The maximum dose of furosemide per day. Powerful loop diuretic Furosemide: what is prescribed and how is a drug with an active diuretic effect used. Furosemide - what are these pills for?

Edema, which have either renal or cardiac origin, are life threatening.

Their appearance affects the well-being and general condition, which is very important for the full functioning of not only all systems of internal organs, but also parts of the body.

The drug "Furosemide" was developed by experienced pharmacists to relieve edema.

The medicine provides a fairly effective result.

Indications for use

Indications for the use of "Furosemide" is the presence of the following symptoms:

• edema of cardiac or renal origin;
• high blood pressure, which accompanies chronic renal failure.

Way

Given medicine should be taken orally. In this case, the dose is determined by the severity of the disease, as well as the period of its course.

With edema of cardiac, renal or hepatic origin, adults are prescribed the drug in the following doses:

• in moderate condition ½-1 tablet per day;
• in serious condition, 2-3 tablets per day. Reception can be carried out in one or two calls. In addition, in some cases, 3-4 tablets per day are prescribed in two divided doses.
• With significantly elevated blood pressure in patients suffering from chronic renal failure, Furosemide is usually used in combination with other antihypertensive drugs, the daily dose of which usually does not exceed 120 mg.

For the treatment of edema in young children the daily dose is 1-2 mg/kg of body weight. Tablets should be taken in 1-2 doses.

Release form and composition

This drug is available in the form of tablets of 40 mg. They differ in white color with a characteristic light cream tint. Tablets have a flat-cylindrical shape.

The composition of the medicine includes:

active ingredient.
1. Additional substances: magnesium stearate, milk sugar, starch 1500 and potato starch.

Interaction with other drugs

With the combined use of "Furosemide" with other medications necessary for the complex treatment of a particular disease, various side effects may occur:

1. Toxic drugs, as well as "Aminoglycoside" often leads to irreversible hearing loss.
2. "Cisplatin" - the nephrotoxic effect is enhanced.
3. It is forbidden to take "Furosemide" with drugs that are intended to slow down the excretion of lithium from the human body.
4. Angiotensin II receptor antagonists, as well as angiotensin-converting enzyme inhibitors - a sharp deterioration in kidney function, as well as the occurrence of kidney failure.
5. "Risperidone" - significantly increases the mortality rate of elderly patients.
6. Non-steroidal anti-inflammatory drugs - worsens the effectiveness of the drug "Furosemide". In some patients, the development of acute renal failure or an increase in the toxic effect characteristic of salicylates is observed.
7. "Phenytoin" slows down the action of "Furosemide".
8. "Carbenoxolone", "Licorice", as well as glucocorticosteroids - hypokalemia.

Side effects

Furosemide is strictly prohibited for the treatment of people with the following symptoms and diseases:

1. Diabetes.
2. Benign prostatic hyperplasia.
3. Hypotension.
4. Atherosclerosis of the cerebral arteries.
5. Hypoproteinemia.
6. hepatorenal syndrome.

Side effects

When taking "Furosemide" manifestations of various side effects are possible:

It is allowed to take "Furosemide" during the entire first trimester of the disease. During the further period of bearing a child, this drug is allowed to be administered to a woman only if there are vital indications.

INN: Furosemide

Manufacturer: Borisov Plant of Medical Preparations JSC

Anatomical-therapeutic-chemical classification: Furosemide

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 011635

Registration period: 20.09.2013 - 20.09.2018

Instruction

Tradename

Furosemide

International non-proprietary name

Furosemide

Dosage form

Solution for injection 10 mg/ml

Compound

One ampoule contains:

active substance- furosemide 20 mg;

Excipients: sodium hydroxide solution 1 M, sodium chloride, water for injection.

Description

Clear colorless or slightly yellowish liquid.

Farmacotherapeutic group

"Loop" diuretics. Sulfonamide diuretics. Furosemide.

ATX code S03CA01

Pharmacological properties

Pharmacokinetics

With intravenous administration, the effect of furosemide develops after 5-10 minutes, the time to reach the maximum concentration (TCmax) with intravenous administration is 30 minutes, the diuretic effect lasts for 2 hours, with reduced kidney function - up to 8 hours.

The relative volume of distribution is 0.2 l / kg. Communication with plasma proteins - 98%. 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. Clearance - 1.5 - 3 ml / min / kg. The half-life of furosemide after intravenous administration is from 1 to 1.5 hours.

It is excreted mainly (88%) by the kidneys unchanged and in the form of metabolites, with feces - 12%.

Furosemide is excreted in breast milk. Furosemide crosses the placental barrier and slowly enters the fetus. It is found in the body of the fetus or in the body of newborns in the same concentrations as in the mother's body.

