Pregnancy Risk Category C
How supplied
Tablets: 20 mg, 40 mg, 80 mg, 500 mg†
Oral solution: 10 mg/ml, 40 mg/5 ml
Injection: 10 mg/ml
Action
A potent loop diuretic that inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle.
Indications & dosage
Acute pulmonary edema--
Adults: 40 mg I.V. injected slowly over 1 to 2 minutes; then 80 mg I.V. in 1 to 11/2 hours if needed.
Edema--
Adults: 20 to 80 mg P.O. daily in the morning, second dose in 6 to 8 hours; carefully adjusted up to 600 mg daily if needed. Or, 20 to 40 mg I.M. or I.V., increased by 20 mg q 2 hours until desired response is achieved. Give I.V. dose slowly over 1 to 2 minutes.
Infants and children: 2 mg/kg P.O. daily, increased by 1 to 2 mg/kg in 6 to 8 hours if needed; carefully adjusted up to 6 mg/
kg daily if needed.
Hypertension--
Adults: 40 mg P.O. b.i.d. Dosage adjusted based on response. May be used as adjunct to other antihypertensives if needed.
Adverse reactions
CNS: vertigo, headache, dizziness, paresthesia, weakness; restlessness.
CV: orthostatic hypotension, increased cholesterol levels.
EENT: transient deafness, blurred or yellowed vision.
GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation, pancreatitis.
GU: nocturia, polyuria, frequent urination, oliguria.
Hematologic: agranulocytosis, leukopenia, thrombocytopenia, azotemia, anemia, aplastic anemia.
Hepatic: hepatic dysfunction.
Metabolic: hypokalemia; hypochloremic alkalosis; fluid and electrolyte imbalances, including dilutional hyponatremia, hypocalcemia, hypomagnesemia; hyperglycemia and impaired glucose tolerance.
Skin: dermatitis, purpura, photosensitivity, volume depletion and dehydration.
Musculoskeletal: muscle spasm.
Other: asymptomatic hyperuricemia, gout, fever, transient pain at I.M. injection site, thrombophlebitis with I.V. administration.
Interactions
Drug-drug. Aminoglycoside antibiotics, cisplatin: potentiated ototoxicity. Use together cautiously.
Amphotericin B, corticosteroids, corticotropin, metolazone: increased risk of hypokalemia. Monitor potassium levels closely.
Antidiabetics: decreased hypoglycemic effects. Monitor blood glucose levels.
Antihypertensives: increased risk of hypotension. Use together cautiously.
Cardiac glycosides, neuromuscular blockers: increased toxicity of these drugs from furosemide-induced hypokalemia. Monitor potassium levels.
Ethacrynic acid: may increase risk of ototoxicity. Don't use concomitantly.
Lithium: decreased lithium excretion, resulting in lithium toxicity. Monitor lithium level.
NSAIDs: inhibited diuretic response. Use together cautiously.
Salicylates: may cause salicylate toxicity. Use together cautiously.
Sucralfate: may reduce diuretic and antihypertensive effect. Separate administration time by 2 hours.
Drug-herb. Aloe: possible increased drug effects. Use together cautiously.
Drug-lifestyle. Sun exposure: photosensitivity reactions may occur. Take precautions.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with anuria.
Nursing considerations
I.V. administration
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING