Furosemide-dependent kidney is a specific renal dysfunction, the development of which is caused by long-term use of furosemide. Among the manifestations are oligoanuria, severe swelling, asthenic syndrome, muscle weakness, dry skin, tachycardia, precordial pain (if you continue to take the diuretic). For diagnosis, it is necessary to conduct a chemical analysis of blood and urine, and an ultrasound examination of the kidneys. Therapeutic measures consist of complete abstinence from the drug and taking a mineral-containing drug. If necessary, the doctor will prescribe a sedative, anxiolytic, or antidepressant.
Based on some observations, we can conclude that such a disease has been extremely common in recent years. The reason is uncontrolled self-medication and the use of a diuretic to improve athletic performance.
Basically, this disorder appears in people who are not confident in themselves, in suspicious young women who place too high demands on their body weight and appearance in general. This pathology often accompanies anorexia nervosa and bulimia.
How does the disease manifest itself?
The development of symptoms of the disease is gradual. The symptoms are caused by an electrolyte imbalance. Among the initial symptoms are weakness, drowsiness, and dry skin. In addition, the patient's blood pressure drops and his head begins to feel dizzy.
Furosemide-dependent pathology is characterized by potassium deficiency, as a result of which myalgia develops, muscle strength decreases, constipation, tachycardia appear, the patient complains of pain in the heart. Since the kidneys excrete sodium in excessive amounts, headaches and nausea appear, which ends in vomiting. The person becomes emotionally unstable, and there is a state of depression.
Due to the fact that magnesium is present in the body in insufficient quantities, certain muscle groups begin to twitch, convulsions and interruptions in the functioning of the heart appear. If you reduce the dosage of the drug or try to abruptly stop it yourself, there will be a decrease in diuresis (sometimes its complete cessation), a rapid increase in body weight, swelling and shortness of breath will appear and increase. Patients using the drug to lose weight may experience symptoms of addiction.
Signs of acute drug overdose
An acute overdose manifests itself quite quickly. First of all, a person’s blood pressure drops sharply. Gradually, unpleasant symptoms develop.
Symptoms:
- Weakness, lethargy, apathy,
- Painful sensations in the back of the head,
- Respiratory dysfunction, shortness of breath,
- Increased sweating
- Dizziness,
- Nausea, urge to vomit,
- Noise in ears,
- Decreased body temperature
- Development of convulsive manifestations.
With excessive intake of furosemide and acute overdose, a decrease in the amount of circulating blood occurs, which leads to disruption of the blood supply to internal organs. The consequences of this phenomenon can be disturbances in the functioning of the kidneys, heart, and death.
When furosemide is consumed in large quantities, the body becomes dehydrated. The result is disruption of many systems. Blood thickening is often observed when taking furosemide in an increased dosage. Such an overdose causes disruptions in the functioning of the cardiac system and the development of heart attacks.
How does an overdose manifest itself?
After taking a diuretic, the blood vessels dilate, and essential microelements are removed, which contribute to the normal functioning of all organs and systems of the body. The patient's general health deteriorates significantly.
Signs of overdose appear if the exact dosage of the drug is exceeded. The symptoms are:
- Due to the high dose of the drug, the volume of circulating blood decreases, as a result of which tachycardia and arrhythmia develop. Blood clots may form.
- Uncontrolled use of a diuretic provokes a sharp drop in blood pressure. At first, this is expressed in the appearance of dizziness and weakness. If the dose is increased significantly, the person may faint.
- Hearing and vision impairment occurs.
- Hypokalemia is detected.
- The appearance of strong thirst. The cause is dehydration.
When is medical help needed?
Medical attention is required in all cases of furosemide intoxication. However, in some cases you need to see a doctor very quickly.
Occasions:
- The child was injured
- Very low pressure
- Lack of consciousness, disturbance of orientation in space,
- Sudden irregularities in heart rhythm,
- Respiratory disorder
- Presence of symptoms of dehydration,
- Sharp blue discoloration of the skin,
- Presence of blood in vomit and feces.
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In a medical institution, the patient is given a set of actions to help reduce the toxic effects on the body.
Actions:
- Administration of medicinal solutions that increase the volume of circulating blood,
- Using a ventilator,
- Prescribing medications to normalize the functionality of the cardiac and respiratory systems,
- Various procedures aimed at eliminating all violations.
