Furosemide instructions for use tablets method of application. Effect on fertility. Unpleasant effects of furosemide

In this article, you can read the instructions for using the drug Furosemide. Reviews of site visitors - consumers of this medication, as well as opinions of doctors of specialists on the use of Furosemide in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Furosemide analogues in the presence of existing structural analogues. The use of a diuretic drug for the treatment of edema, arterial hypertension and kidney disease in adults, children, as well as during pregnancy and lactation.

Furosemide- loop diuretic; causes a rapidly advancing, strong and short-term diuresis. It blocks the reabsorption of sodium and chloride ions both in the proximal and distal parts of the renal tubules and in the thick segment of the ascending part of the loop of Gentle. Furosemide has a pronounced diuretic, natriuretic and chloruretic action. Due to the increase in the release of sodium ions, there is a secondary (mediated by osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. It has secondary effects due to the release of intrarenal mediators and the redistribution of intrarenal blood flow. Against the background of course treatment, there is no weakening of the effect.

In heart failure, furosemide rapidly reduces preload (due to venous dilatation), reduces pulmonary artery pressure and left ventricular filling pressure. It has an antihypertensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in circulating blood volume.

After ingestion of 40 mg of furosemide, the diuretic effect begins within 60 minutes and lasts about 3-6 hours (with reduced kidney function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, however, 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 the renin-angiotensin-aldosterone system 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 blood plasma, causes vasoconstriction. Due to the "rebound" syndrome, when taken once a day, it may not cause a significant effect on the daily release of sodium ions and blood pressure.

Pharmacokinetics

Absorption is high. Bioavailability - 60-70%. Penetrates through the placental barrier, excreted in breast milk. It is excreted mainly (88%) by the kidneys unchanged and in the form of metabolites; the rest is the intestines.

Indications

Edema Syndrome:

• with chronic heart failure;
• with chronic renal failure;
• with nephrotic syndrome (with nephrotic syndrome, the treatment of the underlying disease is in the foreground);
• with liver diseases;
• arterial hypertension;
• some forms of hypertensive crisis;
• pulmonary edema;
• cardiac asthma;
• swelling of the brain;
• eclampsia;
• conducting forced diuresis;
• hypercalcemia.

Release forms

Tablets 40 mg.

Solution for intravenous and intramuscular administration (injections in ampoules for injection).

Instructions for use and dosage

Tablets

Tablets should be taken on an empty stomach, without chewing and drinking plenty of liquid. When prescribing Furosemide, it is recommended to use its smallest doses, sufficient to achieve the desired effect. The maximum daily dose for adults is 1500 mg. Initial single dose in children determined at the rate of 1-2 mg / kg body weight per day with a possible increase in dose to a maximum of 6 mg / kg per day, provided that the drug is taken no more than 6 hours later. The duration of treatment is determined by the doctor individually depending on the indications.

Dosing regimen in adults

Edema syndrome in chronic heart failure

The initial dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended to divide the daily dose into 2-3 doses.

Edema syndrome in chronic renal failure

In patients with chronic renal failure, careful dose selection is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 kg of body weight per day is possible). The recommended initial dose is 40-80 mg per day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients on hemodialysis, the usual maintenance dose is 250-1500 mg per day.

Edema in nephrotic syndrome

The initial dose is 40-80 mg per day. The required dose is selected depending on the diuretic response. The daily dose can be taken at one time or divided into several doses.

Edema syndrome in liver diseases

Furosemide is prescribed in addition to treatment with aldosterone antagonists in case of their insufficient effectiveness. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or electrolyte or acid-base disorders, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of body weight per day is possible). The initial dose is 20-80 mg per day.

Arterial hypertension

Furosemide can be used alone or in combination with other antihypertensive agents. The usual maintenance dose is 20-40 mg per day. When adding furosemide to already prescribed drugs, their dose should be reduced by 2 times. With arterial hypertension in combination with chronic renal failure, higher doses of the drug may be required.

Ampoules

With intravenous (jet) or intramuscular administration, the dose for adults is 20-40 mg 1 time per day, in some cases - 2 times per day. For children, the initial daily dose for parenteral use is 1 mg / kg.

Side effect

• pronounced decrease in blood pressure;
• collapse;
• tachycardia;
• arrhythmias;
• tendency to thrombosis;
• dizziness;
• headache;
• muscle weakness;
• spasms of the calf muscles (tetany);
• paresthesia;
• weakness, lethargy, drowsiness;
• confusion;
• impaired vision and hearing;
• noise in ears;
• anorexia;
• dryness of the oral mucosa;
• thirst;
• nausea, vomiting;
• diarrhea;
• constipation;
• oliguria;
• acute urinary retention (in patients with benign prostatic hyperplasia);
• interstitial nephritis;
• hematuria;
• decrease in potency;
• decreased glucose tolerance;
• manifestation of latent diabetes mellitus;
• hives;
• exfoliative dermatitis;
• vasculitis;
• skin itching;
• chills;
• fever;
• photosensitivity;
• anaphylactic shock;
• Stevens-Johnson syndrome;
• toxic epidermal necrolysis;
• leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia;
• hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia.

