Diuretic
Active substance
Release form, composition and packaging
50 pcs. - contour cell packings.
pharmachologic effect
"Loop" diuretic; causes a fast onset, strong and short-term diuresis. Blocks the reabsorption of sodium and chlorine ions in both proximal and distal areas renal tubules and in the thick segment of the ascending part of the Gentle loop. Furosemide has a pronounced diuretic, natriuretic and chloruretic effect. Due to an increase in the release of sodium ions, a secondary (mediated osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. Has secondary effects due to the release of intrarenal mediators and redistribution of intrarenal blood flow. On the background course treatment there is no weakening of the effect.
In heart failure, furosemide quickly reduces the preload (due to varicose veins), reduces the pressure in pulmonary artery and left ventricular filling pressure. Has an antihypertensive effect due to increased excretion sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in the volume of circulating blood.
After oral administration of 40 mg of furosemide, the diuretic effect begins within 60 minutes and lasts about 3-6 hours (with reduced renal function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, however, after its termination, the rate of excretion decreases below baseline("ricochet" or "cancellation" syndrome). The phenomenon is caused by a sharp activation of the renin-angiotensin-aldosterone system and other antinatriuretic neurohumoral regulation links in response to massive diuresis; stimulates arginine-vasopressive and sympathetic system... Reduces the level of atrial natriuretic factor in the blood, causes vasoconstriction. Due to the "rebound" syndrome, when taken 1 time / day, it may not cause a significant effect on the daily release of sodium ions and blood pressure.
Pharmacokinetics
Absorption is high, C max is observed in blood plasma when taken orally after 1 hour.
Bioavailability is 60-70%. Relative Vd - 0.2 l / kg. Plasma protein binding - 98%. Penetrates through the placental barrier, excreted in breast milk. It is metabolized in the liver to form 4-chloro-5-sulfamoylanthranilic acid. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron. It is excreted mainly (88%) by the kidneys unchanged and in the form of metabolites; the rest is by the intestines. T 1/2 - 1-1.5 h.
Features of pharmacokinetics in selected groups sick
In renal failure, the excretion of furosemide slows down, and T 1/2 increases; with severe renal failure, the final T 1/2 can increase up to 24 hours.
In nephrotic syndrome, a decrease in plasma protein concentrations leads to an increase in the concentration of unbound furosemide (its free faction) in this connection, the risk of developing ototoxic action increases. On the other side,
the diuretic effect of furosemide in these patients may be reduced due to the binding of furosemide to the tubule and a decrease in the tubular secretion of furosemide.
With hemodialysis, peritoneal dialysis and continuous outpatient peritoneal dialysis, furosemide is excreted slightly.
In hepatic insufficiency, T 1/2 of furosemide increases by 30-90%, mainly due to an increase in the relative volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly.
In heart failure, severe arterial hypertension and in elderly patients, the excretion of furosemide slows down due to a decrease in renal function.
Indications
Edematous syndrome:
- with chronic heart failure;
- with chronic renal failure;
- with nephrotic syndrome (with nephrotic syndrome, the treatment of the underlying disease is in the foreground);
- with liver diseases;
- arterial hypertension.
Contraindications
- acute renal failure with anuria;
- severe liver failure, "hepatic" coma and precoma;
— acute glomerulonephritis, pronounced violations of the outflow of urine of any etiology (including unilateral urinary tract damage), hyperuricemia;
- decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (over 10 mm Hg);
- violation of water and electrolyte metabolism (hypovolemia, severe hyponatremia and hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia);
- digitalis intoxication;
- pregnancy;
- lactation period;
- age up to 3 years (solid dosage form);
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome (due to the presence of lactose monohydrate in the preparation);
Wheat allergy (not celiac disease)
- hypersensitivity to the active substance and to any of the components of the drug.
Patients who are allergic to sulfonamides (sulfonamides or sulfonylureas) may have cross allergy on furosemide.