Pharmacodynamics

Furosemide is an effective, fast and short acting loop diuretic. Furosemide is a fast-acting diuretic with a pronounced diuretic effect, has a pronounced diuretic, natriuretic, chloruretic effect, increases the excretion of potassium, calcium, magnesium ions. It inhibits the reabsorption of sodium ions, chlorine, mainly in the thick segment of the ascending part of the loop of Henle. Therefore, the effectiveness of the diuretic action of Furosemide depends on the drug reaching the level of the renal tubules through an anion transport mechanism. The diuretic effect is caused by the suppression of the reabsorption of chloride and sodium ions in this segment of the loop of Henle. As a result, partial sodium excretion can be as high as 35% of glomerular sodium filtration. The consequence of an increase in sodium secretion is an increased excretion of urine (as a result of osmotically bound water) and an increase in the secretion of potassium ions in the distal part of the renal tubules. It also increases the release of calcium and magnesium.

In heart failure, after 20 minutes it leads to a decrease in the preload on the heart. The maximum hemodynamic effect is achieved by the second hour of the drug's action, which is due to a decrease in the tone of the venous vessels, a decrease in the volume of circulating blood and interstitial fluid. It has a hypotensive effect due to an increase in the excretion of sodium chloride, a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in the volume of circulating blood.

During the period of action, the excretion of sodium ions increases significantly, but after its termination, the excretion rate decreases below the initial level (the "rebound" or "cancellation" syndrome). The phenomenon is caused by a sharp activation of renin-angiotensin and other antinatriuretic neurohumoral regulation in response to massive diuresis, stimulates the arginine vasopressive and sympathetic systems. Reduces the level of atrial natriuretic factor in plasma, causes vasoconstriction. Due to the “rebound” phenomenon, when administered once a day, it may not have a significant effect on the daily excretion of sodium and blood pressure.

With intravenous administration at a dose of 20 mg, the onset of the diuretic effect is observed after 15 minutes and the duration is about 3 hours.

Continuous infusion of furosemide is more effective than repeated bolus injections. The important thing is that a dose above a certain loading dose of the drug does not have a significant effect. The action of Furosemide is reduced in patients with reduced tubular secretion or with intratubular drug binding to proteins.

Indications for use

Edema syndrome in chronic heart failure, acute heart failure, chronic renal failure, nephrotic syndrome (with nephrotic syndrome, the treatment of the underlying disease is in the foreground)

Edema syndrome in liver diseases

cerebral edema

Hypertensive crisis, severe forms of arterial hypertension

Maintenance of forced diuresis in case of poisoning with chemical compounds excreted by the kidneys unchanged.

Dosage and administration

When administered intravenously, furosemide should be administered slowly. The rate of administration should not exceed 4 mg per minute. In patients with severe renal impairment (serum creatinine >5 mg/mL), it is recommended not to exceed an infusion rate of 2.5 mg per minute.

Intramuscular administration is possible in exceptional cases when it is impossible to use the intravenous or oral route of administration of the drug. The intramuscular route of administration is not possible in the treatment of acute conditions (eg, pulmonary edema).

The transition from parenteral to oral form should be carried out as early as possible.

The question of the duration of treatment is decided by the doctor, taking into account the nature and severity of the disease.

Edema syndrome

Adults and children over 15 years of age are prescribed at an initial dosage of 20 to 40 mg of furosemide (1-2 ampoules) intravenously, in exceptional cases, intramuscularly. The natriuretic response of furosemide depends on a number of factors, including the severity of renal failure and sodium balance, so the effect of dosage cannot be accurately calculated. For patients with chronic renal failure, the dose of Furosemide should be carefully titrated so that the initial fluid loss is gradual. The dose that leads to fluid loss is approximately equal to 2 kg of body weight (approximately 280 mmol sodium) per day. The dose should be adjusted as necessary according to clinical response. With intravenous administration, furosemide is started by continuous intravenous infusion at a dose of 0.1 mg per minute, then gradually increasing the rate of administration every half hour, taking into account the clinical response. In high doses (80 - 240 mg and above) administered intravenously, at a rate not exceeding 4 mg / min. The maximum daily dose is 600 mg.

Patients with reduced glomerular filtration and a low diuretic response are prescribed in large doses - 1-1.5 g. The maximum single dose is 2 g.

Forced diuresis in case of poisoning

From 20 to 40 mg of furosemide (1 - 2 ampoules) is additionally added to the infusion electrolyte solution. Further treatment is carried out depending on the volume of diuresis and should replace the lost amount of fluid and electrolytes.

Children under 15

The average daily dose for intravenous or intramuscular administration in children under 15 years old is 0.5-1.5 mg / kg.