Contraindications

• acute renal failure with anuria;
• severe liver failure, "hepatic" coma and precoma;
• acute glomerulonephritis, pronounced violations of the outflow of urine of any etiology (including unilateral lesions of the urinary tract), hyperuricemia;
• decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (over 10 mmHg);
• violation of water and electrolyte metabolism (hypovolemia, severe hyponatremia and hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia);
• digitalis intoxication;
• pregnancy;
• lactation period;
• age up to 3 years (solid dosage form);
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome (due to the presence of lactose monohydrate in the preparation);
• wheat allergy (not celiac disease);
• hypersensitivity to the active substance and to any of the components of the drug.

Use during pregnancy and lactation

Furosemide crosses the placental barrier, so it should not be given during pregnancy. If it is necessary to prescribe Furosemide during pregnancy, the ratio of the benefit of using the drug to the mother to the risk to the fetus should be assessed. It is allocated with breast milk. If necessary, treatment with the drug, breastfeeding should be stopped.

special instructions

Before starting therapy with Furosemide, the presence of severe urinary outflow disorders should be excluded, patients with a partial violation of the outflow of urine need to be carefully monitored. Against the background of course treatment, it is necessary to periodically monitor blood pressure, the content of electrolytes in blood plasma (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, carry out appropriate treatment adjustment.

The use of furosemide slows down the excretion of uric acid, which can provoke an exacerbation of the course of gout.

It is believed that it can be used to treat obesity and weight loss, although it is a common diuretic, it has nothing to do with diet and simply reduces the weight of a person within the excreted fluid.

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. For the prevention of hypokalemia, the simultaneous administration of potassium preparations and potassium-sparing diuretics is recommended, as well as a diet rich in potassium. 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 plasma electrolytes.

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 the level of glucose concentration in the blood and urine is required.

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

This medicinal product contains lactose monohydrate, therefore patients with rare hereditary problems of galactose intolerance, the lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.

The composition of the drug includes wheat starch in an amount that is safe for use in patients with celiac disease (gluten enteropathy).

Patients with wheat allergy (other than celiac disease) should not use this medicine.

Influence on the ability to drive vehicles and control mechanisms

During the period of treatment with Furosemide, one should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving vehicles and working with mechanisms).

drug interaction

With simultaneous use with phenobarbital and phenytoin, the effect of furosemide decreases.

Increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion).

With the simultaneous use of aminoglycosides with furosemide, there is a slowdown in the excretion of aminoglycosides and an increase in the risk of developing their ototoxic and nephrotoxic effects. For this reason, the use of this combination of drugs should be avoided, except when necessary for health reasons, in which case a correction (reduction) of maintenance doses of aminoglycosides is required.

Increases the effectiveness of diazoxide and theophylline, reduces - hypoglycemic agents, allopurinol.

Drugs blocking tubular secretion increase the concentration of furosemide in the blood serum. Drugs with a nephrotoxic effect - when combined with furosemide, the risk of developing their nephrotoxic effect increases.

Glucocorticosteroids and carbenoxolone, when combined with furosemide, increase the risk of hypokalemia.

With simultaneous use with cardiac glycosides, the risk of developing digitalis intoxication against the background of water and electrolyte disorders (hypokalemia or hypomagnesemia) increases.

It enhances the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).

Non-steroidal anti-inflammatory drugs (including indomethacin and acetylsalicylic acid) in combination with furosemide can cause a temporary decrease in creatinine clearance and an increase in serum potassium and reduce the diuretic and antihypertensive effect of furosemide. In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may increase the toxic effect of salicylates (due to competitive renal excretion).

Sucralfate reduces the absorption of furosemide and weakens its effect (these drugs must be taken at least 2 hours apart).

Combined use with carbamazepine may increase the risk of hyponarthemia.

Antihypertensive agents, diuretics or other agents that can reduce blood pressure, when combined with furosemide, may lead to a more pronounced antihypertensive effect.

The appointment of ACE inhibitors in patients previously treated with furosemide can lead to an excessive decrease in blood pressure with deterioration of kidney function, and in some cases to the development of acute renal failure, therefore, furosemide is recommended three days before starting treatment with ACE inhibitors or increasing their dose, or reducing its dose.

Probenecid, methotrexate and other drugs that, like furosemide, are secreted in the renal tubules, can reduce the effect of furosemide (the same route of renal secretion), on the other hand, furosemide can lead to a decrease in the excretion of these drugs by the kidneys.

Lithium salts - under the influence of furosemide, lithium excretion is reduced, due to which the serum concentration of lithium increases and the risk of developing the toxic effects of lithium, including its damaging effects on the heart and nervous system, increases. Therefore, when using this combination, monitoring of serum lithium concentrations is required.

Simultaneous use of cyclosporine A and furosemide increases the risk of developing gouty arthritis due to hyperuricemia caused by furosemide and impaired cyclosporine excretion of urates by the kidneys.

Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce the effectiveness.

Radiopaque agents - Patients at high risk of radiopaque nephropathy treated with furosemide had a higher incidence of renal impairment compared to patients at high risk of radiopaque nephropathy who received only intravenous hydration prior to radiocontrast administration.

Analogues of the drug Furosemide

Structural analogues for the active substance:

• Lasix;
• Furon;
• Furosemide (Mifar);
• Furosemide Lannacher;
• Furosemide Sopharma;
• Furosemide-Vial;
• Furosemide-Darnitsa;
• Furosemide-ratiopharm;
• Furosemide-Ferein;
• Furosemide injection 1%;
• Fursemide.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

Furosemide tablets are fast-acting diuretics that have a diuretic effect. They are used for circulatory disorders, pulmonary and cerebral edema.