WITH caution
Arterial hypotension, conditions in which an excessive decrease in blood pressure is especially dangerous (stenosing lesions of the coronary and / or cerebral arteries), with acute myocardial infarction (the risk of developing cardiogenic shock increases), with latent or manifest diabetes mellitus (decreased tolerance to), gout, with hepatorenal syndrome, with hypoproteinemia (risk of developing ototoxicity), with impaired urine outflow (benign hyperplasia prostate, narrowing urethra or hydronephrosis), with hearing loss, pancreatitis, diarrhea, with ventricular arrhythmias history, with systemic lupus erythematosus.
Dosage
The tablets should be taken on an empty stomach without chewing or drinking. enough liquids. When prescribing Furosemide, it is recommended to use its lowest dose sufficient to achieve the desired effect. The maximum daily intake for adults is 1500 mg. Initial single dose in children, it is determined at the rate of 1-2 mg / kg of body weight / day with a possible increase in the dose to a maximum of 6 mg / kg / day, provided that the drug is taken no more than 6 hours later. The duration of treatment is determined by the doctor individually, depending on the indications.
Dosing regimen adults
Edema syndrome in chronic heart failure
The initial dose is 20-80 mg / day. The required dose is selected depending on the diuretic response. It is recommended to divide the daily dose into 2-3 doses.
Have
Arterial hypertension
Furosemide Sopharma can be used alone or in combination with other antihypertensive drugs... The usual maintenance dose is 20-40 mg / day. When adding furosemide to already prescribed drugs, their dose should be reduced by 2 times. In case of arterial hypertension in combination with chronic renal failure, the use of higher doses of the drug may be required.
Side effects
From the side of cardio-vascular system: a marked decrease in blood pressure, collapse, tachycardia, arrhythmias, a tendency to thrombosis, a decrease in the volume of circulating blood.
From the central nervous system: dizziness, headache, muscle weakness, seizures calf muscles(tetany), paresthesia, apathy, weakness, weakness, lethargy, drowsiness, confusion.
From the senses: impaired vision and hearing, tinnitus.
From the side digestive system: anorexia, dryness of the oral mucosa, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation), hepatic encephalopathy.
From the side genitourinary system: oliguria, acute delay urine (in patients with benign hyperplasia prostate gland), interstitial nephritis, hematuria, decreased potency.
From the side endocrine system: decreased glucose tolerance, manifestation of latent diabetes mellitus.
Allergic reactions: purpura, urticaria, exfoliative dermatitis, exudative erythema multiforme, vasculitis, necrotizing angiitis, itchy skin, chills, fever, photosensitivity, anaphylactic shock, Stevens-Johnson syndrome, bullous pemphigoite, toxic epidermal necrolysis.
From the side of the hematopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia.
From the side of water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.
Laboratory indicators: hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalciuria, increased activity of hepatic transaminases, eosinophilia.
Overdose
Symptoms: marked decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including AV blockade, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.
Treatment: correction of water-electrolyte balance and acid-base state, replenishment of circulating blood volume, gastric lavage, intake activated carbon, symptomatic treatment. There is no specific antidote.
Drug interactions
With simultaneous use with and phenytoin, the effect of furosemide decreases.
Increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion).
With the simultaneous use of aminoglycosides with furosemide, the elimination of aminoglycosides is slowed down and the risk of developing their ototoxic and nephrotoxic effects increases. For this reason, the use of this combination of drugs should be avoided except in cases where it is necessary for health reasons, and in this case, a correction (reduction) of maintenance doses of aminoglycosides is required.
Increases the effectiveness of diazoxide and theophylline, reduces - hypoglycemic agents, allopurinol.
Drugs blocking tubular secretion increase the concentration of furosemide in the blood serum. Medicines with nephrotoxic action - when combined with furosemide, the risk of developing their nephrotoxic action increases.
GCS and carbenoxolone, when combined with furosemide, increase the risk of hypokalemia.
With simultaneous use with cardiac glycosides, the risk of developing digitalis intoxication against the background of water-electrolyte disturbances (hypokalemia or hypomagnesemia) increases.
Strengthens the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).
