Buy Furosemide solution intravenously and intramuscularly 1% 2ml No. 10 in pharmacies

Pharmacodynamics and pharmacokinetics

Furosemide - what is it?

Furosemide is a “loop” diuretic, that is, a diuretic that acts primarily on the thick segment of the ascending limb of the loop of Henle. It is fast-acting. The diuretic effect is pronounced, but short-lived.

How long does it take for Furosemide to work?

After oral administration, the drug begins to act within 20-30 minutes, after infusion into a vein - after 10-15 minutes.

Depending on the characteristics of the body, the effect when using the oral form of Furosemide can last for either 3-4 or 6 hours, while it is most powerfully manifested an hour or two after taking the tablet.

After introducing the solution into a vein, the effect reaches a maximum after half an hour and lasts for 2-8 hours (the more severe the kidney dysfunction , the longer the drug lasts).

Pharmacodynamics

The mechanism of action of the drug is associated with impaired reabsorption of chlorine and sodium ions in the tubules of the nephrons of the kidneys. In addition, Furosemide increases the excretion of magnesium, calcium, phosphates and bicarbonates.

The use of the drug in patients with heart failure leads to a decrease in preload on the heart muscle after 20 minutes.

The hemodynamic effect reaches its maximum severity by the 2nd hour of action of Furosemide, which is due to a decrease in the tone of the veins, a decrease in the volume of circulating blood, as well as the volume of fluid filling the intercellular spaces in organs and tissues.

Reduces blood pressure. The effect develops as a consequence:

• reducing the reaction of the muscles of the vascular walls to a vasoconstrictor (provoking narrowing of blood vessels and a decrease in blood flow in them) effect;
• decrease in BCC;
• increasing the excretion of sodium chloride .

During the period of action of Furosemide, the excretion of Na+ ions increases significantly, but after the cessation of the effect of the drug, the rate of their excretion drops below the initial level (withdrawal or rebound syndrome). Due to this, when administered once a day, it does not have a significant effect on blood pressure and daily Na excretion.

The reason for this effect is the sharp activation of antinatriuretic components of neurohumoral regulation (in particular, renin-angiotensin) in response to massive diuresis.

The drug stimulates the sympathetic and arginine vasopressive systems, reduces the plasma concentration of atriopeptin, and causes vasoconstriction.

Pharmacokinetics

Absorption from the digestive tract is high, bioavailability (proportion of absorbed drug) when taken orally is from 60 to 70%. The binding rate to plasma proteins is 98%.

TSmax when taken orally - 1 hour, when infused into a vein - 0.5 hours.

Furosemide is able to cross the placenta and be excreted in breast milk.

The substance undergoes biotransformation in the liver. Metabolites are secreted into the lumen of the renal tubules.

T1/2 for the oral form of the drug - from one hour to one and a half hours, for parenteral - from half an hour to an hour.

From 60 to 70% of the dose taken orally is excreted by the kidneys, the rest - with feces. When administered into a vein, about 88% of furosemide and its metabolic products are excreted by the kidneys, and about 12% with feces.

Buy Furosemide solution intravenously and intramuscularly 1% 2ml No. 10 in pharmacies

Latin name Furosemide

Release form Solution for injection

Pack of 10 ampoules of 2 ml.

Pharmacological action Furosemide is a potent diuretic with a rapidly developing effect. It disrupts the reabsorption of sodium and chloride ions in the thick segment of the ascending loop of Henle. In addition, it increases the excretion of potassium, calcium, and magnesium ions.

Indications: edema syndrome of various origins, incl. for chronic heart failure stages IIB-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome; - pulmonary edema; – post-traumatic cerebral edema; – some forms of hypertensive crisis; – eclampsia; – premenstrual tension syndrome; – program of forced diuresis for barbiturate poisoning.

Contraindications – renal failure with anuria; – hepatic coma and precoma; – disorders of water-salt metabolism: hypokalemia, hyponatremia, hypovolemia (including with hypotension) or dehydration; – I and II trimesters of pregnancy; – hypersensitivity to sulfonamides.

Use during pregnancy and breastfeeding Furosemide is contraindicated for use in the first and second trimesters of pregnancy. In the third trimester, its use is possible only under strict indications and for a short period. If it is necessary to use Furosemide during lactation, breastfeeding should be stopped due to the fact that furosemide is excreted in breast milk and suppresses lactation.

Special instructions The drug should be prescribed with caution in cases of severe cardiovascular insufficiency, long-term therapy with cardiac glycosides, as well as in elderly patients with severe atherosclerosis. Before starting treatment, serious disturbances in water and electrolyte balance should be compensated. Monitoring laboratory parameters During treatment, the level of electrolytes, carbonates, and urea should be regularly monitored (especially when using doses above 80 mg). Impact on the ability to drive vehicles and operate machinery The question of the possibility of engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions should be decided after assessing the patient’s individual reaction, due to a possible decrease in the ability to concentrate.

Composition 1 ml contains furosemide 10 mg

Method of administration and dosage Furosemide is prescribed intravenously and intramuscularly. For adults, the daily dose for parenteral administration is 40 - 60 - 120 mg (1 - 2 times a day). The maximum daily dose for adults is 240 mg. For children, the initial daily dose is 1 mg per kg of body weight, the maximum daily dose is 6 mg per kg of body weight.

Side effects From the water-electrolyte balance and acid-base balance: with long-term use or administration in high doses - hypovolemia, dehydration, hypokalemia, hyponatremia, hypochloremia, alkalosis; in some cases - hypocalcemia. From the cardiovascular system: arterial hypotension, heart rhythm disturbances. From the central nervous system: dizziness, muscle weakness, convulsions; in some cases, when using the drug in high doses in patients with severe impairment of renal excretory function - hearing impairment, vision impairment, paresthesia. From the digestive system: dry mouth; rarely - nausea, vomiting, diarrhea. Metabolism: transient hyperuricemia (with exacerbation of gout), increased levels of urea and creatinine; in some cases - hyperglycemia. Dermatological reactions: dermatitis. Other: in some cases - anaphylactic shock, changes in the peripheral blood picture.

Drug interactions When furosemide is used simultaneously with cardiac glycosides, the risk of developing glycoside intoxication increases, and when used in combination with corticosteroids, the risk of developing hypokalemia increases. With simultaneous use, Furosemide potentiates the effect of muscle relaxants. With the simultaneous use of Furosemide with aminoglycosides or cephalosporins and cisplatin, their concentration in the blood plasma may increase, which can lead to the development of nephro- and ototoxic effects. With simultaneous use, NSAIDs can reduce the diuretic effect of Furosemide. With the simultaneous use of Furosemide and antihypertensive drugs, the hypotensive effect is potentiated. When used simultaneously with Furosemide, the effect of hypoglycemic drugs and pressor amines may be weakened.

