Names and pronunciation
(fur-oh′se-mide) Lasix
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Individual generic drug information
Extracted information for furosemide only.
(fur-oh′se-mide) Lasix
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Func. class.: Loop diuretic
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Chem. class.: Sulfonamide derivative
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Do not confuse: furosemide/torsemide Lasix/Luvox/Lomotil/Lanoxin/Losec
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ACTION: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle
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USES: Pulmonary edema; edema with HF, hepatic disease, nephrotic syndrome, ascites, hypertension
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Extracted information for furosemide only.
CONTRAINDICATIONS: Anuria Precautions: Pregnancy, breastfeed- ing, diabetes mellitus, dehydration, severe renal disease, cirrhosis, ascites, hypersensitivity to sulfonamides/thia- zides, infants, hypovolemia, electrolyte depletion, hypersensitivity
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SIDE EFFECTS CNS: Headache, fatigue, weakness, ver- tigo, paresthesias CV: Orthostatic hypotension, chest pain, ECG changes, circulatory collapse EENT: Loss of hearing, ear pain, tinnitus, blurred vision ELECT: Hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuri cemia, hypocalcemia, hyponatremia, metabolic alkalosis ENDO: Hyperglycemia GI: Nausea, diarrhea, dry mouth, vomit- ing, anorexia, cramps, oral, gastric irrita- tions, pancreatitis GU: Polyuria, renal failure, glycosuria, bladder spasms HEMA: Thrombocytopenia, agranulocyto- sis, leukopenia, neutropenia, anemia INTEG: Rash, pruritus, purpura, sweat- ing, photosensitivity, urticaria MS: Cramps, stiffness SYST: Toxic epidermal necrolysis, ery- thema multiforme, Stevens-Johnson syndrome
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INTERACTIONS Increase: toxicity—lithium, nondepolar- izing skeletal muscle relaxants, digoxin, salicylates, aminoglycosides, CISplatin Increase: hypotensive action of antihy- pertensives, nitrates Increase: ototoxicity—aminoglycosides, CISplatin, vancomycin Increase: effects of anticoagulants, salic- ylates Decrease: furosemide effect—probenecid Drug/Lab Test Interference: GTT Increase: LDL
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TREATMENT OF OVERDOSE: Lavage if taken orally; monitor electro- lytes; administer dextrose in saline; monitor hydration, CV, renal statusF
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Extracted information for furosemide only.
DOSAGE AND ROUTES Acute pulmonary edema • Adult: IV 40 mg slowly over 2 min, then 80 mg in 60-90 min if needed, max 200 mg/dose Edema • Adult: PO 20-80 mg/day in AM; may give another dose after 6 hr up to 600 mg/day; IM/IV 20-40 mg; increase by 20 mg q2hr until desired response • Child: PO/IM/IV 1-2 mg/kg; may increase by 1-2 mg/kg q6-8hr up to 6 mg/kg Hypertension • Adult: PO 40 mg bid, adjust based on response
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Available forms: Tabs 20, 40, 80 mg; oral sol 8 mg/mL, 10 mg/mL; inj 10 mg/mL
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Administer: • In AM to avoid interference with sleep if using product as diuretic • Potassium replacement if potassium <3 mg/dL PO route • PO with food if nausea occurs; absorp- tion may be decreased slightly; tabs may be crushed IV route • Undiluted; may be given through Y-tube or 3-way stopcock; give ≤20 mg/min Intermittent IV INFUSION route • May be added to NS or D5W; if large doses required and given as IV infusion, max 4 mg/min; use infusion pump Y-site compatibilities: Acyclovir, alfentanil, allopurinol, alprostadil, amifostine, ami- kacin, aminocaproic acid, aminophylline, amphotericin B cholesteryl/lipid com- plex/liposome, anidulafungin, argatroban, ascorbic acid, atenolol, atropine, aza- THIOprine, aztreonam, bivalirudin, bleo- mycin, bumetanide, calcium chloride/ gluconate, CARBOplatin, cefamandole, ceFAZolin, cefepime, cefonicid, cefotax- ime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, chloramphenicol, CISplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexa- methasone, dexmedetomidine, digoxin, DOCEtaxel, doripenem, doxacurium, DOXOrubicin liposome, enalaprilat, ePHEDrine, EPINEPHrine, etoposide, fen- taNYL, fludarabine, fluorouracil, folic acid, foscarnet, gallium nitrate, ganciclovir, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem- cilastatin, indomethacin, insulin (regular), isosorbide, kanamycin, leucovorin, lidocaine, linezolid, LORazepam, LR, man- nitol, mechlorethamine, melphalan, meropenem, methicillin, methotrex- ate, methylPREDNISolone, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, mitoMYcin, moxalactam, multiple vitamin injection, nafcillin, nal- oxone, nitroprusside, octreotide, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palono- setron, pamidronate, pantoprazole, PEME- trexed, penicillin G, PENTobarbital, PHE- Nobarbital, phytonadione, piperacillin, piperacillin-tazobactam, potassium chlo- ride, procainamide, propofol, proprano- lol, ranitidine, remifentanil, Ringer’s, rito- drine, sargramostim, sodium acetate/ bicarbonate, succinylcholine, SUFentanil, temocillin, teniposide, theophylline, thio- pental, thiotepa, ticarcillin, ticarcillin-cla- vulanate, tigecycline, tirofiban, TNA, tobra- mycin, urokinase, vit B/C, voriconazole, zoledronic acid
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Extracted information for furosemide only.