NSAIDs (including indomethacin and) in combination with furosemide can cause a temporary decrease in creatinine clearance and an increase in serum potassium and reduce the diuretic and antihypertensive effects of furosemide. In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide can enhance toxic effect salicylates (due to competitive renal excretion).
Sucralfate reduces the absorption of furosemide and weakens its effect (these drugs should be taken at intervals of at least 2 hours).
Combined use with carbamazepine may increase the risk of hyponarthemia.
Antihypertensive drugs, diuretics or other drugs that can lower blood pressure, when combined with furosemide, can lead to a more pronounced antihypertensive effect.
Appointment ACE inhibitors patients who previously received treatment with furosemide can lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases to the development of acute renal failure, therefore, three days before starting treatment with AIF inhibitors or increasing their dose, it is recommended to cancel furosemide, or reduce its dose ...
Probenecid, methotrexate and other drugs, which, like furosemide, are secreted in the renal tubules, can reduce the effect of furosemide (the same pathway of renal secretion), on the other hand, furosemide can lead to a decrease in the excretion of these drugs by the kidneys.
Lithium salts - under the influence of furosemide, the excretion of lithium decreases, due to which the serum concentration of lithium increases and the risk of developing the toxic effect of lithium, including its damaging effects on the heart and nervous system, increases. Therefore, when using this combination, monitoring of serum lithium concentrations is required.
Concomitant use of cyclosporin A and furosemide increases the risk of developing gouty arthritis due to hyperuricemia caused by furosemide and violation of cyclosporine excretion of urate at night.
Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce the effectiveness.
Radiopaque contrast agents - in patients with high risk the development of nephropathy on the introduction of X-ray contrast agents receiving furosemide, was observed more high frequency development of renal dysfunction in comparison with patients with a high risk of developing nephropathy on the introduction of X-ray contrast agents who received only intravenous hydration before the introduction of a X-ray contrast agent.
special instructions
Before starting therapy with Furosemide Sopharma, the presence of pronounced violations outflow of urine, patients with a partial violation of the outflow of urine, need careful monitoring. Against the background of the course of treatment, it is necessary to periodically monitor blood pressure, the content of blood plasma electrolytes (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and carry out, if necessary, appropriate correction of treatment.
The use of furosemide slows down the excretion of uric acid, which can provoke an exacerbation of the course of gout.
Patients with increased sensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to furosemide.
In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is inappropriate to limit consumption table salt... For the prevention of hypokalemia, the simultaneous administration of potassium preparations and potassium-sparing diuretics is recommended, as well as adhere to a diet, rich in potassium... The selection of the dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in stationary conditions(violations of the water-electrolyte balance can lead to the development hepatic coma). This category of patients shows regular monitoring of plasma electrolyte levels.
If azotemia and oliguria appear or intensify in patients with severe progressive kidney disease, it is recommended to suspend treatment.
In patients with diabetes mellitus or those with impaired glucose tolerance, periodic monitoring of blood and urine glucose levels is required.
In unconscious patients with benign prostatic hyperplasia, narrowing of the ureters or hydronephrosis, urinary control is necessary due to the possibility of acute urinary retention.
The drug contains lactose monohydrate, therefore patients with rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption should not take this drug.
The preparation contains wheat starch in an amount that is safe for use in patients with celiac disease (gluten enteropathy).
Patients with wheat allergy (other than celiac disease) should not use this drug.
Influence on the ability to drive vehicles and control mechanisms
During the period of treatment with Furosemide Sopharma, you should avoid engaging in potentially hazardous activities that require increased attention and the speed of psychomotor reactions (driving and working with mechanisms).
Pregnancy and lactation
Furosemide crosses the placental barrier, so it should not be prescribed during pregnancy. If it is necessary to prescribe the drug Furosemide Sopharma during pregnancy, the ratio of the benefits of using the drug for the mother to the risk for the fetus should be assessed. Excreted in breast milk. If necessary, drug treatment, breast-feeding must stop.
Childhood use
Contraindicated in children under 3 years of age.
With impaired renal function
Edema syndrome in chronic renal failure
Have 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 up to about 2 kg of body weight / day is possible). The recommended starting dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken as a single dose or in two divided doses. Have patients on hemodialysis, usually the maintenance dose is 250-1500 mg / day.