Overdose Symptoms: dehydration, decreased blood volume, arterial hypotension, water-electrolyte imbalance, hypokalemia and hypochloremic alkalosis caused by the diuretic effect. Treatment: carry out symptomatic therapy. There is no specific antidote.

Storage conditions The drug should be stored in a dry place, protected from light, at a temperature not exceeding 25°C.

Shelf life: 2 years.

Indications for use of Furosemide

Furosemide - what are these tablets for?

Tablets are prescribed for:

• edema, the causes of which are kidney pathologies (including nephrotic syndrome ), stage II-III CHF or liver cirrhosis ;
• manifested as pulmonary edema of acute heart failure ;
• hypertensive crisis (as monotherapy or in combination with other drugs);
• severe forms of arterial hypertension ;
• cerebral edema;
• hypercalcemia;
• eclampsia.

The drug is also used for forced diuresis in case of poisoning with chemicals that are excreted from the body unchanged by the kidneys.

With elevated blood pressure developing against the background of chronic renal failure, furosemide is prescribed if the patient is contraindicated in thiazide diuretics , and also if Clcr does not exceed 30 ml per minute).

Indications for use of Furosemide in ampoules

The annotation for Furosemide in ampoules contains the same indications for use as for the tablet form of the drug.

When administered parenterally, the drug acts faster than when taken orally. Therefore, doctors, when asked “What is the solution for?”, answer that IV administration of Furosemide allows you to quickly reduce pressure (arterial, pulmonary artery, left ventricle) and preload on the heart, which is extremely important in emergency conditions (for example , in hypertensive crisis ).

In the case when the drug is prescribed for nephrotic syndrome , treatment of the underlying disease should come first.

Furosemide Bufus

Furosemide is a fast-acting diuretic that is a sulfonamide derivative. Furosemide blocks the transport system of sodium, potassium, chlorine ions in the thick segment of the ascending limb of the loop of Henle, and therefore its saluretic effect depends on the drug entering the lumen of the renal tubules (due to the anion transport mechanism). The diuretic effect of the drug Furosemide bufus is associated with inhibition of sodium chloride reabsorption in this section of the loop of Henle. Secondary effects to the increase in sodium excretion are: an increase in the amount of urine excreted (due to osmotically bound water) and an increase in the secretion of potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. With repeated administration of the drug Furosemide Bufus, its diuretic activity does not decrease, since the drug interrupts the tubular-glomerular feedback in the Macula densa (a tubular structure closely associated with the juxtaglomerular complex). Furosemide causes dose-dependent stimulation of the renin-angiotensin-aldosterone system.

In heart failure, furosemide quickly reduces preload (due to venous dilatation), reduces pulmonary artery pressure and left ventricular filling pressure. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which the realization of this effect also requires sufficient preservation of renal function. Furosemide has a hypotensive effect, which is caused by an increase in sodium excretion, a decrease in circulating blood volume and a decrease in the response of vascular smooth muscles to vasoconstrictor effects (due to the natriuretic effect, furosemide reduces the vascular response to catecholamines, the concentration of which is increased in patients with arterial hypertension). A dose-dependent increase in diuresis and natriuresis is observed when taking the drug Furosemide Bufus in a dose of 10 mg to 100 mg (healthy volunteers). After intravenous administration of 20 mg of Furosemide Bufus, the diuretic effect develops within 15 minutes and lasts about 3 hours.

The relationship between intratubular concentrations of unbound (free) furosemide and its natriuretic effect follows a sigmoidal curve with a minimum effective furosemide excretion rate of approximately 10 mcg/min. Therefore, continuous infusion of furosemide is more effective than repeated bolus administration. In addition, there is no significant increase in effect above a certain bolus dose. When tubular secretion of furosemide decreases or when the drug binds to albumin located in the tubular lumen (for example, in nephrotic syndrome), the effect of furosemide is reduced.

Contraindications for Furosemide

The drug is not prescribed for:

• intolerance to its components;
• ARF, which is accompanied by anuria (if the GFR value does not exceed 3-5 ml/min.);
• urethral stenosis;
• severe liver failure;
• hepatic coma;
• hyperglycemic coma;
• precomatose states;
• obstruction of the urinary tract with stones;
• decompensated stenosis of the mitral valve or aortic orifice;
• conditions in which blood pressure in the right atrium exceeds 10 mmHg. Art.;
• gout;
• hyperuricemia;
• myocardial infarction (in the acute stage);
• arterial hypertension;
• hypertrophic subaortic stenosis;
• systemic lupus erythematosus;
• disorders of water-salt metabolism (hypocalcemia, hypochloremia, hypomagnesemia, etc.);
• pancreatitis;
• digitalis intoxication (intoxication caused by taking cardiac glycosides).

Relative contraindications to the use of Furosemide:

• benign prostatic hyperplasia (BPH);
• diabetes;
• hypoproteinemia (taking the drug increases the risk of developing ototoxicity);
• obliterating cerebral atherosclerosis;
• hepatorenal syndrome;
• hypotension in patients at risk of ischemia (coronary, cerebral or other), which is associated with circulatory failure;
• hypoproteinemia against the background of nephrotic syndrome (possible increased undesirable side effects of Furosemide (especially ototoxicity) and a decrease in its effectiveness).

Patients at risk should be under constant medical supervision. Violation of the blood sugar balance, hypovolemia or dehydration are grounds for reviewing the treatment regimen and, if necessary, temporarily discontinuing the drug.

Diuretics promote the removal of sodium from the body, therefore, in order to avoid the development of hyponatremia, before starting therapy and subsequently throughout the course of using Furosemide, it is necessary to monitor the level of sodium in the patient’s blood (especially in patients with cachexia , cirrhosis , as well as in the elderly).

The use of loop diuretics may cause sudden hypokalemia . Risk groups include:

• aged people;
• patients who are undernourished and/or taking multiple medications at the same time;
• patients diagnosed with cirrhosis with ascites ;
• patients with heart failure .

Hypokalemia increases the cardiotoxicity of digitalis (Digitalis) preparations and the risk of cardiac arrhythmias . In long QT syndrome (congenital or drug-induced), hypokalemia contributes to bradycardia or potentially life-threatening torsade de pointes (TdP ).

In this regard, it is recommended to determine the level of potassium in the patient’s blood as often as possible. The first ionogram should be done within a week after the start of the course.

In diabetics, sugar levels must be systematically monitored throughout the course of treatment.

Additional Information

The drug is not a doping, but it is often used to remove prohibited substances from the body, and also as a means of losing weight in sports where the athlete’s weight is important. In this regard, Furosemide is equated to doping drugs and cannot be used in athletes.

University

→ Home → University → University in the media → Algorithm for the use of diuretics in outpatient practice

To date, few studies have examined the effect of diuretic therapy on the prognosis of patients with fluid retention syndrome (FRS).