Side effects

Decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased blood volume

Dizziness, headache, paresthesia, apathy, adynamia, weakness, lethargy, drowsiness, confusion

Visual and hearing impairments

Decreased appetite, dry mouth, thirst, nausea, vomiting, diarrhea or constipation, cholestatic jaundice, pancreatitis (aggravation)

Oliguria, acute urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, reduced potency

Purpura, urticaria, exfoliative dermatitis, erythema multiforme exudative, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock

Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia

Hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis

Muscle weakness, cramps in the calf muscles (tetany)

hyperglycemia, hypercholesterolemia, hyperuricemia, glucosuria,

hypercalciuria

Thrombophlebitis, kidney calcification in premature babies

Contraindications

Hypersensitivity to furosemide or to any component of the drug, sulfonamides or sulfonylurea drugs, cross-hypersensitivity to furosemide may develop

Acute glomerulonephritis, acute renal failure with anuria (glomerular filtration rate less than 3 - 5 ml / min)

Severe liver failure, hepatic coma and precoma

Urethral stenosis, urinary tract obstruction by a stone

Precomatose states

Hyperglycemic coma

Hyperuricemia, gout

Decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (over 10 mm Hg), arterial hypotension, acute myocardial infarction

pancreatitis

Violation of water-electrolyte metabolism and acid-base balance (hypokalemia, alkalosis, hypovolemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia), digitalis intoxication

breastfeeding period

I trimester of pregnancy

Drug Interactions

In some cases, the intravenous administration of furosemide within 24 hours after taking chloral hydrate can lead to flushing, excessive sweating, anxiety, nausea, increased blood pressure, tachycardia. Therefore, co-administration of furosemide and chloral hydrate is not recommended.

The ototoxicity of aminoglycosides and other ototoxic drugs may be increased by concomitant use of furosemide. Since the resulting hearing impairment may be irreversible, the simultaneous use is possible for health reasons.

Combinations requiring special precautions

With the simultaneous use of furosemda and cisplatin, there is a risk of developing an ototoxic effect. If cisplatin treatment requires the achievement of forced diuresis with furosemide, then the latter can be prescribed only at a low dosage (for example, 40 mg with normal renal function) and in the absence of fluid deficiency. Otherwise, it is possible to increase the nephrotoxic effect of cisplatin.

Under the action of Furosemide, the excretion of lithium is reduced, thereby increasing the damaging effect of lithium on the heart and nervous system. Lithium levels should be carefully monitored in patients receiving this combination.

Furosemide treatment can lead to severe hypotension and deterioration of renal function, and in some cases - to the development of acute renal failure, especially when prescribing an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist for the first time or when first taking an increased dose. It is recommended to cancel furosemide or reduce the dose of furosemide 3 days before the start of treatment with ACE inhibitors or angiotensin II receptor antagonists.

Furosemide should be used with caution in combination with risperidone. In elderly patients with dementia, mortality increases with the combined use of furosemide and risperidone. The need for joint use must be justified taking into account the risk and benefits of this combination.

Combinations to consider

The simultaneous administration of non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid, may reduce the effect of Furosemide. In patients with dehydration or hypovolemia, NSAIDs can cause acute renal failure. At the same time, the toxic effect of salicylates may increase.

A decrease in the effectiveness of furosemide has also been described with the simultaneous administration of phenytoin.

With simultaneous treatment with glucocorticosteroids, carbenoxolone, licorice in large quantities, prolonged use of laxatives, hypokalemia may increase.

Possible hypokalemia or hypomagnesaemia can increase the sensitivity of the heart muscle to cardiac glycosides and drugs, leading to a prolongation of the QT interval.

The effect of other drugs that lower blood pressure (BP) (antihypertensive, diuretic and other drugs) may be enhanced when used simultaneously with furosemide.

The simultaneous use of probenecid, methotrexate and other agents that are excreted by tubular secretion (like furosemide) may reduce the effectiveness of furosemide. On the other hand, furosemide may lead to decreased renal elimination of these drugs.

In the treatment of large doses (furosemide and other drugs), it is possible to increase their levels in the blood serum and increase the risk of side effects.

Effectiveness of hypoglycemic agents and pressor amines (eg, epinephrine (adrenaline) , norepinephrine (norepinephrine) may be weakened, and theophylline and curare-like drugs - enhanced.

Furosemide may increase the damaging effect on the kidneys of nephrotoxic drugs.

In patients receiving concomitant treatment with furosemide and some cephalosporins in high doses, deterioration in renal function is possible.

With the simultaneous use of cyclosporine A and furosemide, there may be an increased risk of developing secondary gouty arthritis due to furosemide-induced hyperuricemia and deterioration in the excretion of urate by the kidneys caused by cyclosporine.