Swelling in nephrotic syndrome
The initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. Daily dose can be taken in one dose or divided into several doses.
For violations of liver function
Edematous syndrome in liver diseases
Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are not effective enough. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in the electrolyte or acid-base state, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss up to about 0.5 kg of body weight / day is possible). The initial dose is 20-80 mg / day.
Conditions of dispensing from pharmacies
The drug is available with a prescription.
Storage conditions and periods
The shelf life is 5 years. Do not use after the expiration date printed on the package.
In a dry, dark place at a temperature not exceeding 25 ° C. Keep out of the reach of children!
The drug Furosemide is effective diuretic quick action, used for excessive accumulation of fluid in the organs of the urinary system, as a diuretic for edema, etc. Let's take a closer look at the drug Furosemide - what is it prescribed for, how the tablets or solution work and how effective they are.
Characteristics of the product
The drug is produced both in the form of tablets and in the form of a solution for injections. The rate of appearance of the first positive results of treatment with Furosemide depends on the use of a particular dosage form of the drug. So when administered intravenously, it can quickly cause the desired effect and has a diuretic effect after 15 minutes, when using the tablet form - after half an hour. At the same time, the effect remains quite long time, up to four o'clock.
For Furosemide, the indications for use are quite extensive. This medicine it is prescribed for diseases such as hypertension, renal and heart failure, nephrotic syndrome and also for serious violations liver function (for example, with cirrhosis).
Furosemide is also often chosen for cystitis. Unlike many drugs of this effect, it does not reduce glomerular filtration... This allows it to be used in renal failure. The antihypertensive effect of the drug expands the scope of its application.
However, this drug may not always be prescribed. For Furosemide, contraindications may be:
The drug should be prescribed by a doctor who first explains how to take Furosemide correctly, how to respond to possible side effects... If such phenomena as nausea, vomiting, thirst attacks, dizziness, diarrhea occur, you must immediately inform your doctor about it. Usually, in this case, the dosage of the drug is reduced, or Furosemide is replaced by another drug. In addition to those listed, there may be side effects such as various allergic reactions, general weakness and etc.
As a rule, Furosemide for edema is prescribed at a dosage of 40 mg per day, for which the method of administration is determined - 1 tablet per day in the morning. The dosage can be doubled and divided into two doses at intervals of 6 hours (in the first half of the day). After the swelling decreases, the dosage of the drug is gradually reduced, the interval between applications increases. For children, the dosage is calculated depending on the body weight, namely, 1-2 mg of the drug per kilogram of weight.
The use of Furosemide for cystitis
In order to understand why Furosemide is prescribed for cystitis, you need to know what this disease is. Cystitis is inflammatory process flowing in bladder, which is bacterial in nature and affects primarily the mucous membrane of the organ. The causative agents of cystitis are the bacteria of Escherichia coli and Pseudomonas aeruginosa, Staphylococcus aureus and Candida fungi. Once in the bladder, these microorganisms begin to multiply actively, as a result of which the order of work of this organ is disrupted.
Cystitis, as an indication for the use of Furosemide, is considered because the inflammatory process occurring in the bladder requires the prevention of urinary stagnation, as a condition for its development. Unfortunately, most often cystitis turns into chronic form due to the patient's incorrect approach to treatment. Often, the patient independently chooses drugs and methods of therapy, uses funds traditional medicine, itself determines when to stop treatment. At the same time, little attention is usually paid to establishing the process of excreting urine in a sufficient volume, and this has a direct effect on suppressing the focus of inflammation in the organs of the urinary system in general and the bladder in particular.
Usually, in the process of treating cystitis, doctors recommend that patients drink as much fluid as possible, while prescribing various diuretics. Furosemide for cystitis is prescribed in this capacity. This approach ensures the regular outflow of large volumes of urine, which leads to a decrease in inflammation and a decrease in signs of intoxication.