Overdose is treated until complete recovery. If necessary, special vitamin complexes are selected. There is no specific antidote for overdose.
What to do in case of overdose
If a person intentionally took a large dose of furosemide, he must be given first aid. First of all, you should rinse your stomach. Then treatment measures should be carried out in a hospital setting. The patient is injected with a liquid that can fill the volume of circulating blood. To improve the functioning of the cardiovascular system, the patient is prescribed potassium and magnesium.
If blood pressure has dropped, the patient is prescribed a drug that helps increase it. In addition, it is recommended to drink enough fluid to prevent dehydration. At home, you can increase your blood pressure with strong black sweet tea.
If there is a chronic overdose of this drug, the treatment regimen should be reconsidered. If necessary, the dose of the medicine is reduced or it is changed to a drug with a similar effect. The selection of a medication is carried out exclusively by the attending physician, taking into account the main contraindications and the general condition of the patient.
How can you get an overdose?
Furosemide therapy is carried out in adults and in children over three years of age. For treatment at home, a strictly defined dosage is selected individually for each patient. Why is it possible to develop a drug overdose? There are several reasons that can lead to poisoning.
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Causes:
- Incorrect medication prescription and incorrect dosage regimen,
- Self-treatment with medication
- Unintentional use of higher dosages in the elderly and children,
- Using furosemide as a weight loss medication,
- Intolerance to any component, and, as a result, the development of serious allergic reactions and overdose.
Poisoning in children often occurs as a result of the carelessness of parents who leave the medicine in an accessible place.
How many tablets is a patient allowed to take? The initial dosage of the drug does not exceed 80 mg per day . Gradually the amount of medication is increased. The maximum allowable value is 1500 mg, divided into several doses.
In rare exceptions, a maximum of 600 mg can be consumed at one time. Exceeding the prescribed amount of furosemide can lead to acute overdose. This condition has its own ICD code – 10 – T50.1.
When should you take Furosemide?
Furosemide is a diuretic drug that has a therapeutic effect. The effect appears after a short period of time. If the drug is administered intravenously, the result will be visible within a few minutes. The medicine comes in tablets and injection solutions.
Basically, the drug is prescribed to patients to prevent swelling in diseases of the heart, liver, and lungs. In addition, the use of a diuretic is indicated if intoxication with a chemical component has occurred. In some cases, the use of a diuretic is necessary to lower blood pressure that accompanies hypertension.
Furosemide helps to increase the volume of urine excreted, along with this there is a loss of useful microelements. If you follow the prescribed dosage, the drug will not have a negative effect. However, uncontrolled use of this medication increases the risk of developing dangerous signs of overdose.
Furosemide overdose: chronic
Overdose of medications is possible in chronic form. Develops as a result of constant use of increased dosages of furosemide. Systematic use of the medicine leads to the appearance of unpleasant symptoms.
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What happens:
- The occurrence of thrombophlebitis,
- intestinal disorder,
- Vomiting, nausea,
- The appearance of inflammatory processes in the pancreas,
- Stagnation of bile,
- Hearing impairment
- Confusion of thoughts and consciousness,
- Sudden weight loss, anorexia,
- Constant dizziness, intense pain,
- The presence of allergic manifestations on the skin.
Furosemide has the potential to cause addiction. After some time, the kidneys stop responding to the prescribed dosage. To obtain an effect, it is necessary to increase the amount of the drug taken, which can lead to the development of signs of overdose.
The exact dosage at which death is possible has not been established. However, this drug is used with extreme caution and as prescribed by a physician.
When should you not take Furosemide?
There are a number of contraindications to the use of this drug. Namely:
- Chronic kidney disease.
- Presence of gout, hypokalemia, hyperuricemia.
- The electrolyte balance is severely disturbed.
- Presence of diabetes mellitus.
- Stomach diseases.
- The patient has a strong sensitivity to the components of the drug.
Why does Furosemide dependent kidney develop?
This disorder occurs if a person takes a powerful loop diuretic for a long time and uncontrollably. A diuretic may be taken for an actual health problem or a psychological factor. There are a number of situations where the use of furosemide provokes furosemide-dependent renal dysfunction. This happens when:
- Long-term treatment of a chronic disease. Long-term use of this diuretic is indicated if it is necessary to treat arterial hypertension and reduce the swelling that accompanies congestive heart failure. In addition, indications for long-term use are liver cirrhosis, chronic renal failure, and nephrotic syndrome. To achieve the required therapeutic effect, a gradual increase in the dose of the drug is carried out.