Patients at high risk of developing radiocontrast nephropathy treated with furosemide are more susceptible to impaired renal function after receiving radiocontrast agent compared to high-risk patients who received only intravenous hydration before receiving radiocontrast agent.

Intravenously administered furosemide is slightly alkaline, so it should not be mixed with drugs with a pH less than 5.5.

special instructions

Against the background of treatment, it is necessary to periodically monitor blood pressure, plasma electrolytes (Na, Ca, K, Mg), acid-base status, residual nitrogen, creatinine, uric acid, liver function and, if necessary, to carry out appropriate correction of treatment (with a greater multiplicity in patients with frequent vomiting and on the background of parenteral fluids).

Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives 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 intake of table salt.

An increased risk of developing fluid and electrolyte imbalance is observed in patients with renal insufficiency.

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

With the appearance or increase of azotemia and oliguria in patients with severe progressive kidney disease, it is recommended to suspend treatment.

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

In patients who are unconscious, with prostatic hypertrophy, narrowing of the ureters or hydronephrosis, control of urination is necessary due to the possibility of acute urinary retention.

Use during pregnancy and lactation

During pregnancy (especially the first half), furosemide is taken for health reasons after a careful assessment of the benefit to the mother / risk to the fetus.

It is excreted in milk in women during lactation and suppresses lactation, if necessary, the use of the drug, it is advisable to stop breastfeeding.

Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

During the period of treatment, you should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Overdose

Symptoms: pronounced decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including AV blockade, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.

Treatment: correction of water-salt balance and acid-base state, replenishment of circulating blood volume, symptomatic treatment. There is no specific antidote.

Release form and packaging

2 ml in glass ampoules.

10 ampoules, together with a knife or a scarifier for opening ampoules, are put into a cardboard box with a corrugated paper insert.

The box is pasted over with a label-package made of paper for multi-color printing.

Boxes, together with instructions for use in the state and Russian languages, are packed in a group package.

The number of instructions for should correspond to the number of packages.

Some facts about the product:

Instructions for use

Price in the online pharmacy site: from 20

Description

Furosemide is a highly effective synthetic pharmaceutical agent intended for the treatment of excessive accumulation of fluid in the tissues and cavities of the body, which increases urine output.

Production form, composition

A pharmaceutical preparation is produced in the form of tablets for oral administration and a solution for injection into the muscle and intravenous administration.

Tablets of the medical device are flat, cylindrical in shape with a chamfer, white.

The active ingredient of the tablets: furosemide 40 mg.

Inactive substances: potato starch, lactose monohydrate, magnesium stearate.

The drug solution is made in the form of a clear liquid without color or with a slight yellowish tint.

Active ingredient: furosemide 20 mg.

Inactive ingredients: sodium hydroxide, sodium chloride, water for injection.

Pharmacology

The drug belongs to sulfonamide derivatives. Its effect occurs in the loop of Henle by relaxing the smooth muscles of the vessels and increasing blood flow in the kidneys. As a result, the production of prostaglandin E2 and I2 in vascular cells increases, the mechanism of the reverse-countercurrent system of the loop of Henle is disrupted, glomerular filtration increases and, as a result, the diuretic effect increases.

In therapeutic doses, the pharmaceutical preparation leads to a reabsorption of sodium and chlorine ions in the thick segment of the ascending loop of Henle.

As a result of increased excretion of sodium ions, there is a secondary intensive excretion of fluid and an increase in the production of potassium ions in the distal convoluted tubules. The secondary effect of Furosemide is due to the release of intrarenal mediators and the redistribution of blood flow in the kidneys.

The drug helps to lower blood pressure by increasing the excretion of sodium ions and reducing the response of vascular smooth muscles to vasoconstrictor effects and, as a result, reducing the volume of circulating blood. With functional disorders of the heart, it instantly leads to a decrease in the volume of blood flowing to the myocardium due to the expansion of large veins. The acceleration of blood filtration in the nephron channels and the removal of excess fluid from the body depends on the dose of the drug. When Furosemide is used in a course, the effect of the drug does not weaken. The glomerular filtration rate is not impaired by the drug, but its effectiveness is maintained at a low glomerular filtration rate.

The diuretic effect when using the medication in tablets is noted after 20-30 minutes, the highest therapeutic result is manifested within 1-2 hours.

With the introduction of a medication into a vein, an almost instantaneous diuretic effect is achieved - after 5 to 10 minutes.

The duration of the result after a single application lasts longer than 4 hours, with disorders of the kidneys, this period can be extended up to 8 hours.