When prescribing diuretics, specialists rely primarily on their own clinical experience. It is known that the use of diuretics in those with signs of fluid retention is fraught with side effects (dehydration, hypokalemia, cardiac arrhythmias). It is especially difficult for doctors in outpatient practice to control the results of treatment: they are forced to delegate a significant part of the responsibility for taking medications to patients and their relatives.

The proposed algorithm for prescribing diuretic therapy for CVD was created on the basis of research, recommendations, and clinical experience and is intended to optimize the management of this complex category of patients in an outpatient setting.

Basic rules for prescribing diuretics for CVD Diuretic therapy should begin only if there are symptoms and signs of fluid retention, which include:

• appearance or worsening of inspiratory shortness of breath, tachypnea (RR >16 per minute);

• paroxysmal nocturnal suffocation;

• paroxysmal night cough (in the absence of COPD);

• need to raise the head of the bed to sleep (possibly orthopnea);

• appearance of peripheral edema;

• accumulation of fluid in cavities (ascites, hydrothorax, hydropericardium);

• weight gain by 2 kg in 1 week;

• swelling and pulsation of the neck veins (venous pulse);

• moist rales in the lungs;

• increase in the direct size of the liver;

• X-ray signs of stagnation in the pulmonary circulation (venous hypertension);

• increased left ventricular filling pressure.

If the listed signs and symptoms develop within 1–3 days and are accompanied by tachycardia and hypotension, then such a condition should be regarded as acute decompensation of cardiac activity.

In this case, the proposed algorithm is not applicable and, as a rule, rational management of the patient in an outpatient setting is not possible.

If HF appears as a result of chronic heart failure, then diuretics should be prescribed in combination with ACE inhibitor therapy (if they are intolerant to angiotensin II receptor antagonists, beta-blockers and mineralocorticoid receptor antagonists (MCRA)).

Diuretics for CVS should be used continuously, diuretic therapy should be carried out daily. Intermittent courses of diuretics provoke hyperactivation of neurohormonal systems and may contribute to the progression of CVD.

Weighing yourself daily is important. The maximum permissible weight loss is 1 kg/day, in an outpatient setting - no more than 0.5 kg/day. Dehydration and excessive diuresis are more dangerous than the edema syndrome itself.

Prescribing and titrating the dose of diuretics to increase requires mandatory monitoring of the level of blood electrolytes, glomerular filtration rate (GFR), and the duration of the QT interval at least once a week. Once the condition has stabilized, potassium and creatinine/GFR levels can be determined once every 3–6 months.

When a clinical effect is achieved (reduction in the manifestations of life-threatening symptoms, increase in tolerance to physical activity), it is necessary to begin titrating the dose of the diuretic “downward” with daily weight monitoring. If the patient's condition stabilizes, it is even possible to discontinue the diuretic (the patient should be monitored regularly). When prescribing active diuretic therapy, it is important to remember the peculiarities of the water-salt regime. Optimal diuresis is achieved if treatment is carried out on a diet with the usual amount of sodium with a slight decrease in the volume of fluid drunk (1–1.2 l/day). That is, it is advisable not to sharply reduce salt intake, but only to limit liquids.

Algorithm for prescribing diuretics

If RLS leads to a slight limitation of the patient’s physical activity, which corresponds to class II CHF, in order to make a decision on the choice of diuretics, it is necessary to evaluate renal function and the basic therapy taken (Fig.).

It is preferable to begin diuretic therapy with starting doses of loop diuretics (LDs). Thiazide diuretics (TD), if previously prescribed, can be continued if HF develops in patients with arterial hypertension (AH) and preserved renal function. TDs are safe only in combination with ACE inhibitors or ARBs. Particular attention is paid to the dose. For the treatment of CHF, doses of hydrochlorothiazide (HCTZ) of 25 mg and higher are recommended. In this range, it can lead to severe metabolic disorders, in particular hypokalemia, hyponatremia, and the emergence of new cases of diabetes mellitus. A dose of hydrochlorothiazide of 12.5 mg/day, which is usually prescribed in combination with ACE inhibitors/ARBs as an antihypertensive agent, has a weak diuretic effect.

Achieving positive diuresis using TD is associated with a higher likelihood of hypotension than using PD. A decrease in blood pressure is an independent factor of negative prognosis in patients with CHF, the main cause of HF.

It should be especially noted that even with moderate chronic kidney disease (CKD), the effectiveness of TDs decreases, and a decrease in GFR of less than 30 ml/min/1.73 m2 is an absolute contraindication to their use.

All of the above significantly narrows the role of TD in modern treatment regimens for gastrointestinal tract diseases. They can be included in combination diuretic therapy if large doses of PD are ineffective.

If a clinically significant HF is detected, it is possible to continue taking TDs if they were prescribed as part of combination antihypertensive therapy in a patient with hypertension while maintaining SBP > 140 mm Hg. Art. and GFR > 60 ml/min/1.73 m2. However, in this situation, to eliminate signs of fluid retention, it is necessary to add PD in starting doses. GFR is calculated using the MDRD formula. GFR = 186  (creatinine (in µmol/l) / 88) – 1.154  (age (in years) – 0.203) (for women the result is multiplied by 0.742). Calculation of endogenous creatinine clearance (CC) can be carried out using the Cockcroft–Gault formula: CC = (140 – age)  weight (in kg) / creatinine  1.22 (for men); CC = (140 – age)  weight / creatinine  1.03 (for women).

TD therapy requires daily monitoring of electrolytes in the first stages due to the high risk of hypokalemia, which is difficult to organize in an outpatient setting.

If the patient has significant limitations in physical activity or the clinical picture of the life-saving lifestyle manifests itself at rest (FC III–IV), then it is necessary to begin diuretic therapy with starting doses of PD (Table).

Advantage should be given to PDs with a long half-life and predictable absorption from the gastrointestinal tract. Extending the release interval of diuretic drug molecules, achieved through the use of a special matrix, reduces the peak concentration of the drug in the blood and increases the time of maximum drug concentration. In this regard, when using such drugs (sustained-release torasemide), a milder and more predictable diuretic effect develops, which worsens the quality of life to a lesser extent. In addition, sustained-release torasemide reduces the patient's risk of developing peak natriuresis, which can lead to renal tubular damage, as well as compensatory activation of the SAS and RAAS, which reduces the result of diuretic therapy.