However, Furosemide for cystitis cannot be the only drug or form the basis of therapy. It must be remembered that inflammation of a bacterial nature requires the use of antibiotics or at least drugs based on medicinal herbs antiseptic action when it comes to the initial stage of the disease. In the absence of full-fledged treatment, the disease will progress, and symptoms such as the following will be added to the discomfort during urination, from which it all began:
If the symptomatic picture is replenished with the above signs, the patient will be shown hospitalization and long-term treatment... Otherwise, the patient's condition will worsen even more, and the disease will lead to serious complications.
Furosemide for edema
If Furosemide for cystitis is prescribed to stimulate the excretion of urine and increase the volume of circulating fluid, then with edema it is used to remove excess fluid from the body. In this case, the patient, as a rule, is recommended, on the contrary, to reduce the amount of water consumed.
It is very important to maintain a balance in the process of water-salt metabolism. The consumed and removed liquid must be equivalent in volume. Otherwise, excess fluid will accumulate in the body. If at the same time it begins to be deposited in tissues and cavities, a person at first may not even notice this. Only external edema that forms on the face, limbs, etc. become noticeable immediately.
Edema occurs due to a variety of diseases and dysfunctions. For example, due to allergies, liver diseases, due to the use of certain drugs. In any case, excess fluid must be eliminated from the body. In the absence of contraindications, for edema, Furosemide can be used.
In this case, it is usually prescribed in a standard dosage - 1 tablet per day (in the morning) every day, as the swelling decreases, once every two or three days, until the complete cessation of use.
It is noted that a person who has taken the drug once already notices a slight decrease in edema, and after a few days they, in most cases, disappear altogether.
Of course, in this case, it is necessary to take other measures, primarily aimed at eliminating the causes that caused the appearance of puffiness. If the disease that provoked the formation of edema is not cured, then this symptom after stopping taking Furosemide will return again. Meanwhile, this drug should not be abused. It must be used according to the scheme established by the attending physician and only after the appointment is made.
You should be aware that the uncontrolled use of diuretics, including Furosemide, can lead to very serious consequences. In addition, with the liquid excreted from the body, especially in large volumes, many useful elements, such as magnesium, calcium, potassium, sodium, etc., are washed out. If the drug is prescribed by a doctor, he gives recommendations for correcting nutrition or prescribes vitamin and mineral complexes.
If, for some reason, the use of diuretics is impossible, for example, the maximum permissible course of taking Furosemide has been exceeded, you can use other methods of removing edema. For example, in this case, a light stroking massage, foot baths, and rest help a lot. You can consult with a specialist who can offer additional options elimination of this symptom.
Any changes in the patient's condition and therapy for puffiness should be monitored by the attending physician, since self-medication can lead to a violation water balance in the body, which in itself is very dangerous.
Furosemide is powerful loop diuretic for active elimination of stagnant urine, reduction of edema in renal pathologies, arterial hypertension. Diuretic tablets and injection solution are prescribed for severe conditions, accompanied by pronounced swelling, a sharp increase in pressure, and acute intoxication.
Furosemide - powerful tool with an active diuretic effect. Misuse of the medication can be harmful. The instruction contains data on the properties, side effects of the drug, describes the rules for taking pills, administering a solution intravenously and intramuscularly, and the effectiveness of therapy.
Composition
Furosemide is an active substance of a diuretic. It is important to know that loop diuretics act on the Gengle loop - a special renal tubule responsible for the reabsorption of fluid with solutes.
Release form
The drug Furosemide is marketed in two forms - for oral administration and injection:
- Furosemide tablets with a diuretic effect. The content of the active substance in each tablet of the loop diuretic is 40 mg. Additional ingredients are also added: milk sugar, colloidal form of silicon dioxide, gelatin, potato starch and others. Pharmacy chains receive packages No. 20 and 50;
- injection. The concentration of furosemide in 1 ml of a diuretic is 10 ml. Additional substances: sodium hydroxide and chloride, water for injection. Each ampoule contains 2 ml of the drug, the package contains 10 containers with the drug.
Action
A powerful diuretic affects the ascending part of the Gingle loop (thick segment). A characteristic feature is a fast but short-term diuretic effect.