Pharmacokinetics

The active ingredient of the pharmaceutical product after administration is rapidly absorbed from the digestive organs, the bioavailability of which reaches 64%. The highest amount of the drug in the blood increases with increasing dosage, but the period of its achievement is independent of the dose, and varies over a wide range, depending on the patient's condition.

Up to 95% binds to blood albumins. The active substance passes through the placenta and is excreted in mother's milk. The process of biotransformation takes place in the liver, resulting in the formation of glucuronide. The pharmaceutical preparation and its biotransformation products are quickly excreted by the urinary system. The time for which the serum concentration of the substance is halved is 1 - 1.5 hours. During the day, approximately 50% of the dose that enters the body is excreted in the urine, while in the first 4 hours 59% of the total medication that is excreted in 24 hours. The rest of the medication leaves the body with feces.

Indications for use

The instructions for the medication indicate the following range of indications for the appointment:

Regulations for the use of Furosemide, dosing

Instructions for use for the medicine gives clear instructions for use and dosing. Tablets are administered orally before meals. The selection of the dosage of the medication depends on the severity of the disease and the severity of the symptoms. Per day, 1 tablet (40 mg) is prescribed in the morning. With incomplete exposure, it is possible to increase the dosage from 2 to 4 tablets, the reception is divided into 2-3 times with an interval of 6 hours. After reducing swelling, the dosage is reduced, the reception is carried out with an interval of 1 - 2 days. The highest dose per day is 4 tablets (160 mg).

With high blood pressure, the medication is started with a dose of 80 mg once for 24 hours, divided into 2 times. The dosage should be prescribed according to the patient's condition. With an insufficient therapeutic result, Furosemide is recommended to be used with other pharmaceuticals that reduce blood pressure.

In the presence of myocardial dysfunction, the allowable dose per day can be increased to 2 tablets (80 mg).

For children aged 3 years and older, the dose per day averages 4-3 mg / kg, divided by 1-4 times. The highest therapeutic result from the medication is observed in the first 3-5 days of use.

After the disappearance of puffiness, the pharmaceutical preparation is prescribed in a day or up to 2 times a week.

In the case when the child did not receive this medication or other medications designed to remove fluids from the body with urine, Furosemide should not be prescribed in an average daily dosage. First, the pharmaceutical preparation is recommended to be used in ¼ - ½ of the average daily dose. Only in the absence of a diuretic effect, the dosage is increased. The initial dose for children is 2 mg / kg, if necessary, it can be increased by 1 - 2 mg / kg.

A solution of the drug is used for injection into a vein and rarely for injection into a muscle. The dosage is selected specifically for the individual patient on the basis of his condition, in the course of treatment it is possible to adjust it. This form of medication is used in urgent cases or with severe swelling of the tissues.

With a pathological accumulation of an excessive amount of fluid in the tissues and cavities of the body, the solution is used for adults and children from 15 years of age, starting with 1-2 ampoules (20-40 mg). It is injected into the vein for 1 - 2 minutes. If the diuretic action is not achieved, then the administration is continued every 2 hours at a dose higher by 50% until the therapeutic effect is achieved. The highest daily dose is 600 mg.

To carry out emergency methods of detoxifying the body by increasing the amount of urine excreted from the body in case of severe poisoning, 1-2 ampoules (20-40 mg) are used together with an electrolyte infusion solution.

With a sharp excessive increase in blood pressure to critical levels, a pharmaceutical preparation is prescribed in 1-2 ampoules for injection into a vein. The dosage is adjusted according to need and the patient's response to treatment.

For children under 15 years of age, an average of 0.5 - 1.5 mg / kg is used for injection into the muscle and injection into the vein.

When the expected therapeutic result is achieved, therapy is continued by taking the medication inside.

Contraindications

Furosemide is contraindicated for use in the presence of the following list of pathologies and conditions of the body:

Carefully

Furosemide is used with caution in the following range of pathologies:

• BPH.
• Libman-Sachs disease.
• An abnormally low level of protein in the blood plasma (the risk of damage to the auditory and vestibular apparatus by chemical compounds).
• Diabetes.
• Violation of blood circulation in the vessels of the brain due to the formation of atherosclerotic plaques in them.

Unwanted Consequences

The use of the drug can lead to the following range of undesirable consequences:

• A painful feeling in the epigastric zone or in the pharynx, ending in vomiting.
• Reflex involuntary emptying of the stomach through the mouth.
• Decrease in the volume of circulating blood.
• Dehydration of the body.
• Increased blood flow to organs and tissues.
• Skin itching.
• Decreased blood pressure.
• Disorders of frequency, rhythm and sequence of contractions of the heart muscle.
• A specific type of violation of the sensitivity of the skin.
• Reversible hearing and visual impairment.
• Acute or chronic inflammatory process in the interstitial tissue and tubules of the kidneys.