- Correction of body weight and for cosmetic purposes. Due to its powerful diuretic effect and affordable cost, Furosemide has become a fairly popular medicine, which is used to reduce puffiness under the eyes, body weight, and refine facial features. In such situations, the dose that is observed by the person is significantly increased. That is, they take not one or two tablets, but ten to twenty.
- Improving sports performance. Some athletes need to quickly lose weight in order to fit into a certain weight category. In addition, furosemide is used to mask the intake of a prohibited substance, which is easily detected by urine analysis. There is the World Anti-Doping Committee, which in 9% of cases determines the presence of furosemide in those urine samples that contain a doping drug.
How dangerous is the disease?
Due to this disorder, various pathological conditions can arise, which are associated with the fact that key macroelements are present in insufficient quantities in the body. If large doses of this diuretic are taken uncontrolled, a hyperglycemic state or coma may occur. This applies to those people who have been diagnosed with diabetes. Due to the lack of the required amount of potassium, insulin secretion decreases. If the potassium level has decreased critically, very dangerous disturbances in the functioning of the heart (fibrillation, atrial fibrillation) can develop.
Due to prolonged calcium deficiency, hair will fall out, nails will break, and osteoporosis and multiple caries will occur. Glomerulonephritis, extraglomerular and medullary interstitial hyperplasia are rare complications of the disease. If furosemide is abruptly discontinued in patients diagnosed with kidney disease, the risk of developing acute renal failure increases.
Furosemide tablets 40 mg No. 10x5
Name
Furosemide.
Description
Tablets are white or almost white, flat-cylindrical, with a bevel.
Main active ingredient
Release form
Pills.
Dosage
40 mg.
special instructions
Pharmacotherapeutic group
Highly active diuretics. Sulfonamides. ATX code: C03CA01.
Pharmacodynamics
"Loop" diuretic; causes a rapidly onset, strong and short-term diuretic effect. The diuretic effect depends on the dose. When taken orally, the onset of action is after 20–30 minutes, reaches a maximum after 1–2 hours, the duration of action is from 3–4 to 6 hours. It inhibits the reabsorption of sodium and chlorine ions mainly 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, and magnesium ions. In case of heart failure, after 20 minutes it leads to a decrease in preload on the heart. The maximum hemodynamic effect is achieved by the second hour of action of the drug, which is due to a decrease in the tone of the venous vessels, a decrease in the volume of circulating blood and intercellular 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 circulating blood volume.
Pharmacokinetics
Absorption is high, the maximum concentration is observed in the blood plasma when taken orally after 1 hour. Bioavailability is 60–70%. The relative volume of distribution is 0.2 l/kg. Connection with blood plasma proteins – 98%. Penetrates the placental barrier and is excreted in breast milk. Metabolized in the liver. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron. 60–70% is excreted by the kidneys, the rest by the intestines. The half-life is 1–1.5 hours.
Indications for use
Edema of cardiac or renal origin. Edema of hepatic origin is usually in combination with potassium-sparing diuretics. Arterial hypertension in patients with chronic renal failure for whom the use of thiazide diuretics is contraindicated (especially when creatinine clearance is below 30 ml/min).
Directions for use and doses
Taken orally. The dose depends on the course and severity of the disease. Adults. For edema of cardiac, renal or hepatic origin: - moderate condition: ½-1 tablet per day, - severe condition: 2-3 tablets per day in 1 or 2 doses, or 3-4 tablets per day in 2 doses. For high blood pressure in patients with chronic renal failure: in combination with other antihypertensive drugs (antagonists of the renin-angiotensin system), the usual doses of 20-120 mg per day in one or two doses are recommended. Children For the treatment of edema, a daily dose of 1–2 mg/kg body weight in 1–2 divided doses. Use in Elderly Patients Dose selection and adjustment in elderly patients must be done with caution, usually starting at the lower end of the therapeutic dose range.
Use during pregnancy and lactation
During the first trimester, in the II–III trimesters of pregnancy, it is possible to use furosemide for health reasons. It is excreted in milk in women during lactation, and therefore it is necessary to stop breastfeeding for the period of treatment.
