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7/31/2019 Generic Name Lasix
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Generic Name:Furosemide Brand Name:Fumide,Furomide,Lasix,Luramide
Classifications:electrolytic and water balance agent; loop diuretic
Pregnancy Category:C
Availability
20 mg, 40 mg, 80 mg tablets; 10 mg/mL, 40 mg/5 mL oral solution; 10 mg/mL injection
Actions
Rapid-acting potent sulfonamide “loop” diuretic and antihypertensive with pharmacologiceffects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly
defined; decreases renal vascular resistance and may increase renal blood flow.
Therapeutic effectsInhibits reabsorption of sodium and chloride primarily in loop of Henle and also in proximal and
distal renal tubules; an antihypertensive that decreases edema and intravascular volume.Reportedly less ototoxic than ethacrynic acid.
UsesTreatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including
nephrotic syndrome. May be used for management of hypertension, alone or in combination with
other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly
with mannitol for treatment of severe cerebral edema, particularly in meningitis.
Contraindications
History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and
electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.
Cautious useInfants, older adults; hepatic cirrhosis, nephrotic syndrome; cardiogenic shock associated with
acute MI; history of SLE, history of gout; patients receiving digitalis glycosides or potassium-
depleting steroids.
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Route & dosage
Edema adult:PO 20 – 80 mg in 1 or more divided doses up to 600 mg/d if needed
IV/IM 20 – 40 mg in 1 or more divided doses up to 600 mg/d
child:PO 2 mg/kg, may be increased by 1 – 2 mg/kg q6 – 8h (max: 6 mg/kg/dose)
IV/IM 1 mg/kg, may be increased by 1 mg/kg q2h if needed (max: mg/kg/dose)neonate:PO 1 – 4 mg/kg q12 – 24h
IV/IM 1 – 2 mg/kg q12 – 24h
Hypertension adult:PO 10 – 40 mg b.i.d. (max: 480 mg/d)
Administration
Oral
Give with food or milk to reduce possibility of gastric irritation.
Schedule doses to avoid sleep disturbance (e.g., a single dose is generally given in themorning; twice-a-day doses at 8 a.m. and 2 p.m.).
Note: Slight discoloration of tablets reportedly does not alter potency.
Store tablets at controlled room temperature, preferably at 15° – 30° C (59° – 86° F) unless
otherwise directed. Protect from light.
Store oral solution in refrigerator, preferably at 2° – 8°C (36° – 46 F). Protect from light and
freezing.
Intramuscular
Protect syringes from light once they are removed from package.
Discard yellow or otherwise discolored injection solutions.
Intravenous
Note: Verify correct IV concentration and rate of infusion/injection with physician beforeadministration to infants or children.
PREPARE direct: Give undiluted.
ADMINISTER direct: Give undiluted at a rate of 20 mg or a fraction thereof over 1 min. With
high doses a rate of 4 mg/min is recommended to decrease risk of ototoxicity.
Incompatibilities Solution / Additive:Buprenorphine, chlorpromazine, ciprofloxacin, diazepam,diphenhydramine, dobutamine, doxapram, doxorubicin, droperidol, erythromycin, gentamicin,
isoproterenol, labetalol, meperidine, metoclopramide, milrinone, netilmicin, pancuronium,
prochlorperazine, promethazine, quinidine, thiamine vinblastine, vincristine. Y-site: Amrinone,amsacrine, ciprofloxacin, diazepam, diltiazem, dobutamine, diphenhydramine, dopamine,
doxorubicin, droperidol, esmolol, filgrastim, fluconazole, gemcitabine, gentamicin, hydralazine,
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idarubicin, methocarbamol, metoclopramide, midazolam, milrinone, morphine, netilmicin,
nicardipine, ondansetron, quinidine, thiopental, tobramycin, vecuronium, vinblastine, vincristine,vinorelbine, TPN.
Use infusion solutions within 24 h. • Store parenteral solution at controlled room
temperature, preferably at 15° – 30° C (59° – 86° F) unless otherwise directed. Protect fromlight.
Adverse effects CV:Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes,
circulatory collapse.
Metabolic:Hypovolemia, dehydration, hyponatremia, hypokalemia, hypochloremia metabolic
alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN,
hyperuricemia;.
GI:Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominalcramping, acute pancreatitis, jaundice.
Urogenital:Allergic interstitial nephritis, irreversible renal failure, urinary frequency.Hematologic:Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis(rare).
SpecSenses:Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred
vision.
Skin:Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde,
necrotizing angiitis (vasculitis).
BodyWhole:Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness;
thrombophlebitis, pain at IM injection site.
Nursing implications
Assessment & Drug Effects
Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs.
Sudden death from cardiac arrest has been reported.
Monitor BP during periods of diuresis and through period of dosage adjustment.
Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid
and electrolyte balance may precipitate significant adverse reactions. Report symptoms tophysician.
Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood
sugar, and uric acid values during first few months of therapy and periodically thereafter.
Monitor for S&S of hypokalemia .
Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive
diuresis can result in dehydration and hypovolemia, circulatory collapse, and
hypotension. Weigh patient daily under standard conditions.
Monitor urine and blood glucose & HbA1C closely in diabetics and patients with
decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
Note: Excessive dehydration is most likely to occur in older adults, those with chroniccardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.
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Patient & Family Education
Consult physician regarding allowable salt and fluid intake.
Ingestion potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to
reduce or prevent potassium depletion.
Learn S&S of hypokalemia . Report muscle cramps or weakness to physician.
Make position changes slowly because high doses of antihypertensive drugs taken
concurrently may produce episodes of dizziness or imbalance.
Avoid replacing fluid losses with large amounts of water.
Avoid prolonged exposure to direct sun.
Do not breast feed while taking this drug