Due to increased urine output, the following undesirable consequences may occur:

• Vertigo.
• Weakness in the body and muscles.
• Irresistible desire to drink water.
• Depressive state.
• Dehydration of the body.
• Deficiency of potassium in the body.
• Lack of sodium in the body.
• Lack of chlorine in the body.
• Pathological accumulation of bases or excessive loss of acids from the body.
• Metabolic disorder with excessive accumulation of uric acid in the blood.
• Exacerbation of gouty arthritis.
• Abnormal increase in blood sugar.
• Deterioration in obstruction of the urinary tract.

If adverse events appear, then immediately reduce the dosage of the pharmaceutical product or completely cancel it.

Compatibility of Furosemide with other medicines

The simultaneous use of a pharmaceutical preparation with cardiac glycosides increases the risk of poisoning with cardiac glycosides. Parallel use of the drug with glucocorticoids can cause a decrease in the content of potassium in the blood.

Furosemide enhances the effect of drugs that reduce the tone of skeletal muscles and normalize blood pressure.

When the drug is used together with aminoglycosides, antibiotics of the cephalosporin group and cisplatin, their concentration in the blood may increase, which is fraught with damage to the hearing and vestibular apparatus or disruption of the kidneys by chemical compounds.

The diuretic effect of the drug decreases with parallel treatment with non-steroidal anti-inflammatory drugs.

Furosemide, used in parallel with drugs that reduce blood sugar, weakens their effect.

The simultaneous use of a pharmaceutical preparation with medicines containing lithium can provoke an increase in the quantitative number of lithium in the blood.

The use of contrast agents containing iodine in high doses increases the risk of kidney disorders due to excessive fluid loss from the body. Before using contrast agents containing iodine, it is necessary to compensate for the lost volume of fluid in the body.

Driving a car

During the period of therapy, you should refrain from work, the required clear concentration and driving.

Storage

Away from children and sunlight, at a temperature not exceeding 25°C.

Storage period

No more than 2 years. After the expiration of the period of suitability for use is not allowed.

Vacation by pharmacies

It is sold by pharmacies upon presentation of a prescription sheet.

Analogues

The pharmaceutical product has many drugs that are identical in active substance or the effect of an imported manufacturer:

• Lasix manufactured in India, Aventis Pharma Limited.
• Diusemide is manufactured in Jordan by Arab Pharmaceutical Manufacturing Co Ltd.
• Difurex of Indian origin, Menon Pharma.
• Kinex pharmaceutical from India, Unique Pharmaceutical Laboratories.
• Novo-Semid is manufactured in Canada by Novofarm.
• Tasek of Indian origin, Tata Pharma.
• Tasimaid made in India, Tamilnadu Dadha Pharmaceuticals Ltd.
• Indian-made urix, Torrent Pharmaceuticals.
• Florix medicine from India, Rusan Pharma.
• Fruziks is produced in India by British Pharmaceutical Laboratories.
• Furosemix of French origin, Biogalenique.

Compound

1 tablet contains the active substance: furosemide 40 mg.

Pharmacotherapeutic group

Diuretic

ATX code

pharmachologic effect

"Loop" diuretic; causes a rapidly advancing, strong and short-term diuresis. Violates the reabsorption of sodium and chloride ions both in the proximal and distal parts of the convoluted tubules and in the thick segment of the ascending part of the loop of Henle. Furosemide has a pronounced diuretic, natriuretic, chloruretic effect. In addition, it increases the excretion of potassium, calcium, magnesium ions.

Indications for use

Edematous syndrome in heart failure IIB - III stage, cirrhosis of the liver, kidney disease (including nephrotic syndrome); acute left ventricular failure (pulmonary edema), edema with burns, arterial hypertension.

Contraindications

Hypersensitivity to furosemide, acute renal failure with anuria (glomerular filtration rate less than 3-5 ml / min), severe liver failure, hepatic coma, urethral stenosis, acute glomerulonephritis, urinary tract obstruction with a stone, precomatous conditions, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis, increased central venous pressure (over 10 mm Hg), idiopathic hypertrophic subaortic stenosis, arterial hypotension, acute myocardial infarction, systemic lupus erythematosus, pancreatitis, impaired water and electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia), digitalis intoxication.