Against the background of taking pills, the diuretic effect appears after a third of an hour, after intravenous injection- after 10-15 minutes. Maximum effect develops after 60 minutes, persists for three to four hours, rarely - up to six hours.
Furosemide not only removes excess fluid and stagnant urine, but also flushes out chlorine and sodium salts. For this reason it is important to apply carefully potent remedy, with light and moderate hypertension, renal pathologies, poisoning, use thiazide or osmotic diuretics. The optimal type of diuretic is selected by a urologist, nephrologist. In case of diseases of the heart and blood vessels, a consultation with a cardiologist is required.
Diuretic Furosemide undergoes metabolism in the liver, the processed substance enters the renal tubules. After oral administration, up to 70% is excreted by the kidneys, 30% - with feces, with intravenous administration, the percentage changes - 88 and 12%, respectively.
Indications for use
A diuretic is prescribed for the following pathologies and severe conditions:
- hypertensive crisis;
- puffiness against the background of the second and third degree, nephrotic syndrome, cirrhosis of the liver;
- increased calcium accumulation;
- swelling of the brain;
- acute heart failure, accompanied by pulmonary edema;
- eclampsia;
- acute toxicosis on later dates pregnancy (only a short course as prescribed by a doctor);
- poisoning with pronounced signs of intoxication for the speedy elimination of poisons.
Important:
- during the course of therapy it is possible a sharp decline potassium levels. At risk are patients with cirrhosis of the liver, heart failure, taking a large amount of various medications;
- you need to regularly (once a week) take a blood test to control the level of potassium in elderly people with a poor diet. The first ionogram is required 7 days after taking the first diuretic tablet;
- against the background of hypokalemia, bradycardia, cardiac arrhythmia, life-threatening pirouette tachycardia develop. These points should be taken into account by the doctor, who selects the optimal diuretic for patients at risk.
On a note! The diuretic Furosemide is prescribed for chronic renal failure, if creatinine clearance is not higher than 30 ml / minute, it is forbidden to use thiazide diuretics. Intravenous administration of the solution is indicated when hypertensive crisis, for active lowering of pressure at high stress on the heart. If the patient suffers from nephrotic syndrome, then it is imperative to treat the underlying pathology that provokes severe kidney damage.
Contraindications
Important to remember: Furosemide is a powerful diuretic. Improper use or use of a medicine without taking into account the restrictions provokes dangerous complications.
The list of contraindications is quite long, there are temporary and absolute restrictions. It is forbidden to use injection solution and tablets for nursing mothers.
Relative contraindications for prescribing the drug Furosemide:
- low blood pressure against the background of insufficient blood circulation, the risk of various types of ischemia;
- diabetes;
- hyperplasia of the prostate (benign form);
- hepatorenal syndrome;
- cerebral atherosclerosis (obliterating variety);
- low levels of proteins in the body.
The doctor selects another diuretic if there are absolute contraindications:
- acute stage of myocardial infarction;
- renal failure (severe);
- hyperglycemic and hepatic coma;
- moderate degree of hypertension;
- urethral stenosis;
- anuria (a sharp decrease in the volume of urine excreted);
- hypersensitivity to furosemide or excipients;
- hyperuricemia;
- deviations in the water-salt balance, increase / decrease in the level of calcium, potassium, magnesium;
- excess pressure in the right atrium up to 10 mm. rt. Art. and higher;
- intoxication caused by taking cardiac glycosides;
- deposition of uric acid salts;
- occlusion of the urinary tract calculus;
- systemic lupus erythematosus;
- precomatous states;
- aortic stenosis either mitral valve(decompensated form);
- pancreatitis.
Instructions for use and dosage
How to take Furosemide? Loop diuretics exhibit a lot side effects... Excess one-time or daily dosage the drug Furosemide is fraught with complications. You can take pills with the permission of your doctor. Injections for severe conditions are carried out only by health workers.
Pills
At moderate pathologies, half or a whole tablet of Furosemide is prescribed twice a day. At serious condition the norm is increased to two or three units of the drug, the frequency of use is 1 or 2 times a day.
