Furosemide
Unchecked
Furosemide
Lasix
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Summary
Classes
Common uses
Volume overload in heart failure0, Acute pulmonary edema0, Ascites in cirrhosis0, Edema in CKD0, Adjunct in hypercalcemia0, Hypertension (specific cases)0
Pharmacy
Starting dose
20-40 mg PO/IV; titrate by clinical response. In diuretic-resistant heart failure or CKD, doses to 200 mg or higher may be needed
Preparations
20, 40, 80 mg tablets; 10 mg/mL oral solution; 10 mg/mL IV
US FDA Max
600 mg/d typical practical ceiling in heart failure
Pharmacology
Routes
Oral, IV, IM
Onset
IV: 5 minutes; PO: 30-60 minutes
Duration
IV: ~2 hours; PO: 6-8 hours
Half-life
1.5-2 hours (longer in renal failure)[1]
Bioavailability
~50% (oral; highly variable, 10-100%, hence the standard 1:2 IV-to-PO conversion)[1]
Pregnancy
Avoid where possible; can reduce uteroplacental perfusion and produce neonatal electrolyte disturbance. Reserved for compelling indications.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Furosemide blocks the Na+/K+/2Cl- cotransporter (NKCC2) on the apical membrane of thick ascending limb cells, abolishing the medullary osmotic gradient and producing brisk natriuresis, kaliuresis, and free-water clearance.0 Loop diuretics are the most potent diuretics in routine clinical use because the ascending limb reabsorbs ~25% of filtered sodium. Ototoxicity (especially with rapid IV bolus), hypokalemic metabolic alkalosis, hyperuricemia, and gout flare are the characteristic side effects[1].
References
[edit | edit source]- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Lasix (furosemide), Sanofi-Aventis, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/016273s069lbl.pdf