Indications and method of application

Furosemide is prescribed for the following pathological conditions:

• swelling of the brain and lungs;
• edema due to eclampsia or preeclampsia;
• stagnant processes in the pulmonary and systemic circulation that occur against the background of heart failure;
• barbiturate poisoning;
• (including);
• cirrhosis of the liver.

Furosemide is often used in combination with other antihypertensive drugs, thus enhancing its effect.

For adults, the initial dosage of Furosemide is 40 mg (this is 1 tablet). If after 8 hours, the desired diuretic effect does not occur, the patient needs to take another 2-3 tablets (no more than 120 mg). In the absence of the desired effect, 160 mg of Furosemide can be used at a time. For a maintenance effect, the daily dosage of Furosemide is 40 mg, in this case, you can not take more than 80 mg of the drug. The maximum dose of Furosemide during the day should not exceed 300 mg.

With regards to children, the drug intake is calculated depending on the weight of the child (about two mg per 1 kg per day).

Pharmacological properties

Furosemide is a "loop" diuretic. The pharmacological actions of the drug are characterized by their speed, short duration and strength. Taking the drug orally, its action begins after 20 minutes, and the maximum effectiveness is achieved after 60-120 minutes. The duration of action of Furosemide is from 3 to 6 hours.

The drug produces an inhibitory effect on the reabsorption of chloride and sodium ions, promotes an increase in magnesium, calcium and potassium ions. It has natriuretic, diuretic and chloruretic effects. Taking the drug for a disease such as, already 20 minutes after ingestion, reduces the preload on the heart.

By the second hour after taking Furosemide, there is a decrease in the amount of circulating blood and a decrease in vascular tone, at which time the drug reaches its maximum effect. It also reduces the amount of interstitial fluid. Furosemide increases the excretion of sodium chloride, which makes it possible to speak of its effective hypotensive effect.

Furosemide has a high absorption. The maximum amount in the blood is reached 60 minutes after ingestion.

When should Furosemide not be taken?

It is necessary to find an alternative to this drug in the following pathological conditions:

• renal failure (severe, acute);
• glomerulonephritis in acute form;
• urolithiasis in severe manifestations (stone obstruction);
• hypertrophic stenosis;
• increased venous pressure;
• precomatose state;
• digitalis intoxication;
• imbalance of water and electrolyte metabolism;
• various forms of arterial hypertension;
• acute form of myocardial infarction;
• lupus erythematosus;
• urethral stenosis;
• pancreatitis;
• renal coma.

It is necessary to take special care in the treatment with Furosemide in the presence of such diseases:

• prostatic hyperplasia (benign);
• atherosclerosis of cerebral vessels;
• hypoproteinemia;
• (if there is a risk of ischemia associated with insufficient blood flow);
• diabetes;
• hepatorenal syndrome.

Insufficient efficacy of Furosemide and the manifestation of undesirable effects are observed if the patient has hypoproteinemia against the background of nephrotic syndrome.

In the presence of sodium, it is necessary to analyze the level of sodium before starting treatment, with subsequent monitoring during therapy. Treatment with diuretic drugs can cause development. Decreased sodium levels at the very beginning have no characteristic manifestations. Therefore, the control of its concentration should be carried out in patients at risk, namely the elderly, patients with cirrhosis of the liver and extreme exhaustion of the body (cachexia).

"Loop" diuretics are able to reduce the level of potassium, provoking. Therefore, patients who belong to the risk group must be constantly monitored. These patients include the elderly, those with ascites or cirrhosis, and those with heart failure.

When taking Furosemide, patients with a high potential for electrolyte disorders (vomiting, diarrhea, sweating) should be under close medical supervision.

Possible side effects

The drug Furosemide can have multiple side effects, however, cases of their manifestation are rare. Instructions for use Furosemide describes side effects, after the manifestation of which, it is necessary to stop taking the drug.

Cardiovascular disorders can manifest as:

• or ;
• arrhythmias.

The nervous system may experience disorders, expressed in the following:

• paresthesia;
• apathy;
• convulsions;
• muscle weakness;
• lethargy and drowsiness;
• confusion;
• headache and dizziness.

There may also be disturbances in the functioning of the senses, namely the deterioration of vision and hearing.

The digestive system may respond:

• diarrhea
• nausea, thirst, dry mouth;
• constipation
• vomiting;
• exacerbated pancreatitis.

In addition, taking Furosemide can have the following side effects:

• hematuria;
• urinary retention;
• impotence;
• hives;
• skin itching;
• anaphylactic shock;
• chills and fever;
• leukopenia;
• glycosuria;
• hypochloremia;
• hypokalemia;
• thrombocytopenia.

It's important to know

The drug Furosemide has special indications that you need to pay close attention to before starting treatment.

During the entire course of treatment, it is important to monitor blood pressure, as well as the concentration of electrolytes in the blood. In addition, the content of uric acid, creatinine and residual nitrogen is subject to special control. The work of the liver should be monitored. For any deviations, an appropriate correction of therapy is carried out.

If a high dosage of Furosemide is necessary, it is not advisable to limit the intake of table salt, since there is a risk of developing hyponatremia. To reduce the likelihood of its development, potassium-sparing diuretics and maintenance of a diet based on the maximum consumption of potassium products are prescribed in combination with Furosemide.

