frusemide
Table of Contents
frusemide / furosemide / Lasix
see also:
introduction
- a potent potassium losing loop diuretic mainly used in the Rx of congestive cardiac failure
- inhibits sodium and chloride absorption in the ascending limb of Henle's loop and in both the proximal and distal tubules
P/K
- rapidly absorbed from GIT:
- 60-69% in normal adults
- < 50% in end stage renal failure (ESRF)
- onset of diuresis following oral administration is within 1 hour
- peak effect occurs within the first or second hour
- duration of diuretic effect is 6 to 8 hours
- in intravenous usage:
- onset of diuresis following oral administration is within 5 minutes
- peak effect occurs within the first hour
- duration of diuretic effect is ~2 hours
C/I
- known hypersensitivity to frusemide or sulphonamides or any of the inactive ingredients
- complete renal shut down / anuria
- increasing oliguria and azotaemia during progressive renal failure
- lactation
- pregnancy
- icteric neonates
- do not inject 250mg frusemide iv as a bolus
precautions
- elderly patients and others at risk of dehydration, collapse and deep venous thrombosis (DVT)
- digoxin Rx as risk of hypokalaemia leasing to toxicity
- cirrhosis as sudden changes in fluid balance may precipitate hepatic encephalopathy
- risk of ototoxicity, especially if either:
- rapid injection or infusion (maximum injection rate of 4 mg/minute)
- severe renal impairment
- hypoproteinaemia / nephrotic syndrome
- doses exceeding several times the usual recommended dose
- concomitant therapy with aminoglycoside antibiotics, ethacrynic acid or other ototoxic drugs
- risperidone - combined use in the elderly with dementia appeared to double mortality!
- avoid strict restriction of sodium intake
- impairment of micturition (e.g. prostatic hypertrophy) as risk of acute retention
- gout, may precipitate gout
- monitor for electrolyte disturbances such as hypokalaemia, hyponatraemia and hypochloraemic alkalosis
- may lower calcium levels
- increases cholesterol and triglycerides short-term
- may exacerbate or, rarely, activate systemic lupus erythematosus (SLE)
dose
- usual starting dose is 20-40mg mane or 2mg/kg in children
- may increase to 2nd dose at midday
- may be carefully titrated up to 400 mg/day (except in advanced renal failure) in those patients with severe clinical oedematous states
- patients with acute pulmonary oedema (APO) are often given 40mg slow iv stat dose and if no response within 1 hr, a 2nd 80mg slow iv dose given
frusemide.txt · Last modified: 2015/12/29 05:11 by 127.0.0.1