Patients with high pressure against the background of chronic renal failure, Furosemide is prescribed in combination with drugs that lower blood pressure. The rate of a loop diuretic per day is from 20 to 120 mg.
Injections
The best way to use a powerful diuretic is intravenous administration, always slow, for one to two minutes. In case of pulmonary edema, intramuscular use is prohibited, in most cases, a diuretic solution is injected into a vein.
At a dosage of Furosemide above 80 ml, droppers are prescribed. In case of poisoning, hypertensive crisis, the initial dose is 20 to 40 mg. Maximum daily rate active substance - 600 mg (in exceptional cases).
Go to the website and read about medication for treating kidney inflammation.
Possible side effects
Negative manifestations are possible depending on the individual characteristics of the organism. varying degrees gravity:
- oliguria, acute urinary retention;
- a sharp drop in blood pressure, arrhythmia, collapse, tachycardia;
- impaired vision and hearing;
- aplastic anemia, leukopenia, thrombocytopenia;
- hyperglycemia, increased cholesterol levels, glucosuria, excessive urine production;
- different kinds allergic reactions, photosensitivity, anaphylactic shock, urticaria;
- constipation, exacerbation of pancreatitis, cholestatic jaundice, nausea, dry mouth, diarrhea;
- increased risk of thrombosis, metabolic acidosis, dehydration;
- muscle weakness, confusion, apathy, headaches, lethargy, dizziness;
- thrombophlebitis (when administered intravenously).
Important! A long list of side effects shows how actively furosemide affects organs and systems. Any dosage adjustment is done as directed by a physician. Uncontrolled reception on the recommendation of non-specialists can cause complications, life threatening... The drug is dispensed only with a prescription.
Overdose
It is impossible to exceed the optimal rate for each type of pathology. The optimal dosage is prescribed by the doctor. Excess furosemide negatively affects the body. It's important to know: the drug does not have a specific antidote; if the rules are violated, it is quite difficult to return the indicators to normal.
Overdose signs:
- dehydration;
- thrombosis;
- arrhythmia;
- a sharp decrease in blood pressure;
- collapse;
- thromboembolism;
- drowsiness;
- flaccid paralysis;
- confusion of consciousness;
- acute renal failure, a sharp decrease in the volume of excreted urine;
- hypovolemia (decrease in the volume of circulating blood).
What to do: call an ambulance for urgent action to restore water-salt balance, heart disorders, reduce fluid deficiency.
Cost and storage conditions
Furosemide is an effective and cheap diuretic. The cost of tablets and solution for injection varies slightly depending on the manufacturer.
Average price of Furosemide:
- tablets, package No. 20 - from 25 to 45 rubles;
- tablets, package number 50 - from 30 to 65 rubles;
- ampoules 1% solution, package No. 10 - from 30 to 85 rubles.
The cost of Lasix - 10 ampoules - 350 rubles, 50 capsules - 460 rubles.
Place the diuretic in a dark place. Indoor temperature - no more than + 25C.
Use the opened ampoule immediately. There should be no dampness in the room. Keep the diuretic away from children.
Furosemide: analogues
Identical preparations for oral administration:
- Lasix.
- Furosemide Sopharma.
Analogs for intravenous administration:
- Furosemide Vial.
- Lasix.
- Furosemide-Darnitsa.
1. Pharmacological action
Active substance Furosemide has bad influence on the process of reabsorption of sodium and calcium ions during the second stage of urination. At the same time, there is practically no negative effect on the reabsorption of potassium ions and glomerular filtration of urine.Furosemide is active with any change in acid-base balance, which makes it possible to use it in almost any pathology.
In addition to the diuretic effect, Furosemide expands peripheral vessels, which leads to a decrease in blood pressure.
After the introduction of the drug into the blood, the therapeutic effect occurs after 20 minutes and lasts for 3 hours, when taking the drug in the form of tablets - after an hour and lasts for 4 hours.
Furosemide actively binds to plasma blood proteins, is rendered harmless in the liver and excreted mainly by the kidneys.