Dosage and administration

The dosage regimen is set individually, depending on the indications, the clinical situation, the age of the patient. During treatment, the dosage regimen is adjusted depending on the magnitude of the diuretic response and the dynamics of the patient's condition. The drug is prescribed orally in the morning, before meals, and the initial dose for adults is 20-40 mg (1/2 - 1 table). With insufficient exposure, the dose is gradually increased to 80-160 mg per day (2-3 doses at intervals of 6 hours). After reducing edema, the drug is prescribed in smaller doses with a break of 1-2 days. In case of arterial hypertension, 20-40 mg is prescribed; in the absence of a sufficient decrease in blood pressure, other antihypertensive drugs should be added to the treatment. When adding furosemide to already prescribed antihypertensive drugs, their dose should be reduced by 2 times. The initial single dose in children is 1-2 mg / kg, the maximum is 6 mg / kg.

Release form

Tablets of 40 mg. 10, 50 tablets in a blister pack made of polyvinyl chloride film and printed lacquered aluminum foil. 10, 20, 30, 40, 50 or 100 tablets in polymer jars for medicines. One jar or 1, 2, 3, 4, 5 or 10 blister packs together with instructions for use are placed in a carton (pack).

An inexpensive diuretic proven over the years, furosemide, has a complex effect on the body, helping to remove excess water from tissues and internal organs. Its effect is noticeable almost immediately, and it lasts longer than conventional drugs.

The scope of its application is extremely wide, because our women even use furosemide for weight loss. Features of the pharmacological action and instructions for use - all useful information on the topic is given below.

pharmachologic effect

The drug belongs to the so-called loop diuretics. After administration, the absorption of sodium ions in the thick segment of the loop of Henle (kidney) is impaired. After that, there is an increase in the output of water in the distal part of the renal tubule. Furosemide helps release intrarenal mediators and redistributes the blood flow of the organ.

The hypotensive effect is due to increased excretion of sodium salts and a decrease in the volume of circulating blood. In addition, the action of the drug is aimed at relieving spasm of vascular smooth muscles and reducing their response to vasoconstrictors.

Pharmacokinetics of the drug:

1. Absorption when taken orally is about 20 minutes. With the intravenous method, the effect of the drug is observed already 5-10 minutes after administration.
2. It binds to plasma proteins within 96 - 98%. This property is reduced in liver failure.
3. The therapeutic effect lasts approximately 2-3 hours. If kidney function is reduced, the period can be up to 8 hours.
4. Inactivation of the active substance occurs in the liver. This process produces glucuronides.
5. The elimination half-life is usually about 50 minutes. It is excreted unchanged in the urine (approximately 88%) and feces (12%).
6. Penetrates through the placental barrier and into breast milk.
7. On older patients, the effect will be weaker than on young people.

The use of the drug can cause a "rebound" effect. This means that after the maximum effect, the elimination rate upon drug withdrawal decreases below the level of the initial data. In medical terminology, another name for this phenomenon is often found - "cancellation".

The mechanism of action of this phenomenon is such that a single intake of a diuretic during the day may not give the desired therapeutic effect.

Release form

Furosemide is available in two dosage forms. These are tablets and solution for injections. Tablets are packaged in standard blisters of 10 pieces (5 blisters per pack), and injection solution - in glass ampoules of 2 ml. the dosage of the active active substance is 40 mg / tab. and 20 mg/ampoule.

Indications for use

The diuretic properties of this drug make it possible to use it to relieve complications and threatening symptoms in a number of diseases. Quick effect provides emergency care function for various pathologies

When is furosemide used:

• Cirrhosis of the liver;
• Severe treatment of arterial hypertension;
• Kidney disease without impaired excretion function;
• Exceeding the concentration of calcium in the blood (hypercalcemia);
• Threat of preeclampsia and eclampsia.

The drug is most often used in combination with other drugs. Intravenous administration of the drug is carried out in stationary conditions under the supervision of a doctor. A common indication for such therapy is the emergency elimination of toxic substances from the body that pass through the kidneys unchanged. Furosemide in combination with other drugs will help reduce the effects of such chemical poisoning.

Mode of application

The drug is taken orally or intravenously as prescribed by a doctor. To enhance absorption, it is recommended to use the drug before meals. The course of treatment and dosage is calculated individually. Usually the daily dose is 40-160 mg of furosemide (1-4 tablets). The maximum dosage should not exceed 300 mg/day.

Taking drugs during pregnancy in the first trimester is prohibited due to the high degree of risk to the developing fetus. In the future, the decision to prescribe drugs is made after a thorough assessment of the risk to the child and mother. The active ingredient furosemide passes into breast milk and leads to lactation suppression. During the period of taking the drug, it is necessary to interrupt or stop breastfeeding.

Furosemide for children is used for medical reasons

The diuretic effect in this case can be increased due to insufficiently formed renal channels. The dosage is calculated at the rate of 1 - 2 mg / kg per day.

It should be noted that the use of drugs of this type can lead to a violation of the mechanical reaction.