In combination with other drugs

Drug interactions Furosemide is not recommended with the following drugs:

• chloral hydrate;
• aminoglycosides (Furosemide may increase their ototoxicity).

Special precautions require the simultaneous administration of Furosemide with such drugs:

• Cisplatin. Furosemide may enhance its nephrotoxic effect. Therefore, when taken simultaneously, for special indications, Furosemide can only be administered in a low dosage (40 mg).
• lithium preparations.
• ACE inhibitors.
• Respiredon.

And the combination of Furosemide with anti-inflammatory drugs is also undesirable, since they reduce its effectiveness. The appointment of Phenytoin while taking Furosemide reduces the effectiveness of the latter.

Combining reception with glucocorticosteroids, a lot of licorice and diuretics, can provoke an increase in the symptoms of hypokalemia.

Drugs that lower blood pressure may increase the effectiveness of Furosemide. These include diuretics, antihypertensives, and others.

In patients treated with Furosemide concomitantly with high doses of cephalosporins, deterioration of renal function is possible.

Cases of overdose

Taking high doses of the drug entails many negative consequences:

• decrease in blood pressure;
• thrombosis;
• collapse;
• drowsiness and apathy;

• confusion;
• anuria and renal failure;
• paralysis;
• dehydration;

Packaging and storage conditions

• 1 pack of Furosemide contains 5 packs, each of which contains 10 tablets of the drug.
• 1 pack contains 2 packs, each containing 25 tablets of Furosemide.

It is necessary to store the drug in a dry, protected from sunlight and out of the reach of children, at a temperature not exceeding 25 degrees.

Price and reviews about the drug

The average price of Furosemide in Russian pharmacies ranges from 25 rubles.

The drug has earned a lot of positive feedback related to the speed and short duration of its action. Furosemide is one of the most effective diuretics, while its cost is affordable for everyone.

The availability of the drug allows its use in multiple poisonings. Furosemide is one of the main drugs in the arsenal of ambulance medical staff.

However, do not forget about the ability of the drug to lead to loss of calcium, magnesium, seizures and many other side effects. This suggests that the correct and competent use of the drug is possible only on prescription.

Stagnation, swelling of soft tissues are quite common disorders that occur in many diseases of various organ systems. It is possible to improve the outflow and exit of fluid from the body with the help of drugs, of which there are a huge variety today. And quite often, doctors recommend the drug "Furosemide" to their patients. What does he help? What properties does it have? Are there any contraindications to treatment? Is it possible for side effects to occur? The answers to these questions are of interest to every patient.

The composition and form of release of the drug

The diuretic "Furosemide" is available in the form of tablets, as well as a solution for intravenous or intramuscular administration. There are also granules for the preparation of a suspension - this form of medicine is more suitable for the treatment of children.

The main active substance of the drug is furosemide. One tablet contains 40 mg of this component. In the pharmacy you can buy packs of 20 or 50 tablets. In some cases (especially when it comes to severe edema), it is advisable to use an injection solution - it is sold in 2 ml glass ampoules with a furosemide concentration of 1%. To date, packages of 10, 25 and 50 ampoules are sold.

In fact, in almost every pharmacy you can easily buy the drug "Furosemide". A prescription from a doctor for pills is not needed in this case, although some pharmacies have sales restrictions.

Main pharmacological properties

In modern medicine, the medicine "Furosemide" is very often used. Its use in some cases is simply necessary. This is a fast-acting diuretic that inhibits the reabsorption of chloride and sodium ions in the proximal and distal tubules of the kidney, which accelerates the process of excretion of their body fluid. The drug does not affect glomerular filtration in any way, so it is prescribed even in the presence of renal failure. Furosemide also dilates peripheral vessels, which reduces blood pressure.

After taking the pill, the effect, as a rule, begins to appear after 30-50 minutes. If we are talking about intravenous administration, then an increase in the volume of urine released begins after 15-20 minutes. The effect of the drug lasts about 3-4 hours.

The drug "Furosemide": what is it taken from? Indications for therapy

Everyone experiences health problems from time to time. So in what cases is it advisable to take the drug "Furosemide"? What does he help? The main indication for admission is edematous syndrome. In turn, edema can be a symptom of a variety of diseases.

Of course, often the stagnation of fluid indicates the presence of problems with the kidneys. In such cases, doctors often prescribe Furosemide. Indications for use - edema that has arisen against the background of chronic renal failure, nephrotic syndrome, hypercalcemia. In addition, the drug helps with hypertension, chronic heart failure, eclampsia, cardiac asthma. Also, the medicine helps fight swelling, which is associated with liver diseases. Indications also include pulmonary and cerebral edema.

The drug "Furosemide": instructions

These tablets, as mentioned earlier, can be freely bought at the pharmacy. If you have any problems, however, you should first consult a doctor. Only a specialist can prescribe you the drug "Furosemide". How to take pills, what is the maximum daily dose, how long will the treatment last - you will find answers to all these questions from your doctor. The instructions for use contain only general recommendations.

As a rule, the initial dose of the drug for adults is 40 mg of furosemide (one tablet). If there are no changes after taking the medicine, the doctor can increase the dose by 80-120 mg every 6-8 hours until a normal diuretic effect appears. However, there are some restrictions. No more than four tablets (160 mg) can be taken at a time. The maximum daily dose is 300 mg, but in such quantities the drug cannot be used for maintenance therapy, only as an emergency measure.