If the starting doses of PD are ineffective, they should be doubled, but the maximum allowable doses cannot be exceeded. If furosemide is chosen as the starting drug, it is preferable to switch to torsemide due to higher bioavailability in patients with edema syndrome (the dose ratio of torasemide to furosemide is approximately 1:4). If high doses of PD do not lead to relief of the manifestations of CVD, it is recommended to add a carbonic anhydrase inhibitor - acetazolamide. This drug, in addition to its diuretic effect, has the ability to change the pH of urine to the acidic side and can lead to the restoration of sensitivity to PD. The following regimen is usually followed: acetazolamide 250 mg 2-3 times a day for 3-4 days (once every 2-3 weeks). If therapy has not led to a significant improvement in the patient’s condition and he remains limited in physical activity at the level of FC II–IV, it is necessary to prescribe or increase doses of AMCR up to the maximum.

• Increasing doses of AMKR for life-saving lifestyle is allowed up to 200 mg/day for veroshpiron. The dose of the drug should be divided into 2 doses: in the morning and at lunch.

• Increasing AMKR doses is allowed only in situations where CKD is not more severe than stage 3 and potassium levels are normal or low.

• Laboratory monitoring of potassium and creatinine (GFR) is strictly required. When the potassium level is more than 5.0–5.5 mmol/l, the AMKR dose is halved. If GFR decreases < 10 ml/min/1.73 m2, discontinuation of AMCR is required.

• If the potassium level differs more significantly from the norm—more than 5.5 mmol/l—the dose is adjusted until the drug is discontinued, and a low-potassium diet is prescribed.

• After reducing the dose by 50%, a repeated increase in the AMKR dose is possible after 1 month, provided that normokalemia is persistent.

• If the condition is stable and there are no fluctuations in creatinine levels, potassium levels should be monitored once every 3 months.

• It must be remembered that the combination of an ACE inhibitor and a MAKR should always be considered as potentially leading to hyperkalemia. The ineffectiveness of all of these measures requires an assessment of the possible causes of refractoriness to diuretic therapy. The causes of edematous syndrome refractory to combined diuretic therapy may be:

• slowing down the absorption of diuretics (mainly furosemide) in the gastrointestinal tract in patients with ascites and anasarca;

• uncontrolled polydipsia;

• uncontrolled intake of NaCl;

• severe hypotension;

• current NSAID therapy;

• progression of renal failure;

• hypoalbuminemia.

The next stage of treatment for SGI should include intravenous bolus or drip administration of diuretics (furosemide), and, if necessary, a combination of PD and HCTZ.

It is likely that in this situation low systemic blood pressure comes to the fore. In this case, it is important not to further increase diuretic therapy, but to increase plasma flow through the kidney, which is achieved by introducing pressor amines.

There is also a high probability of need for non-drug methods of combating CVD - hemodialysis, ultrafiltration, etc. At this stage, it is unrealistic to continue outpatient management of the patient; the tactics of his further treatment are beyond the scope of this algorithm.

Obviously, the presented algorithm does not consider all possible clinical situations. It does not replace the need for an individual approach, taking into account the underlying and concomitant diseases, the patient’s living conditions and the experience of the attending physician. However, it indicates the main directions for finding rational solutions in the management of patients with fluid retention syndrome in outpatient practice.

Alexander Bova , doctor of medicine. Sciences, Professor, Honored Doctor of the Republic of Belarus,

Sergey Tregubov , assistant at the Department of Military Field Therapy, BSMU Medical Bulletin , August 6, 2014

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Side effects of Furosemide

The following side effects may occur while using the drug:

• cardiovascular disorders , including orthostatic hypotension , arterial hypotension , arrhythmias , tachycardia , collapse ;
• dysfunctions of the nervous system , manifested by dizziness, muscle weakness, headache, tetany , apathy , adynamia , paresthesia , drowsiness, lethargy, weakness, confusion;
• dysfunction of the sensory organs (in particular hearing and vision impairment);
• disorders of the digestive system, including dry mouth, anorexia , cholestatic jaundice , diarrhea/constipation, nausea, vomiting, exacerbation of pancreatitis ;
• disorders of the urogenital tract, including oliguria , interstitial nephritis , acute urinary retention (with BPH), hematuria , impotence ;
• hypersensitivity reactions, including exfoliative dermatitis , urticaria , purpura , necrotizing angiitis , vasculitis , erythema multiforme , chills, pruritus, photosensitivity, fever , anaphylactic shock ;
• disorders of the hematopoietic organ system, including aplastic anemia , thrombocytopenia , leukopenia , agranulocytosis ;
• disorders of water-salt metabolism, including dehydration and, as a consequence, an increased risk of thrombosis/thromboembolism , hypovolemia , hypomagnesemia , hypochloremia , hypokalemia , hypocalcemia , hyponatremia , metabolic acidosis ;
• changes in laboratory parameters, including hypercholesterolemia , hyperglycemia , glucosuria , hyperuricemia .

When Furosemide is administered intravenously, thrombophlebitis , and in newborn infants, renal calcification .

Instructions for use of Furosemide

How to take Furosemide for edema?

Diuretic tablets are taken orally. The doctor selects the dose individually depending on the indications and characteristics of the course of the disease.

An adult with edema that has developed against the background of pathologies of the liver, kidneys or heart is prescribed to take ½-1 tablet/day if the condition is assessed as moderate. In severe cases, the doctor may recommend taking 2-3 tablets. 1.r./day or 3-4 tablets. in 2 doses.

How to lower blood pressure with Furosemide?

To reduce high blood pressure in patients with chronic renal failure, the drug is used in combination with antagonists of the renin-angiotensin system. The recommended dose varies from 20 to 120 mg/day. (½-3 tablets/day). The medicine is taken in one or two doses.

Furosemide for weight loss

Some women use the properties of the drug for weight loss. Taking Furosemide tablets (Furosemide Sopharma) really allows you to get rid of several kilograms, but this weight loss can hardly be called weight loss, since the drug does not remove excess fat in problem areas, but only removes water from the body.

Instructions for use of Furosemide in ampoules

The preferred method of administering the solution is a slow intravenous injection (performed over 1-2 minutes).

The drug is administered into the muscle in exceptional cases when oral or intravenous administration is not possible. Contraindications for intramuscular administration of Furosemide are acute conditions (for example, pulmonary edema ).

Taking into account the clinical condition of the patient, it is recommended to transfer Furosemide from parenteral to oral administration as soon as possible.

The question of the duration of treatment is decided taking into account the nature of the disease and the severity of symptoms. The manufacturer recommends using the lowest possible dose at which the therapeutic effect will be maintained.

For edematous syndrome in adults and adolescents over 15 years of age, treatment begins with the injection of 20-40 mg of Furosemide into a vein (in exceptional cases, into a muscle).

In the absence of a diuretic effect, the drug is continued to be administered every 2 hours at a dose increased by 50%. Treatment according to this regimen is continued until adequate diuresis is achieved.

A dose exceeding 80 mg should be administered into a vein by drip. The rate of administration should not be more than 4 mg/min. The maximum permissible dose is 600 mg/day.