Precautionary measures
Accidental administration of the drug can lead to hypovolemia and dehydration. In case of hepatocellular failure, treatment should be carried out with caution, under strict monitoring of electrolytes, taking into account the risk of hepatic encephalopathy. If necessary, treatment should be stopped immediately. Taking furosemide in case of partial obstruction of the urinary tract can lead to urinary retention. Careful monitoring of urine output should be ensured, especially at the start of furosemide treatment. Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitization to furosemide. Cases of photosensitivity reactions have been reported with the use of thiazide diuretics. If photosensitivity reactions occur, it is recommended to discontinue furosemide. If necessary, it is recommended to protect exposed skin exposed to sunlight or artificial ultraviolet radiation. Since the drug contains lactose, its use is not recommended for patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome. Electrolyte balance Natremia. It is necessary to monitor sodium levels before starting therapy and regularly monitor them thereafter. Treatment with diuretics may cause hyponatremia. A decrease in sodium levels in the blood is initially asymptomatic; regular monitoring should be more frequent in patients at risk: advanced age, cachexia (malnutrition) or cirrhosis. Kalemia. When using loop diuretics, a decrease in sodium levels with hypokalemia may occur. Risk of sudden hypokalemia (
Interaction with other drugs
Combinations not recommended 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. Such combinations should be avoided, since the resulting hearing impairment may be irreversible. The exception is when this combination is used for health reasons. The simultaneous use of furosemide and lithium preparations is not recommended. Combinations requiring special precautions If, during treatment with cisplatin, it is necessary to achieve forced diuresis with furosemide, the latter can be prescribed in a low dosage (up to 40 mg) if renal function is normal and there is no fluid deficiency. Otherwise, the nephrotoxic effect of cisplatin may be enhanced. Treatment with furosemide can lead to severe hypotension and deterioration of renal function, and in some cases to the development of acute renal failure, especially when angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor antagonists (sartans) are prescribed at the first dose or at higher doses. It is necessary to discontinue furosemide or reduce its dose 3 days before using ACE inhibitors or sartans. Furosemide should be used with caution in combination with risperidone, as there may be an increase in mortality in elderly patients. The need for co-administration must be justified based on the risks and benefits of the combination. The risk of mortality increases with the presence of dehydration. Significant interactions between furosemide and other drugs Co-administration of non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid, may reduce the effect of furosemide. In patients with dehydration or hypovolemia, NSAIDs may cause acute renal failure. The toxic effect of salicylates may be increased. The effectiveness of furosemide may be reduced with simultaneous administration of phenytoin. With the simultaneous use of glucocorticosteroids, carbenoxolone, licorice in large quantities, and prolonged use of laxatives, hypokalemia may increase. Hypokalemia or hypomagnesemia may increase the sensitivity of the myocardium to cardiac glycosides and drugs leading to prolongation of the QT interval. The effect of drugs that lower blood pressure (antihypertensive, diuretic and other drugs) can be enhanced when used simultaneously with furosemide. The simultaneous use of probenecid, methotrexate and other drugs that are eliminated by tubular secretion may reduce the effectiveness of furosemide. Furosemide may result in decreased elimination of these drugs. Their serum levels may increase and the risk of side effects may increase. The effectiveness of hypoglycemic agents and vasoconstrictor amines (epinephrine/adrenaline, norepinephrine/noradrenaline) may be weakened, and theophylline and curare-like agents may be enhanced. Furosemide may enhance the damaging effects of nephrotoxic drugs on the kidneys. In patients simultaneously treated with furosemide and certain cephalosporins in high doses, deterioration of renal function may occur. With simultaneous use of cyclosporine A and furosemide, there may be an increased risk of developing secondary gouty arthritis due to furosemide-induced hyperuricemia and worsening renal excretion of urate caused by cyclosporine. Patients at high risk of developing nephropathy are more susceptible to renal dysfunction when furosemide is used in conjunction with radiocontrast agents. When used together with thiazides, photosensitivity reactions may develop. In the event of an unexpected photosensitivity reaction while taking furosemide, it is recommended to discontinue therapy. If repeated administration is necessary, ultraviolet irradiation or solar insolation should be avoided.