Often, patients suffering from edema and arterial hypertension are prescribed the drug Furosemide. How to take it in such cases? Most often, doctors recommend drinking one tablet twice a day. The duration of therapy is determined individually. As soon as the swelling begins to disappear, the dose of the drug is gradually reduced.

Intravenous and intramuscular administration is advisable only for persistent edema, as well as in cases where oral administration is not possible. If we are talking about the treatment of children, then the daily dose is 1-2 mg of furosemide per kilogram of weight.

Doctors often prescribe Furosemide (tablets) to their patients. The instructions for use contain some specific recommendations. Against the background of a long-term course of taking the drug, it is very important to control blood pressure all the time, as well as monitor the concentration of electrolytes in the plasma. Also, some patients are advised to take potassium supplements and eat a diet rich in this and other minerals.

Are there contraindications?

Many people are interested in the question of whether all categories of patients are allowed to take the drug "Furosemide" (tablets). Instructions for use confirms that there are some contraindications in this case. Each patient should familiarize themselves with their list even before the start of therapy.

To begin with, it is worth saying that the drug is not prescribed for a patient with hypokalemia, since the tablets can further reduce the level of potassium in the blood, which will affect the work of the whole organism, especially the cardiovascular system. Contraindications also include hypersensitivity to any of the components of the drug, lactose intolerance, lactase deficiency and wheat allergy.

The drug should not be prescribed in the presence of severe renal or hepatic insufficiency, hepatic coma. Also, contraindications include acute glomerulonephritis, in which there is a violation of the outflow of urine. The drug should not be taken by patients with impaired water and electrolyte balance, decompensated aortic and mitral stenosis, increased venous pressure, hypertrophic obstructive cardiomyopathy. The tablets are not intended for the treatment of children under the age of three.

Many people need to take the drug Furosemide. Indications for therapy are most often puffiness, and it is no secret to anyone that many pregnant women face a similar problem. It is immediately worth noting that taking this medication in the first trimester is strictly prohibited. In the second half of pregnancy, therapy is possible, but only under medical supervision. By the way, during lactation, the drug affects the functioning of the mammary glands, causing a decrease in the amount of milk (due to the removal of fluid). If therapy is still necessary, then it is better to stop breastfeeding for the duration of treatment.

Main Side Effects

Many people are interested in questions about what Furosemide is, what it is used for, etc. But no less important aspect is the presence of side effects. Statistical studies have shown that complications in most cases are the result of incorrect or too long medication. If you follow all the doctor's recommendations, the likelihood of side effects is minimal.

Against the background of therapy, hypotension, interstitial nephritis may develop. It is also possible to reduce the level of potassium in the blood, increase the level of glucose and uric acid, which is associated with increased diuresis. Sometimes there are reactions from the digestive (nausea, vomiting) and nervous systems (dizziness, headaches, fatigue, depression, confusion). It is also possible the appearance of strong thirst, dryness of the mucous membranes. Some patients develop allergic skin reactions.

Interaction with other drugs

Diuretic "Furosemide" is not recommended to be taken together with cephalosporins, ethacrynic acid, amphotericins and other drugs that have a nephrotoxic effect. This drug also increases the activity of theophylline and diazoxide, reduces the effect of allopurinol, non-depolarizing muscle relaxants. Be sure to tell your doctor about all medications you are taking. During therapy, it is strictly forbidden to drink alcohol.

Overdose and its consequences

Today, many patients are faced with the need to take the drug "Furosemide". Indications for its use are swelling and stagnation of fluid, which, alas, some people encounter very often. Unfortunately, too high doses of this drug can lead to dangerous consequences, in particular, hypovolemia, a condition that is accompanied by a decrease in circulating blood volume. Against the background of such a disorder, a sharp decrease in blood pressure is possible, as well as orthostatic collapse. The patient after an overdose urgently needs to be taken to the hospital. First of all, he needs to enter an electrolyte solution in order to restore blood volume. If necessary, further symptomatic therapy is carried out.

How much does the medicine cost?

So, we found out what the instruction tells about the drug "Furosemide". Tablets, their composition and properties are certainly very interesting. But no less important factor for many is the price of the medicine.

So how much will the drug cost? In fact, Furosemide stands out among other diuretics not only for its high efficiency, but also for its affordable cost. A package of 50 tablets with a dose of the active substance of 40 mg costs about 30-40 rubles. But 10 ampoules of this medicine will cost 25-30 rubles, which, you see, is not so much. Of course, the figure may vary depending on the city of residence of the patient, the pharmacy, the services of which he decided to use, and many other factors.

Drug analogues

In some cases, for a number of reasons, this or that medicine is not suitable for patients. Therefore, many are interested in whether it is possible to replace Furosemide with something. Analogues of this drug, of course, exist. The modern pharmaceutical market offers a huge selection of diuretics.

For example, Lasix is ​​considered a pretty good substitute. Also, the doctor may recommend taking drugs such as Furon or Frusemide. These are structural analogues that contain the same active substance and, accordingly, have a similar effect.

There are other diuretics that contain different ingredients but provide the same effect. Doctors often prescribe to their patients drugs such as "Urea", "Mannitol", "Trifas", "Clopamide", "Uregit". These are quite strong drugs that help to quickly solve the problem with edema. There are milder agents, the list of which includes Cyclomethiazide, Hypothiazid, Pterofen, Diakarb, Veroshpiron.