In case of poisoning, to maintain forced diuresis, the patient should be administered from 20 to 40 mg of the drug, having previously dissolved the required dose in an infusion solution of electrolytes. Further treatment is carried out depending on the volume of diuresis. It is mandatory to replace the salts and fluids lost by the body.

The initial dose for hypertensive crisis is 20-40 mg. It is subsequently adjusted based on clinical response.

Furosemide injections and tablets: instructions for use in children

In pediatrics, the dose is selected depending on the patient’s weight. Furosemide tablets are given to a child at a rate of 1-2 mg/kg/day. The dose can be taken in one dose or divided into two doses.

Only the attending physician can answer questions about how often you can take the drug in a given case, as well as how long the course of treatment will be. The only clear recommendations are as to what to take Furosemide with: in addition to diuretics, you should definitely take potassium supplements.

The medicine is administered intravenously to children under 15 years of age at a dose of 0.5-1.5 mg/kg/day.

Furosemide tablets: what are they used for in veterinary medicine?

Why is Furasemide Sopharma used in veterinary medicine? In veterinary practice, Furosemide and similar drugs are used as part of complex therapy for the treatment of heart pathologies in dogs.

The use of diuretics allows you to remove fluid that accumulates around the lungs, abdominal or chest cavity, thereby reducing the load on the heart.

For dogs, the dosage of Furosemide depends on the weight of the animal. As a rule, the drug is given 2 times a day at a rate of 2 mg/kg. As an addition to treatment, it is recommended to give your dog bananas daily (one per day) to compensate for potassium losses.

Furosemide, solution 10 mg/ml, ampoules 2 ml, 10 pcs.

General recommendations

When using the drug Furosemide, it is recommended to administer it in the smallest doses sufficient to achieve the required therapeutic effect. The dose is selected individually.

The drug Furosemide is administered intravenously (slowly in a stream), if impossible - intramuscularly (the effectiveness is much lower) for 7-10 days or more. Intramuscular administration of the drug is not suitable for the treatment of acute conditions such as pulmonary edema. Intravenous administration of the drug Furosemide is carried out only when taking the drug orally is impossible or there is a malabsorption of the drug in the small intestine, as well as if it is necessary to obtain the fastest possible effect. When administering Furosemide intravenously, it is always recommended to switch to taking Furosemide orally as soon as possible.

When administered intravenously, Furosemide should be administered slowly. The rate of intravenous administration should not exceed 4 mg/min. In patients with severe renal impairment (serum creatinine concentration ≥ 5 mg/dL), it is recommended that the rate of intravenous administration of Furosemide not exceed 2.5 mg/min. To achieve optimal effectiveness and suppress counterregulation (activation of the renin-angiotensin and antinagriuretic neurohumoral regulation links), prolonged intravenous infusion of the drug Furosemide is preferable to its repeated intravenous bolus administration. If a continuous intravenous infusion is not possible after one or more intravenous bolus administrations in an acute setting, then administering low doses with short intervals between administrations (approximately 4 hours) is preferable to intravenous bolus administration of higher doses at longer intervals. between injections.

The solution for parenteral administration has a pH of about 9 and does not have buffering properties. At a pH below 7, the active substance may precipitate, therefore, when diluting the drug Furosemide, it is necessary to strive to ensure that the pH value of the resulting solution is from neutral to slightly alkaline. For dilution, you can use 0.9% sodium chloride solution. A diluted solution of Furosemide should be used, if possible, immediately after preparation.

The drug is administered in doses of 20-60 mg 1-2 times a day; in the absence of a diuretic response, a dose increased by 50% is administered every 2 hours until adequate diuresis is achieved.

The recommended maximum daily dose for intravenous administration in adults is 1500 mg and in children - 20 mg.

The duration of treatment in children and adults is determined by the doctor individually depending on the indications.

Special dosage recommendations

Children

In children, the dose should be reduced according to body weight. In children, the recommended dose for parenteral administration is 1 mg/kg/body weight per day, but not more than 20 mg/day.

Adults

Edema syndrome in liver diseases

Furosemide is used in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation, disturbances in water-electrolyte balance or acid-base status, 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 is possible per day). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.

Edema syndrome in chronic renal failure

The natriuretic response to Furosemide depends on several factors, including the severity of renal impairment and blood sodium levels, so the dose effect cannot be accurately predicted. 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 approximately 2 liters per day is possible, which can amount to up to 280 mmol Na + per day). In patients on hemodialysis, the usual maintenance dose is 250-1500 mg/day orally.

When administered intravenously, the dose of Furosemide can be determined as follows: treatment begins with intravenous drip administration at a rate of 0.1 mg per minute, and then gradually increases the rate of administration every 30 minutes, depending on the therapeutic effect.

Acute renal failure (to maintain fluid excretion)

Before starting treatment with Furosemide, hypovolemia, arterial hypotension and significant disturbances in water-electrolyte balance and/or acid-base status must be eliminated. It is recommended that the patient, as soon as possible, be switched from intravenous administration of the drug Furosemide to taking Furosemide tablets (the dose of Furosemide tablets depends on the selected dose for intravenous administration).

The recommended starting dose for intravenous administration is 40 mg. If after its administration the required diuretic effect is not achieved, then Furosemide can be administered as a continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.

Edema in nephrotic syndrome

The recommended starting dose is 20-40 mg per day. The required dose is selected depending on the diuretic effect. The daily dose can be administered once or divided into several administrations.

Edema syndrome in chronic heart failure

The recommended starting dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended that the daily dose be divided into 2-3 administrations.

Edema syndrome in acute heart failure

The recommended initial dose of Furosemide is 20-40 mg as an intravenous bolus. If necessary, the dose of Furosemide can be adjusted depending on the therapeutic effect.

Hypertensive crisis, cerebral edema

The recommended starting dose is 20-40 mg by intravenous bolus. The dose may be adjusted depending on the effect.

Maintaining forced diuresis during poisoning

The drug Furosemide is used in addition to intravenous infusion of electrolyte solutions. The recommended starting dose for intravenous administration is 20-40 mg. The dose depends on the response to the drug Furosemide. Before and during treatment with Furosemide, fluid and electrolyte losses should be monitored and restored. In case of poisoning with substances with an acidic or alkaline reaction, their elimination can be accelerated by additional alkalization or an increase in the acidity of the urine, respectively.

Overdose

Symptoms of Furosemide overdose:

• a sharp drop in blood pressure;
• hypovolemia;
• dehydration;
• collapse;
• hemoconcentration;
• shock;
• arrhythmias (including atrioventricular block and ventricular fibrillation);
• thrombosis;
• thromboembolism;
• confusion;
• drowsiness;
• acute renal failure with anuria ;
• apathy;
• flaccid paralysis

To normalize the patient’s condition, measures are prescribed aimed at correcting CSR and water-salt metabolism, replenishing the deficit of blood volume. Further treatment is symptomatic.

