishing the deficit of blood volume. Further treatment is symptomatic.

Furosemide does not have a specific antidote.

Interaction

Furosemide increases the concentration and toxicity (in particular, oto- and nephrotoxicity) of Ethacrynic acid , Aminoglycosides , Cephalosporins , Cisplatin , Chloramphenicol , Amphotericin B.

Enhances the therapeutic effectiveness of Theophylline and Dazoxide , reduces the effectiveness of Allopurine and hypoglycemic drugs .

Reduces the rate of renal excretion of Li+ drugs from the blood, thereby increasing the likelihood of intoxication with them.

Strengthens the neuromuscular blockade caused by non-depolarizing relaxants (peripheral relaxants) and the effect of antihypertensive drugs , weakens the effect of non-depolarizing relaxants .

In combination with pressor amines, there is a mutual decrease in the effectiveness of the drugs; with Amphotericin B and GCS, the risk of developing hypokalemia .

Use in combination with cardiac glycosides (CGs) may provoke the development of the latter's inherent toxic effects due to a decrease in the level of potassium in the blood (for low- and high-polarity CGs) and an extension of the half-life (for low-polarity CGs).

Drugs that block tubular secretion help increase the serum concentration of furosemide.

Sucralfate and NSAIDs reduce the diuretic effect of the drug due to suppression of Pg synthesis, changes in plasma renin and aldosterone .

The use of high doses of salicylates during treatment with the drug increases the risk of their toxicity, which is caused by competitive renal excretion of the drugs.

The Furosemide solution injected into a vein has a slightly alkaline reaction, so it is contraindicated to mix it with drugs whose pH is below 5.5.

Not recommended combinations for the solution

Administration of Furosemide into a vein within 24 hours after chloral hydrate can provoke:

nausea;
flushes of blood;
anxiety;
increased sweating;
increased blood pressure;
tachycardia.

The use of furosemide with ototoxic drugs (for example, aminoglycosides ) can cause irreversible hearing damage . This combination can only be used for health reasons.

Description of the drug FUROSEMIDE

When used simultaneously with aminoglycoside antibiotics (including gentamicin, tobramycin), nephro- and ototoxic effects may be enhanced.

Furosemide reduces the clearance of gentamicin and increases plasma concentrations of gentamicin and tobramycin.

When used simultaneously with cephalosporin antibiotics, which can cause renal dysfunction, there is a risk of increased nephrotoxicity.

When used simultaneously with beta-agonists (including fenoterol, terbutaline, salbutamol) and corticosteroids, hypokalemia may increase.

When used simultaneously with hypoglycemic agents and insulin, the effectiveness of hypoglycemic agents and insulin may decrease, because furosemide has the ability to increase plasma glucose levels.

When used simultaneously with ACE inhibitors, the antihypertensive effect is enhanced. Severe arterial hypotension is possible, especially after taking the first dose of furosemide, apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of ACE inhibitors. The risk of renal dysfunction increases and the development of hypokalemia cannot be excluded.

When used simultaneously with furosemide, the effects of non-depolarizing muscle relaxants are enhanced.

When used simultaneously with indomethacin and other NSAIDs, the diuretic effect may be reduced, apparently due to inhibition of prostaglandin synthesis in the kidneys and sodium retention in the body under the influence of indomethacin, which is a nonspecific COX inhibitor; decrease in antihypertensive effect.

It is believed that furosemide interacts with other NSAIDs in a similar way.

When used simultaneously with NSAIDs, which are selective COX-2 inhibitors, this interaction is much less pronounced or practically absent.

When used simultaneously with astemizole, the risk of developing arrhythmia increases.

When used simultaneously with vancomycin, oto- and nephrotoxicity may increase.

When used simultaneously with digoxin and digitoxin, an increase in the toxicity of cardiac glycosides is possible, associated with the risk of developing hypokalemia while taking furosemide.

There are reports of the development of hyponatremia when used simultaneously with carbamazepine.

When used simultaneously with cholestyramine and colestipol, the absorption and diuretic effect of furosemide decreases.

When used simultaneously with lithium carbonate, the effects of lithium may be enhanced due to an increase in its concentration in the blood plasma.

When used simultaneously with probenecid, the renal clearance of furosemide decreases.

When used simultaneously with sotalol, hypokalemia and the development of ventricular arrhythmias are possible.

When used simultaneously with theophylline, a change in the concentration of theophylline in the blood plasma is possible.

When used simultaneously with phenytoin, the diuretic effect of furosemide is significantly reduced.

After intravenous administration of furosemide during therapy with chloral hydrate, increased sweating, a feeling of heat, instability of blood pressure, and tachycardia are possible.

When used simultaneously with cisapride, hypokalemia may increase.

It is assumed that furosemide may reduce the nephrotoxic effect of cyclosporine.

When used simultaneously with cisplatin, the ototoxic effect may be enhanced.

special instructions

During the entire course of treatment, it is recommended to avoid activities that potentially threaten life and health, which require rapid psychomotor reactions and increased attention.

During the course of treatment, you should periodically do a blood ionogram, as well as monitor blood pressure levels, blood pressure, uric acid, creatinine, residual nitrogen, and liver function. If necessary, the treatment regimen is revised taking into account these indicators.

When using high doses of Furosemide, it is not recommended to limit the consumption of table salt, which is associated with the risk of developing metabolic acidosis and hyponatremia .

In patients with BPH, hydronephrosis , narrowing of the ureters , and in patients who are unconscious, urinary output should be monitored due to the possibility of acute urinary retention.

The tablet form of the drug is contraindicated for people with glucose/galactose malabsorption syndrome, congenital galactosemia, hypolactasia .

Furosemide, 20 mg/2 ml, solution for injection, 2 ml, 10 pcs.