In any case, it should be understood that you cannot independently look for a substitute for the drug Furosemide. Analogues can only be selected by the attending physician, since everything here depends on the patient's state of health, his age, the characteristics of the disease and individual needs. Uncontrolled intake of diuretics can lead to dangerous consequences.

Furosemide is a so-called "loop" diuretic. Loop, because the violation of the reabsorption of sodium and chlorine ions caused by it is localized in the ascending part of the loop of Henle. Due to an increase in the excretion of sodium ions, there is an increased, osmotically related excretion of water and potassium, calcium and magnesium ions. With insufficient heart function, the drug quickly reduces the preload on the myocardium by increasing the lumen of large veins. It has an antihypertensive effect due to the intensive excretion of sodium and chlorine ions, a decrease in the volume of circulating blood and a decrease in the sensitivity of the vascular walls to vasoconstrictor factors. The effect of the drug after intravenous administration occurs after 5-10 minutes, after oral administration - after 30-60 minutes. The peak activity of furosemide is noted after 1-2 hours, the duration of action is 2-3 hours (with renal failure - up to 8 hours). The drug is characterized by a withdrawal syndrome: after the termination of its action, the rate of excretion of sodium ions decreases below the initial level. This pharmacological "rebound" is due to a sharp increase in the activity of antinatriuretic neurohumoral links, including renin-angiotensin, which occurs in response to profuse diuresis. Due to the withdrawal syndrome when taken once a day, the drug may not have a significant effect on the daily excretion of sodium ions and blood pressure.

Furosemide is available in the form of tablets and solution for intravenous and intramuscular administration. The dosage regimen of the drug is set by the doctor individually, taking into account the indications, the nature of the course of the disease and the age of the patient. During pharmacotherapy, the dose and frequency of taking the drug is adjusted depending on the therapeutic response and the general condition of the patient. The diuretic (diuretic) effect of furosemide directly depends on its dose, while it is practically impossible to achieve a certain therapeutic "ceiling".

Among the pharmacokinetic disadvantages of furosemide, one should mention too wide a "scatter" of the bioavailability of the drug when taken orally. In different clinical situations, it can vary from 11 to 90%.

Since furosemide has a rapid and at the same time powerful antihypertensive effect, it is often used in the relief of hypertensive crises. For crises of the 1st degree, furosemide is administered orally at a dose of 40-80 mg, for crises of the 2nd degree, it is administered intravenously or intramuscularly at the same dose. At the same time, the use of furosemide in the long-term therapy of arterial hypertension seems to be irrational, because a sharp decrease in circulating blood volume and vasodilation caused by the drug cause reflex sympathetic and renin-angiotensin activation, which eliminates the antihypertensive effect. Fursemide can be used in acute heart failure. Thus, in acute left ventricular failure, under the action of the drug, the volume of circulating blood (BCC) decreases, which reduces the work of the myocardium in pumping blood from a small circle to a large one. On the other hand, a decrease in BCC and expansion of the vessels of the small circle entails a decrease in pressure in the latter, as a result of which the release of blood plasma into the lung stops and edema increases. Furosemide is used to reduce total swelling in congestive forms of heart failure. The use of other diuretics does not allow to achieve such a pronounced effect due to a violation of their absorption in the digestive tract due to edema of the internal organs. After the elimination of massive edema, the use of furosemide is inappropriate, because. further excretion of fluid from the body activates the sympathetic renin-angiotensin-aldosterone system. The drug is also used in acute renal failure. It increases the excretion of urine, regulates the excretion of potassium ions, and in case of poisoning - "washes" the renal tubules.

Pharmacology

"Loop" diuretic. Violates the reabsorption of sodium ions, chlorine in the thick segment of the ascending part of the loop of Henle. Due to the increase in the release of sodium ions, there is a secondary (mediated by osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases.

It has secondary effects due to the release of intrarenal mediators and the redistribution of intrarenal blood flow. Against the background of course treatment, there is no weakening of the effect.

In heart failure, it quickly leads to a decrease in the preload on the heart through the expansion of large veins. It has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in BCC. The action of furosemide after intravenous administration occurs within 5-10 minutes; after oral administration - after 30-60 minutes, the maximum effect - after 1-2 hours, the duration of the effect - 2-3 hours (with reduced kidney function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, however, 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 taken 1 time / day, it may not have a significant effect on the daily excretion of sodium ions and blood pressure. When administered intravenously, it causes dilatation of peripheral veins, reduces preload, reduces left ventricular filling pressure and pulmonary artery pressure, as well as systemic blood pressure.

The diuretic effect develops 3-4 minutes after the on / in the introduction and lasts 1-2 hours; after oral administration - after 20-30 minutes, lasts up to 4 hours.

Pharmacokinetics

After oral administration, absorption is 60-70%. In severe kidney disease or chronic heart failure, the degree of absorption decreases.

Vd is 0.1 l/kg. Plasma protein binding (mainly albumin) - 95-99%. Metabolized in the liver. Excreted by the kidneys - 88%, with bile - 12%. T 1 / 2 in patients with normal kidney and liver function is 0.5-1.5 hours. With anuria, T 1 / 2 can increase up to 1.5-2.5 hours, with combined renal and hepatic insufficiency - up to 11-20 hours.