Furosemide does not have a specific antidote.

Interaction

Furosemide increases the concentration and toxicity (in particular, oto- and nephrotoxicity) of Ethacrynic acid , Aminoglycosides , Cephalosporins , Cisplatin , Chloramphenicol , Amphotericin B.

Enhances the therapeutic effectiveness of Theophylline and Dazoxide , reduces the effectiveness of Allopurine and hypoglycemic drugs .

Reduces the rate of renal excretion of Li+ drugs from the blood, thereby increasing the likelihood of intoxication with them.

Strengthens the neuromuscular blockade caused by non-depolarizing relaxants (peripheral relaxants) and the effect of antihypertensive drugs , weakens the effect of non-depolarizing relaxants .

In combination with pressor amines, there is a mutual decrease in the effectiveness of the drugs; with Amphotericin B and GCS, the risk of developing hypokalemia .

Use in combination with cardiac glycosides (CGs) may provoke the development of the latter's inherent toxic effects due to a decrease in the level of potassium in the blood (for low- and high-polarity CGs) and an extension of the half-life (for low-polarity CGs).

Drugs that block tubular secretion help increase the serum concentration of furosemide.

Sucralfate and NSAIDs reduce the diuretic effect of the drug due to suppression of Pg synthesis, changes in plasma renin and aldosterone .

The use of high doses of salicylates during treatment with the drug increases the risk of their toxicity, which is caused by competitive renal excretion of the drugs.

The Furosemide solution injected into a vein has a slightly alkaline reaction, so it is contraindicated to mix it with drugs whose pH is below 5.5.

Not recommended combinations for the solution

Administration of Furosemide into a vein within 24 hours after chloral hydrate can provoke:

• nausea;
• flushes of blood;
• anxiety;
• increased sweating;
• increased blood pressure;
• tachycardia.

The use of furosemide with ototoxic drugs (for example, aminoglycosides ) can cause irreversible hearing damage . This combination can only be used for health reasons.

Lasix®

Combinations not recommended

- Chloral hydrate - intravenous infusion of furosemide within a 24-hour period after administration of chloral hydrate can lead to flushing of the skin, profuse sweating, anxiety, nausea, increased blood pressure and tachycardia. Therefore, the use of furosemide in combination with chloral hydrate is not recommended.

- Aminoglycosides - slowing down the excretion of aminoglycosides by the kidneys when used simultaneously with furosemide and increasing the risk of developing ototoxic and nephrotoxic effects of aminoglycosides. For this reason, the use of this combination of drugs should be avoided, except in cases where it is necessary for health reasons, in which case an adjustment (reduction) of maintenance doses of aminoglycosides is required.

Combinations that should be used with caution

- Ototoxic drugs - furosemide potentiates their ototoxicity. Such drugs can be used simultaneously with Lasix® only for strict medical indications, since combined use can lead to irreversible damage to the hearing organ.

- Cisplatin - when used simultaneously with furosemide, there is a risk of ototoxicity. In addition, the nephrotoxic effect of cisplatin may be enhanced when furosemide is used for forced diuresis during treatment with cisplatin, unless furosemide is used at a low dose (such as, for example, 40 mg in patients with normal renal function) and without combination with appropriate hydration of the patient.

- Sucralfate - decreases the absorption of furosemide when taken orally and weakens its effect (furosemide when taken orally and sucralfate should be taken at least two hours apart).

- Lithium salts - under the influence of furosemide, the excretion of lithium is reduced, due to which the content of lithium in the blood serum increases, which increases the risk of its toxic effects, including cardiotoxic and neurotoxic effects. Therefore, when using this combination, monitoring of lithium levels in the blood serum is required.

- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists - the use of ACE inhibitors or angiotensin II receptor antagonists in patients previously treated with furosemide may lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases, to the development of acute renal disease. deficiency, therefore, three days before starting treatment or increasing the dose of ACE inhibitors or angiotensin II receptor antagonists, it is recommended to discontinue furosemide, or at least reduce its dose.

- Risperidone - caution should be exercised, carefully weighing the balance of risk and benefit, before deciding to use a combination of risperidone with furosemide or other strong diuretics, as an increase in mortality was observed in elderly patients with dementia receiving concomitant treatment with risperidone and furosemide.

- Levothyroxine-furosemide in high doses can inhibit the binding of thyroid hormones to carrier proteins and thus lead initially to a transient increase in the concentrations of free thyroid hormones, and then, overall, to a decrease in the total concentration of thyroid hormones. When using this combination, thyroid hormone concentrations should be monitored.

Interactions to Consider

- Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, including acetylsalicylic acid, may reduce the diuretic 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 toxicity of salicylates.

- Phenytoin - decreases the diuretic effect of furosemide.

- Glucocorticosteroids, carbenoxolone, licorice preparations in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of developing hypokalemia.

- Cardiac glycosides, drugs that cause prolongation of the QT interval - if water and electrolyte imbalances (hypokalemia or hypomagnesemia) develop during the use of furosemide, the toxic effect of cardiac glycosides and drugs that cause prolongation of the QT interval increases (the risk of developing cardiac arrhythmias increases).

- Antihypertensives, diuretics or other drugs that can lower blood pressure - when combined with furosemide, a more pronounced decrease in blood pressure is possible.

- Probenecid, methotrexate or other drugs that, like furosemide, are excreted in the renal tubules, can reduce the effects of furosemide (same route of renal excretion); on the other hand, furosemide may lead to a decrease in the renal excretion of these drugs. All this increases the risk of developing side effects, both of Lasix® and the above-mentioned medications taken simultaneously with it.

- Hypoglycemic agents (both for oral administration and insulin preparations), pressor amines (epinephrine, norepinephrine) - weakening of effects when combined with furosemide.

- Theophylline, diazoxide, curare-like muscle relaxants - enhanced effects when combined with furosemide.

- Medicines with nephrotoxic effects - when combined with furosemide, the risk of developing their nephrotoxic effect increases.

- High doses of some cephalosporins (excreted primarily by the kidneys) - in combination with furosemide, the risk of nephrotoxicity of cephalosporins increases.

- Cyclosporine A - when combined with furosemide, the risk of developing gouty arthritis increases due to hyperuricemia caused by furosemide and impaired renal urate excretion under the influence of cyclosporine.

- Radiocontrast agents - in patients at high risk of developing nephropathy due to the administration of radiocontrast agents who were treated with furosemide, there was a higher incidence of renal dysfunction after administration of radiocontrast agents, compared with patients with a high risk of developing nephropathy due to the administration of radiocontrast agents who before administration of radiocontrast agents. X-ray contrast agent was administered only by intravenous fluid administration (hydration).

special instructions

During the entire course of treatment, it is recommended to avoid activities that potentially threaten life and health, which require rapid psychomotor reactions and increased attention.

