Indicated for:

Edema:

• Indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. LASIX is particularly useful when an agent with greater diuretic potential is desired. 

Hypertension:

• Oral LASIX may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents. Hypertensive patients who cannot be adequately controlled with thiazides will probably also not be adequately controlled with LASIX alone.

LASIX is contraindicated in patients with anuria. 

In patients with hepatic cirrhosis and ascites, LASIX therapy is best initiated in the hospital. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved.

Hypertensive patients should avoid medications that may increase blood pressure, including over-the-counter products for appetite suppression and cold symptoms.

Hypokalemia may develop with furosemide, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives. Digitalis therapy may exaggerate metabolic effects of hypokalemia, especially myocardial effects.

In patients with severe symptoms of urinary retention (because of bladder emptying disorders, prostatic hyperplasia, urethral narrowing), the administration of furosemide can cause acute urinary retention related to increased production and retention of urine. Thus, these patients require careful monitoring, especially during the initial stages of treatment.

Patients allergic to sulfonamides may also be allergic to LASIX.

The possibility exists of exacerbation or activation of systemic lupus erythematosus.

Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency.

Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported. Reports usually indicate that LASIX ototoxicity is associated with rapid injection, severe renal impairment, the use of higher than recommended doses, hypoproteinemia or concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs.

In patients at high risk for radiocontrast nephropathy, furosemide can lead to a higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast.

In patients with hypoproteinemia (e.g., associated with nephrotic syndrome) the effect of furosemide may be weakened and its ototoxicity potentiated.

Asymptomatic hyperuricemia can occur and gout may rarely be precipitated.

Patients with diabetes mellitus should be told that furosemide may increase blood glucose levels and thereby affect urine glucose tests.

The skin of some patients may be more sensitive to the effects of sunlight while taking furosemide.

LASIX may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination.

LASIX should not be used concomitantly with ethacrynic acid or lithium.

Furosemide has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine.

Concomitant use of cyclosporine and LASIX is associated with increased risk of gouty arthritis secondary to LASIX-induced hyperuricemia and cyclosporine impairment of renal urate excretion.

LASIX combined with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers may lead to severe hypotension and deterioration in renal function, including renal failure.

Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs.

In patients at high risk for radiocontrast nephropathy LASIX can lead to a higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast.

Furosemide may decrease arterial responsiveness to norepinephrine. However, norepinephrine may still be used effectively.

Simultaneous administration of sucralfate and furosemide tablets may reduce the natriuretic and antihypertensive effects of furosemide.

Use of furosemide concomitantly with chloral hydrate is therefore not recommended.

Phenytoin interferes directly with renal action of furosemide. There is evidence that treatment with phenytoin leads to decrease intestinal absorption of furosemide, and consequently to lower peak serum furosemide concentrations.

Methotrexate and other drugs that, like furosemide, undergo significant renal tubular secretion may reduce the effect of furosemide.

Furosemide can increase the risk of cephalosporin-induced nephrotoxicity even in the setting of minor or transient renal impairment.

There are case reports of patients who developed increased BUN, serum creatinine and serum potassium levels, and weight gain when furosemide was used in conjunction with NSAIDs.

Co-administration of indomethacin may reduce the natriuretic and antihypertensive effects of furosemide in some patients by inhibiting prostaglandin synthesis.

In premature infants LASIX may precipitate nephrocalcinosis/nephrolithiasis.  Nephrocalcinosis/nephrolithiasis has also been observed in children under 4 years of age with no history of prematurity who have been treated chronically with LASIX.

There are no adequate and well-controlled studies in pregnant women. Animal studies: unexplained maternal deaths. Treatment during pregnancy requires monitoring of fetal growth because of the potential for higher birth weights.

Because it appears in breast milk, caution should be exercised when furosemide is administered to a nursing mother. Furosemide may inhibit lactation.

GoToSource

• Prevention of asthma. GoToSource

• Optic disc edema. GoToSource

• Resistant nocturnal enuresis and nocturnal polyuria. GoToSource

• Reduce risk of hospitalization for prostatism. GoToSource

• Dyspnea in terminally ill cancer patients. GoToSource 

• Refractory ascites. GoToSource

Ototoxicity (drug-induced damage to inner ear). GoToSource

Urinary frequency, urgency and incontinence. GoToSource

Acute kidney injury. GoToSource

Hypokalemia (low potassium). GoToSource

Urinary calculi (kidney stones). GoToSource

Anaphylactoid reactions. GoToSource

Stevens-johnson syndrome (severe skin reaction). GoToSource

Hyperuricemia (high level of uric acid in the blood). GoToSource

Orthostatic hypotension (fall in blood pressure when an upright position is assumed). GoToSource

Sexual dysfunction in male patients. GoToSource

Deterioration in glucose control. GoToSource

Photosensitivity (sensitivity of the skin to ultraviolet light). GoToSource

Increased cholesterol and triglyceride serum levels. GoToSource

No major injury lawsuits reported.