Release form

2 ml - dark glass ampoules (10) - packs of cardboard.
2 ml - dark glass ampoules (5) - contour plastic packaging (1) - cardboard packs.
2 ml - dark glass ampoules (5) - contour plastic packaging (2) - cardboard packs.

Dosage

Installed 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.

When taken orally, the initial dose for adults is 20-80 mg / day, then, if necessary, the dose is gradually increased to 600 mg / day. For children, a single dose is 1-2 mg / kg.

The maximum oral dose for children is 6 mg/kg.

With intravenous (jet) or intramuscular administration, the dose for adults is 20-40 mg 1 time / day, in some cases - 2 times / day. For children, the initial daily dose for parenteral use is 1 mg / kg.

Interaction

With simultaneous use with antibiotics of the aminoglycoside group (including with gentamicin, tobramycin), it is possible to increase the nephro- and ototoxic effect.

Furosemide reduces the clearance of gentamicin and increases plasma concentrations of gentamicin, as well as tobramycin.

With simultaneous use with antibiotics of the cephalosporin group, which can cause impaired renal function, there is a risk of increased nephrotoxicity.

With simultaneous use with beta-agonists (including fenoterol, terbutaline, salbutamol) and with GCS, hypokalemia may increase.

With simultaneous use with hypoglycemic agents, insulin may reduce the effectiveness of hypoglycemic agents and insulin, tk. furosemide has the ability to increase the content of glucose in the blood plasma.

With simultaneous use with ACE inhibitors, the antihypertensive effect is enhanced. Severe arterial hypotension is possible, especially after taking the first dose of furosemide, apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of ACE inhibitors. The risk of impaired renal function increases and the development of hypokalemia is not excluded.

With simultaneous use with furosemide, the effects of non-depolarizing muscle relaxants are enhanced.

With simultaneous use with indomethacin, other NSAIDs, a decrease in the diuretic effect is possible, apparently due to inhibition of prostaglandin synthesis in the kidneys and sodium retention in the body under the influence of indomethacin, which is a nonspecific COX inhibitor; decrease in antihypertensive effect.

It is believed that furosemide interacts in a similar way with other NSAIDs.

When used simultaneously with NSAIDs, which are selective COX-2 inhibitors, this interaction is much less pronounced or practically absent.

With simultaneous use with astemizole, the risk of developing arrhythmias increases.

With simultaneous use with vancomycin, it is possible to increase oto- and nephrotoxicity.

With simultaneous use with digoxin, digitoxin, an increase in the toxicity of cardiac glycosides is possible, associated with the risk of developing hypokalemia while taking furosemide.

There are reports of the development of hyponatremia with simultaneous use with carbamazepine.

With simultaneous use with colestyramine, colestipol, the absorption and diuretic effect of furosemide decreases.

With simultaneous use with lithium carbonate, it is possible to enhance the effects of lithium due to an increase in its concentration in the blood plasma.

With simultaneous use with probenecid, the renal clearance of furosemide decreases.

With simultaneous use with sotalol, hypokalemia and the development of ventricular arrhythmia of the "pirouette" type are possible.

With simultaneous use with theophylline, a change in the concentration of theophylline in the blood plasma is possible.

With simultaneous use with phenytoin, the diuretic effect of furosemide is significantly reduced.

After the on / in the introduction of furosemide against the background of therapy with chloral hydrate, an increase in sweating, a feeling of heat, instability of blood pressure, tachycardia is possible.

With simultaneous use with cisapride, hypokalemia may increase.

It is assumed that furosemide can reduce the nephrotoxic effect of cyclosporine.

With simultaneous use with cisplatin, an increase in the ototoxic effect is possible.

Side effects

From the side of the cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased BCC.

From the side of the central nervous system and peripheral nervous system: dizziness, headache, myasthenia gravis, spasms of the calf muscles (tetany), paresthesia, apathy, adynamia, weakness, lethargy, drowsiness, confusion.

From the senses: visual and hearing impairment.

From the digestive system: loss of appetite, dry mouth, thirst, nausea, vomiting, constipation or diarrhea, cholestatic jaundice, pancreatitis (exacerbation).

From the genitourinary system: oliguria, acute urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, reduced potency.

From the hemopoietic system: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.

From the side of water and electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.

From the side of metabolism: hypovolemia, hypokalemia, hyponatremia, hypochloremia, hypokalemic metabolic alkalosis (as a result of these disorders - arterial hypotension, dizziness, dry mouth, thirst, arrhythmia, muscle weakness, convulsions), hyperuricemia (with possible exacerbation of gout), hyperglycemia .

Allergic reactions: purpura, urticaria, exfoliative dermatitis, erythema multiforme exudative, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock.

Others: with intravenous administration (optional) - thrombophlebitis, kidney calcification in premature babies.

Indications

Edema syndrome of various origins, incl. with chronic heart failure stage II-III, cirrhosis of the liver (portal hypertension syndrome), nephrotic syndrome. Pulmonary edema, cardiac asthma, cerebral edema, eclampsia, forced diuresis, severe arterial hypertension, some forms of hypertensive crisis, hypercalcemia.

Contraindications

Acute glomerulonephritis, urethral stenosis, urinary tract stone obstruction, acute renal failure with anuria, hypokalemia, alkalosis, precoma, severe liver failure, hepatic coma and precoma, diabetic coma, precoma, hyperglycemic coma, hyperuricemia, gout, decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (more than 10 mm Hg), arterial hypotension, acute myocardial infarction, pancreatitis, impaired water and electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia), digitalis intoxication, hypersensitivity to furosemide.