That is why it is desirable to refuse to drive a vehicle and control complex mechanisms. The action of furosemide can affect mental activity and the ability to remember.

special instructions

According to the World Anti-Doping Agency, furosemide is prohibited for use in athletes. The active substances of the drug are not doping, but are often used by athletes to quickly remove illegal drugs from the body. If residual traces of furosemide are detected in the body, the athlete may be suspended from participation in competitions.

Furosemide at therapeutic doses usually does not cause adverse reactions and is well tolerated by patients. At the same time, before prescribing the drug, the doctor must clarify possible contraindications and manufacturer's recommendations for use.

In what cases is admission prohibited:

The drug is used with caution in diabetes mellitus, prostatic hyperplasia and cerebral artery stenosis. The need to take furosemide during pregnancy is decided after assessing the ratio of benefit to the mother and risk to the fetus. When lactation, the drug is not prescribed, admission for medical reasons is possible only after the abolition of breastfeeding.

Compatibility with other medicines and alcohol

The action of furosemide can cause a negative reaction with the simultaneous use of drugs of the cephalosporin group, aminoglycosides and gentamicins. In addition, it is not compatible with chloramphenicol (broad-spectrum antibiotic), ethacrynic acid (also diuretic), and cisplatin-based drugs.

With the simultaneous administration of furosemide and lithium preparations, the toxic effect on liver cells increases. It is also forbidden to use in combination with salicylates (leads to kidney damage) and alcohol, which enhances the toxic effect and can lead to severe pathologies of the excretory system. In the case of obstructive processes of the urinary tract, the use of furosemide should also be limited and take place exclusively under the supervision of a physician.

Side effects

Negative reactions of the body are possible not only with existing contraindications and incompatibility of drugs. In some cases, furosemide may simply not be suitable for patients, as evidenced by the following signs.

Negative reactions to the use of furosemide:

• Severe drop in blood pressure;
• Tachycardia and arrhythmia;
• headache, migraine;
• Dry mouth, intense thirst;
• Cramps of the calf muscles;
• General weakness and drowsiness;
• nervousness, confusion;
• Sweating, trembling in limbs;
• Temporary impairment of hearing and visual function;
• indigestion, vomiting, diarrhea or constipation;
• Exacerbation of pancreatitis and yellowness of the skin;
• Spasm of smooth muscles.

In the event of any of the above symptoms or a combination of them, you should stop taking the drug and consult with your doctor about the advisability of its further use.

It should be noted that often side effects occur when the recommended dosage of the drug is exceeded. In no case should you independently increase the dosage prescribed by your doctor, as well as exceed the recommended course of treatment.

Storage conditions

The drug is valid for five years from the date of issue. Store at room temperature, protected from sunlight. If the packaging is damaged, the medicine must be discarded. The storage location must be inaccessible to children and pets.

In case of accidental swallowing of a tablet by a child, induce vomiting immediately and then take absorbent preparations.

If the dosage was too high, you should immediately contact a medical facility for emergency care (gastric lavage and hospital observation). You can not use the drug after the expiration date, as well as in cases where the storage conditions did not comply with the rules prescribed by the manufacturer.

Estimated cost

The price of furosemide is quite affordable, because for a pack of 50 tablets you will have to pay in the region of 18 - 25 rubles. Ampoules will cost a little more: from 40 rubles for 10 pieces. For the best result, it will be necessary to complete the full course of treatment, so the amount of medicines will need to be calculated in advance.

Similar medicines

The choice of a suitable substitute for furosemide should be entrusted to the attending physician.

Despite the budget cost, the drug is considered one of the most effective and proven.

If it is impossible to use or purchase furosemide, you should consult your doctor about the use of similar drugs - diuretics.

What can replace furosemide:

• Lasix. Also, a representative of drugs - sulfonamides, has a strong diuretic effect, is available in the form of tablets and a solution. The estimated cost is: 50 tablets - 140 rubles, ampoules (10 pieces per pack) - from 180 rubles and more.
• Britomar. Refers to loop diuretics, like furosemide. The average cost of a package of 15 tablets is from 160 rubles.
• Torasemide. The drug is a diuretic, not recommended for use in children, the price is from 67 rubles for 10 pieces.



The optimal drug - a diuretic must be agreed with the attending physician. The dosage and course of treatment of similar medicines may differ from the regimen for taking furosemide, which makes it difficult to use the drug.

Furosemide for weight loss

The principle of action of this drug is based on the removal of excess fluid from the body. The components of the product penetrate into all departments and internal organs, which is why furosemide is famous for such a strong diuretic effect. The diuretic properties of this drug began to be used not only for medical purposes. For a long time, women have been using furosemide for weight loss.