Assess: • HF: weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily • Hypertension: B/P lying, standing; pos- tural hypotension may occur; assess for full risk in older adults, and implement fall prevention strategies • Metabolic alkalosis: drowsiness, rest- lessness • Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness; assess those who are also tak- ing digoxin for digoxin toxicity due to hypokalemia • Rashes, temperature elevation daily • Confusion, especially in geriatric pa- tients; take safety precautions if needed • Hearing, including tinnitus and hearing loss, when giving high doses for extended periods or rapid infusion • Rate, depth, rhythm of respiration, ef- fect of exertion, lung sounds • Electrolytes (potassium, sodium, chlo- ride); include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid • Glucose in urine if patient diabetic • Allergies to sulfonamides, thiazides • Serious rash: monitor for skin rash often; Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multi- forme may occur and are life threatening • Beers: use with caution in older adults; may exacerbate or cause syndrome of inap- propriate antidiuretic hormone secretion or hyponatremia; monitor sodium level closely when changing doses • Pregnancy/breastfeeding: use only if benefit outweighs fetal risks; do not breastfeed, excretion unknown
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Evaluate: F • Therapeutic response: improvement in edema of feet, legs, sacral area (HF); increased urine output, decreased B/P; decreased calcium levels (hypercalcemia)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To discuss the need for a high-potas- sium diet or potassium replacement with prescriber • To rise slowly from lying or sitting position because orthostatic hypoten- sion may occur; teach fall prevention strategies • To recognize adverse reactions that may occur: muscle cramps, weakness, nausea, dizziness; teach diabetic patients to monitor blood glucose carefully; blood glucose levels can be elevated • About the entire treatment regimen, including exercise, diet, stress relief for hypertension • To contact prescriber if rash, cramps, nausea, dizziness, numbness, weakness occur • To take with food or milk for GI symp- toms • To use sunscreen or protective clothing to prevent photosensitivity • To take early in the day to prevent sleeplessness • To avoid OTC medications unless di- rected by prescriber
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Extracted information for furosemide only.
PHARMACOKINETICS PO: Onset 1 hr, peak 1-2 hr, duration 6-8 hr, absorbed 70% IV: Onset 5 min; peak 1⁄2 hr; duration 2 hr (metabolized by the liver 30%); excreted in urine, some as unchanged product, and feces; crosses placenta, enters breast milk; excreted in breast milk; half- life ½-1 hr, protein binding 90%-99%
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Filter the extracted dose blocks for this individual drug.
Acute pulmonary edema
• Adult: IV 40 mg slowly over 2 min, then 80 mg in 60-90 min if needed, max 200 mg/dose Edema
Candidate age grouping · source page 609
Acute pulmonary edema
• Adult: PO 20-80 mg/day in AM; may give another dose after 6 hr up to 600 mg/day; IM/IV 20-40 mg; increase by 20 mg q2hr until desired response
Candidate age grouping · source page 609
Acute pulmonary edema
• Child: PO/IM/IV 1-2 mg/kg; may increase by 1-2 mg/kg q6-8hr up to 6 mg/kg Hypertension
Candidate age grouping · source page 609
Acute pulmonary edema
• Adult: PO 40 mg bid, adjust based on response
Candidate age grouping · source page 609