Application features

Use during pregnancy and lactation

During pregnancy, the use of furosemide is possible only for a short time and only if the expected benefit of therapy for the mother outweighs the potential risk to the fetus.

Since furosemide can be excreted in breast milk, as well as suppress lactation, if necessary, use during lactation, breastfeeding should be discontinued.

Application for violations of liver function

Application for violations of kidney function

special instructions

Use with caution in prostatic hyperplasia, SLE, hypoproteinemia (risk of developing ototoxicity), diabetes mellitus (decrease in glucose tolerance), with stenosing atherosclerosis of cerebral arteries, against the background of prolonged therapy with cardiac glycosides, in elderly patients with severe atherosclerosis, pregnancy (especially first half), lactation period.

Before starting treatment, electrolyte disturbances should be compensated. During treatment with furosemide, it is necessary to control blood pressure, electrolyte and glucose levels in the blood serum, liver and kidney function.

For the prevention of hypokalemia, it is advisable to combine furosemide with potassium-sparing diuretics. With the simultaneous use of furosemide and hypoglycemic drugs, dose adjustment of the latter may be required.

Influence on the ability to drive vehicles and control mechanisms

When using furosemide, it is impossible to exclude the possibility of a decrease in the ability to concentrate, which is important for people who drive vehicles and work with mechanisms.

Probably, many are interested in the drug Furosemide - what these pills are prescribed for and how to take them. This drug is considered a good diuretic, but it is not safe enough to take it uncontrollably. Some take it without paying attention to the instructions (for example, models) and without thinking about the health consequences. Let's clarify why Furosemide deserved such an attitude.

What does furosemide help with?

This is a diuretic that can increase the excretion of certain elements from the body - for example, sodium and chlorine. It dilates peripheral vessels and has a hypotensive effect. Furosemide indications for use:

• edematous syndrome (with heart failure, for example, cirrhosis of the liver or nephrotic syndrome);
• pulmonary edema;
• swelling of the brain; cardiac asthma;
• high blood pressure;
• hypertensive crisis;
• hypercalcemia.

This is not a complete list of what doctors prescribe Furosemide for.

Application of Furosemide

The doctor sets the required dosage individually for each individual patient - taking into account the clinical picture of his disease and his age; dose adjustment during treatment is also necessary, depending on the patient's condition.

The maximum allowable dose of Furosemide when taken orally: for adults - 600 mg per day; for children - 6 mg / kg. For adult patients, the initial dose is 20-80 mg per day, then it is gradually increased. Children are usually prescribed 1-2 mg per kilogram of body weight.

Contraindications

In general, contraindications to the use of Furosemide are:

• hypersensitivity to Furosemide;
• the first months of pregnancy;
• hypokalemia (lack of potassium);
• hepatic coma;
• terminal stage (that is, the last stage of the disease);
• kidney failure;
• obstruction of the urinary tract, etc.

You also need to remember that this drug easily passes into breast milk, so for the duration of treatment, women should stop breastfeeding. In addition, the list of contraindications is supplemented by disorders of the genitourinary system (glomerulonephritis, urinary tract obstruction, urethral stenosis), acute myocardial infarction, precoma, pancreatitis, and disturbances in water and electrolyte metabolism.

Side effects and overdose

Furosemide is one of those medicines that cause side effects very often. The patient should stop taking the drug if he has:

• lowering blood pressure;
• tachycardia;
• arrhythmia;
• collaptoid state;
• headache or dizziness;
• myasthenia gravis;
• tetany (cramps of the calf muscles);
• numbness of the limbs;
• apathy;
• a sharp decline in strength;
• general weakness;
• violations of the organs of vision and hearing;
• constipation or diarrhea;
• nausea and vomiting;
• cholestatic jaundice;
• exacerbation of pancreatitis;
• interstitial nephritis;
• hematuria;
• decrease in potency;
• leukopenia and other disorders of the hematopoietic system;
• decrease in the volume of circulating blood;
• allergic reactions;
• thrombophlebitis, etc.

Compatibility with other drugs

In the case of joint use, Furosemide interacts (in most cases negatively) with many drugs:

• increased oto- and nephrotoxic action (antibiotics of the aminoglycoside group, vancomycin, cisplatin);
• impaired renal function, increased risk of increased nephrotoxicity of the drug (antibiotics of the cephalosporin group);
• increased hypokalemia (beta-agonists and glucocorticosteroids);
• decrease in the effectiveness of drugs (hypoglycemic drugs or insulin);
• increased antihypertensive action (ACE inhibitors);
• increased action (non-depolarizing muscle relaxants);
• a decrease in the diuretic effect and a decrease in the antihypertensive effect (non-steroidal anti-inflammatory drugs);
• increased risk of developing arrhythmias (astemizole);
• decrease in the diuretic effect of Furosemide itself (colestyramine, colestipol, phenytoin);
• decrease in renal clearance of Furosemide (probenecid), etc.

The fact that during treatment with Furosemide it is recommended to abstain from alcohol is probably not worth talking about: the indications for the use of Furosemide exclude alcohol. The joint intake of alcohol with this drug can have an extremely negative impact on the patient's health - up to and including death.

Now you know what Furosemide should be taken from and what not. It is only worth recalling once again the need to consult a doctor before using this remedy. Be healthy!