During the course of treatment, you should periodically do a blood ionogram, as well as monitor blood pressure levels, blood pressure, uric acid, creatinine, residual nitrogen, and liver function. If necessary, the treatment regimen is revised taking into account these indicators.

When using high doses of Furosemide, it is not recommended to limit the consumption of table salt, which is associated with the risk of developing metabolic acidosis and hyponatremia .

In patients with BPH, hydronephrosis , narrowing of the ureters , and in patients who are unconscious, urinary output should be monitored due to the possibility of acute urinary retention.

The tablet form of the drug is contraindicated for people with glucose/galactose malabsorption syndrome, congenital galactosemia, hypolactasia .

Furosemide, 10 pcs., 2 ml, 20 mg/2 ml, solution for injection

When used simultaneously with aminoglycoside antibiotics (including gentamicin, tobramycin), nephro- and ototoxic effects may be enhanced.

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

When used simultaneously with cephalosporin antibiotics, which can cause renal dysfunction, there is a risk of increased nephrotoxicity.

When used simultaneously with beta-agonists (including fenoterol, terbutaline, salbutamol) and corticosteroids, hypokalemia may increase.

When used simultaneously with hypoglycemic agents and insulin, the effectiveness of hypoglycemic agents and insulin may decrease, because furosemide has the ability to increase plasma glucose levels.

When used simultaneously 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 renal dysfunction increases and the development of hypokalemia cannot be excluded.

When used simultaneously with furosemide, the effects of non-depolarizing muscle relaxants are enhanced.

When used simultaneously with indomethacin and other NSAIDs, the diuretic effect may be reduced, 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 with other NSAIDs in a similar way.

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

When used simultaneously with astemizole, the risk of developing arrhythmia increases.

When used simultaneously with vancomycin, oto- and nephrotoxicity may increase.

When used simultaneously with digoxin and 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 when used simultaneously with carbamazepine.

When used simultaneously with cholestyramine and colestipol, the absorption and diuretic effect of furosemide decreases.

When used simultaneously with lithium carbonate, the effects of lithium may be enhanced due to an increase in its concentration in the blood plasma.

When used simultaneously with probenecid, the renal clearance of furosemide decreases.

When used simultaneously with sotalol, hypokalemia and the development of ventricular arrhythmias are possible.

When used simultaneously with theophylline, a change in the concentration of theophylline in the blood plasma is possible.

When used simultaneously with phenytoin, the diuretic effect of furosemide is significantly reduced.

After intravenous administration of furosemide during therapy with chloral hydrate, increased sweating, a feeling of heat, instability of blood pressure, and tachycardia are possible.

When used simultaneously with cisapride, hypokalemia may increase.

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

When used simultaneously with cisplatin, the ototoxic effect may be enhanced.

How to replace Furosemide?

Analogues of Furosemide in tablets: Furosemide Sopharma , Lasix .

Analogues of the parenteral form of the drug: Furosemide-Darnitsa , Furosemide-Vial , Lasix .

Drugs belonging to the same pharmacological subgroup with Furosemide: Bufenox , Britomar , Diuver , Trigrim , Torasemide .

What is better - Lasix or Furosemide?

Lasix is ​​one of the trade names for furosemide. The drug is produced by the Indian company Sanofi India Ltd. and, like its analogue, has two dosage forms: a one-percent d/i solution and 40 mg tablets.

Thus, when choosing one or another remedy, one should be guided by subjective feelings. The advantage of Furosemide is its lower price.

Furosemide for weight loss

There is a lot of advice on the Internet regarding the use of diuretics for weight loss. One of the most accessible drugs in this group is Furosemide.

What does the medicine help with? According to the instructions, Furosemide is used for ascites , edema syndrome , and hypertension . Thus, the manufacturer does not report anything regarding the possibility of using diet pills.

However, many women note that with the help of this remedy they were able to quickly lose several kilograms (in some cases, up to 3 kg per night). However, such weight loss cannot be regarded as weight loss: the action of the drug is aimed at removing excess fluid, and not at all at breaking down fat.

Why is Furosemide dangerous?

The use of diuretics for weight loss can cause serious health problems, since by removing water, these drugs also upset the balance of electrolytes in the body. one of the most common side effects is hypokalemia .

Potassium deficiency, in turn, leads to muscle cramps, weakness, blurred vision, sweating, loss of appetite, nausea, and dizziness.

A very dangerous side effect is arrhythmia . SOLVD studies have shown that treatment with loop diuretics is associated with increased mortality among patients. At the same time, both the rates of general and cardiovascular mortality and the number of sudden deaths are increasing.

Another danger that can result from the uncontrolled use of diuretics for weight loss is impaired kidney function. Moreover, it may take more than one month to restore the function of the kidneys and lymphatic system.

How to take Furosemide for weight loss?

To remove a few extra pounds, women usually take 2-3 (no more!) Furosemide tablets during the day with an interval of three hours between doses, and then 2 more tablets at night.

You can repeat the one-day course no earlier than after 2-3 days.

Furosemide and Asparkam for weight loss

Since one of the side effects of Furosemide is hypokalemia , it is very important during the period of use of this drug to adhere to a certain diet (this means eating foods high in potassium) or additionally take medications that can minimize the side effects inherent in diuretics .

As a rule, Furosemide is recommended to be taken in combination with Asparkam (Panangin) . What is Asparkam ? This is a drug that is used as an additional source of potassium and magnesium. The medicine has a harmless composition, which eliminates the possibility of its unwanted interaction with Furosemide.

recommendations on how to take diuretics with Asparkam . Asparkam tablets , according to the manufacturer's instructions, are taken 3-6 pieces per day, dividing the indicated dose into three doses.

How often can you take Furosemide for weight loss?

Optimally - never. As a last resort, the drug can be used as an emergency remedy when swelling is urgently needed.

Reviews from women who tried to lose weight on Furosemide indicate that taking more than 2 tablets per week is always accompanied by side effects. In addition, another problem often arises - how to “get off” the drug.

Is it possible to drink Furosemide during pregnancy?

When asked whether pregnant women can take diuretics , most doctors answer that modern medicine offers much safer methods of gestosis and preeclampsia

That is, Furosemide during pregnancy can only be used as an emergency aid, for the shortest possible course and only on condition that the woman is under strict medical supervision.

According to the FDA classification, the drug belongs to category C.

Despite all the contraindications, women quite often leave reviews on forums about the use of Furosemide during pregnancy.

Almost all of them note that the drug really quickly removed excess fluid from the body, but it also caused unpleasant side effects (for example, leg cramps).

Therefore, all mothers are unanimous in their opinion - Furosemide can be taken only according to strict indications and only in a situation without alternative.

Use during lactation

Furosemide penetrates into milk and is capable of suppressing lactation, so its use in nursing women is possible only if the child is transferred to artificial feeding during the mother's treatment.