Contraindications
- hypersensitivity to furosemide or to any of the excipients; - acute renal failure; - hepatic encephalopathy; - obstruction of the urinary tract; - hypovolemia or dehydration; - decompensated hypokalemia; - decompensated hyponatremia; — pregnancy, breastfeeding; - combinations with lithium; - galactosemia, glucose-galactose malabsorption syndrome, lactase deficiency; - hepatitis and hepatocellular failure in patients on hemodialysis with severe renal failure (creatinine clearance
Compound
One tablet contains: active ingredient: furosemide – 40 mg; excipients: lactose monohydrate, potato starch, starch 1500 (partially pregelatinized corn starch), magnesium stearate.
Overdose
Symptoms: decreased blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias, acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, paralysis, apathy, hypokalemia and hypochloremic alkolosis. Treatment: correction of water-salt balance and acid-base status, replenishment of circulating blood volume, symptomatic treatment. There is no specific antidote.
Side effect
From the cardiovascular system: arterial hypotension, orthostatic hypotension, collapse, tachycardia, arrhythmias. From the nervous system: dizziness, headache, muscle weakness, cramps of the calf muscles (tetany), paresthesia, apathy, adynamia, weakness, lethargy, drowsiness, confusion. From the senses: visual and hearing impairment. From the digestive system: anorexia, dry mouth, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, exacerbation of pancreatitis. From the genitourinary system: oliguria, acute urinary retention (with benign prostatic hyperplasia), interstitial nephritis, hematuria, impotence. Allergic reactions: purpura, urticaria, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock. From the hematopoietic organs: 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. Metabolic disorders: hyperglycemia, hypercholesterolemia, hyperuricemia, glycosuria. In newborns and premature infants, long-term use of high doses of furosemide increases the risk of developing nephrocalcinosis and/or nephrolithiasis. Ultrasound monitoring of the kidneys is recommended.
Storage conditions
In a place protected from light, at a temperature not exceeding 25 ° C. Keep out of the reach of children.
Buy Furosemide tablet 40 mg in container pack No. 10x5 in the pharmacy
Price for Furosemide tablet 40 mg in container pack No. 10x5
Instructions for use for Furosemide tablet 40 mg in container pack No. 10x5
How is furosemide dependent kidney diagnosed?
A nephrologist can make an accurate diagnosis. This happens without any difficulties, since the patient who has been taking furosemide for a long time has characteristic symptoms and impaired renal excretory function. Difficulty in making a diagnosis occurs at an early stage of the disease. During this period, signs are presented in the form of nonspecific changes that are of a general nature. To diagnose furosemide-dependent kidney, specialists at our medical center can use the following methods:
- Taking a biochemical blood test. According to the results of such a study, it is revealed that sodium, potassium, chlorides, calcium, and magnesium are reduced. If the disease has progressed to a more severe stage, urea and creatine levels may increase. In addition, furosemide-dependent renal dysfunction is characterized by hypoproteinemia.
- Taking a general urine test. Organic kidney damage is characterized by moderate proteinuria, cylindruria, hypoisosthenuria, erythrocyturia, leukocyturia. A biochemical analysis is also carried out, the results of which reveal that potassium, sodium, chlorine, calcium, and magnesium are increased. Excretory and concentration functions are assessed by performing the Zimnitsky test.
- Ultrasonography. The size and shape of the kidneys are determined using sonography. In addition, this method will help to study how the cortex and medulla are structured. The renal parenchyma is also measured, namely how thick it is. If changes in the anatomical structure are detected during an ultrasound examination, this is an unfavorable prognostic sign. If the disease has just begun to develop, ultrasound will be an uninformative method. This is explained by the absence of macroscopic disturbances.
If red blood cells and hemoglobin are reduced, this may indicate that the pathology has reached a severe stage. To determine how functional an organ is, glomerular filtration is assessed, namely its rate. The urinary system can be examined comprehensively. For this purpose, excretory urography, computed tomography, magnetic resonance imaging, and nephroscintigraphy are performed.
What awaits a patient with furosemide-dependent kidney
In most cases, spontaneous diuresis is completely restored. The main condition for this is complete withdrawal of the medication. If there is no qualified and timely treatment, renal function will be irreversibly impaired due to electrolyte imbalance and persistent damage to the renal glomerulus, which is characteristic of chronic glomerulonephritis.
To prevent furosemide-dependent disease, self-medication should not be carried out. In addition, it is forbidden to take the drug for a long time. Electrolyte levels should be monitored. Those patients who are at risk are recommended to take a potassium-sparing or thiazide diuretic.