Reviews of Furosemide

Furasemide is one of the most effective diuretics with fast and short action.

Reviews from doctors confirm the fact that the drug plays a key role in the treatment of edema syndrome in patients with heart failure , since loop diuretics most effectively block the reabsorption of Na+ ions in the ascending segment of the loop of Henle. At the same time, Furosemide retains its activity even in patients with chronic renal failure (including at the terminal stage of the disease).

However, the use of loop diuretics may cause irreversible damage to the renal tubules, especially when the drug is prescribed in high doses.

A parallel increase in the delivery of Na+ ions to the distal nephron, where loop diuretics , leads to sodium overload and structural damage to these parts of the nephron with the development of hyperplasia and hypertrophy .

In addition, after the end of the drug’s action, Na+ reabsorption increases significantly and, as a result, a “ricochet” effect develops, manifested by an increase in post-diuretic reabsorption.

Reviews left by patients allow us to conclude that the medicine helps well against edema and is indispensable for hypertensive patients. The disadvantages of the drug are usually side effects, contraindications and the fact that it is addictive.

Another category of reviews is reviews of Furosemide for weight loss. Despite the fact that the drug really allows you to quickly reduce weight by 3-5 kg, both doctors and those losing weight do not recommend using it for weight loss. This is due to the fact that the drug does not remove excess fat, but only removes water (and with it substances necessary for the body to function normally).

Thus, given that Furosemide is a very powerful drug, it can only be used taking into account contraindications, not exceeding the prescribed dose and only under the supervision of a doctor (especially during pregnancy). Also, you should not take it for other purposes (for example, for cystitis ).

When treating with diuretics, a very important question is what to take the drug with. It is optimal to supplement therapy by eating potassium-rich foods or taking potassium supplements.

Furosemide

When prescribing Furosemide, it is recommended to use the smallest doses sufficient to achieve the required therapeutic effect.

The drug is administered intravenously and, in exceptional cases, intramuscularly (when intravenous administration or oral administration of the drug is not possible). Intravenous administration of the drug Furosemide is carried out only when taking the drug orally is impossible or there is a malabsorption of the drug in the small intestine or if it is necessary to obtain the fastest possible effect. When administering Furosemide intravenously, it is always recommended that the patient be transferred to Furosemide tablets as early as possible. When administered intravenously, Furosemide should be administered slowly. The rate of intravenous administration should not exceed 4 mg per minute. In patients with severe renal impairment (serum creatinine > 5 mg/dL), it is recommended that the rate of intravenous administration of Furosemide not exceed 2.5 mg per minute. To achieve optimal effectiveness and suppression of counterregulation (activation of renin-angiotensin and antinatriuretic neurohumoral regulation), prolonged intravenous infusion of the drug Furosemide should be preferable compared to repeated intravenous bolus administration of the drug. If a continuous intravenous infusion is not possible after one or more intravenous boluses in an acute setting, administering low doses with short intervals between administrations (approximately 4 hours) is preferable to administering higher-dose intravenous boluses with long intervals between administrations. introductions. The solution for parenteral administration has a pH of about 9 and does not have buffering properties. At a pH below 7, the active substance may precipitate, therefore, when diluting the drug Furosemide, it is necessary to ensure that the pH of the resulting solution ranges from neutral to slightly alkaline. For dilution, you can use 0.9% sodium chloride solution. The diluted solution of Furosemide should be used as soon as possible after preparation. The recommended maximum daily intravenous dose for adults is 1500 mg. In children, the recommended dose for parenteral administration is 1 mg/kg body weight (but not more than 20 mg per day).

The duration of treatment is determined by the doctor individually depending on the indications.

Special dosage recommendations for adults

Edema syndrome in chronic heart failure

The recommended starting dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended that the daily dose be administered two to three times.

Edema syndrome in acute heart failure

The recommended starting dose is 20-40 mg as an intravenous bolus. If necessary, the dose of Furosemide can be adjusted depending on the therapeutic effect.

Edema syndrome in chronic renal failure

The natriuretic response to furosemide depends on several factors, including the severity of renal impairment and blood sodium levels, so the dose response cannot be accurately predicted. In patients with chronic renal failure, careful selection of the dose is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 liters per day is possible).

In patients on hemodialysis, the usual maintenance dose is 250-1500 mg/day. When administered intravenously, the dose of Furosemide can be determined as follows: treatment begins with an intravenous drip at a rate of 0.1 mg per minute, and then gradually increases the rate of administration every 30 minutes. depending on the therapeutic effect.

Acute renal failure (to maintain fluid excretion)

Before starting treatment with Furosemide, hypovolemia, arterial hypotension and significant disturbances in water-electrolyte and acid-base status must be eliminated. It is recommended that the patient be switched from intravenous administration of Furosemide to Furosemide tablets as soon as possible (the dose of Furosemide tablets depends on the selected intravenous dose). The recommended initial intravenous dose is 40 mg. If after its administration the required diuretic effect is not achieved, then Furosemide can be administered as a continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.

Edema in nephrotic syndrome

The recommended starting dose is 20-40 mg per day. The required dose is selected depending on the diuretic response.

Edema syndrome in liver diseases

Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in water-electrolyte or acid-base status, 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). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg. Hypertensive crisis, cerebral edema

The recommended starting dose is 20-40 mg by intravenous bolus. The dose may be adjusted depending on the effect.

Maintaining forced diuresis during poisoning

Furosemide is prescribed after intravenous infusion of electrolyte solutions. The recommended starting dose for intravenous administration is 20-40 mg. The dose depends on the response to furosemide. Before and during treatment with Furosemide, fluid and electrolyte losses should be monitored and restored.

How much do the tablets cost and how much can you buy Furosemide solution for?

The price of Furosemide in injection form in Ukraine is from 14 UAH. The price of Furosemide in tablets is from 5.5 UAH.

The price of Furosemide diuretic tablets in Russian pharmacies is from 15 rubles. The price of ampoules is from 22.5 rubles.

• Online pharmacies in RussiaRussia
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ZdravCity

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Pharmacy24

• Furosemide-Darnitsa 1% 2 ml No. 10 solution for injection PrAT" Pharmaceutical company "Darnitsa", Ukraine
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• Furosemide 40 mg No. 20 tablets AT "Sopharma", Bulgaria

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PaniPharmacy

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• Furosemide tablets Furosemide tablets. 40 mg No. 20 Bulgaria, Sopharma

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• Furosemide ampoule Furosemide solution d/in. 1% amp. 2ml No. 10 Ukraine, Darnitsa ChAO

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• Furosemide tablets Furosemide tablets 0.04g No. 50 Ukraine, Kievmedpreparat OJSC

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• Furosemide tablets Furosemide tablets 40 mg No. 50 Ukraine, Darnitsa ChAO

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