2.indications for use
- accompanied by an increase in blood pressure;
- Phenomena of stagnation of blood flow due to functional heart failure;
- Swelling of the respiratory system;
- Cerebral edema;
- Phenomena of late toxicosis of pregnant women;
- Poisoning drugs from the group of barbiturates;
- A sharp and persistent increase in blood pressure.
3. Method of application
Furosemide in tablet form:The average dose of the drug is 40 mg, with a single use at the beginning of the day. If there is a special need, the dosage of the drug can be increased to 80-160 mg, but it is divided into several doses during the day with an interval of 6 hours.
In severe renal insufficiency, the dosage of the drug increases to 240-320 mg per day and decreases to a minimum (the intervals between use increase to 1-2 days) with the onset positive effects from treatment.
With a chronic increase in blood pressure (), the dosage of Furosemide is 20-40 mg once a day.
With a chronic increase in blood pressure in combination with functional heart failure - up to 80 mg once a day.
Furosemide in the form of a solution for injection:
In this form, Furosemide is prescribed if it is impossible to take it in the form of tablets, or if it is necessary to achieve a faster therapeutic effect... It is permissible to administer the drug intramuscularly and intravenously by the jet method. Intravenous administration should be done slowly enough to avoid complications.
The dosage of the drug in both cases is 20-60 mg and, if necessary, can be increased to 120 mg. Injections are made twice a day.
The duration of treatment is from a week until a stable therapeutic effect is obtained, after which patients switch to taking Furosemide in the form of tablets.
4. Side effects
- Digestive system disorders (nausea, vomiting, stool disorders);
Disorders of the urinary system (inflammation of the kidneys with damage to the connective tissue);
Disturbance of the nervous system (dizziness, persistent depression of mood (depression), thirst, muscle weakness);
Violation of the picture of blood and urine tests (increased content of uric acid in urine, increased content of glucose and uric acid in the blood).
5. Contraindications
- Decreased blood calcium;
- Mechanical obstruction of the urinary tract;
- Functional failure of the liver and kidneys in a severe stage;
- Hepatic coma;
- Hypersensitivity to the drug or its components;
- The first half of pregnancy and lactation;
- End stage renal failure;
- Individual intolerance to the drug and its components.
6. During pregnancy and lactation
The use of the drug during pregnancy is permissible only at a later date, exclusively for a short time and in cases where the benefits of treatment outweigh the risk of complications.Furosemide penetrates well into breast milk and may even stop the processes of its formation, and therefore, during the use of Furosemide, it is recommended to refuse breastfeeding.
7. Interaction with other medicinal products
- The simultaneous use with antibiotics of the aminoglycoside group (Gentamicin, Theobramycin and the like) and Cisplatin leads to the appearance of side effects associated with the activity of the kidneys and disruption of the activity of the auditory and vestibular apparatus;
- Simultaneous use with antibiotics of the Cephalosporin group, their toxic effect on the kidneys is enhanced;
- With simultaneous use with drugs that stimulate adrenaline receptors and Cisapride, a significant decrease in potassium levels;
- Simultaneous use with drugs that reduce blood pressure, there is an increase in the therapeutic effect of the latter;
- Simultaneous use with drugs that have a relaxing effect on the muscles, there is an increase in the therapeutic effect of the latter;
- Simultaneous use with non-steroidal anti-inflammatory drugs, Kolestyramine, Phenytoin and Colestipol leads to a decrease in the diuretic effect of Furosemide;
- Concomitant use with Astemizole and Sotalol significantly increases the risk of arrhythmia;
- Concomitant use with Carbamazepine leads to a decrease in sodium content;
- Simultaneous use with Digoxin, Digitoxin and other cardiac glycosides, leads to increased toxicity of the latter;
- Simultaneous use with Probenecid leads to an increase in the period of elimination of Furosemide from the body;
- Simultaneous use with Theophylline leads to an increase in the concentration in the blood of the latter.
8. Overdose
The phenomena of an overdose of Furosemide have not been described. A significant increase in side effects is possible.9. Release form
Tablets, 40 mg - 10, 20, 25, 30, 40, 50, 60, 75, 90, 100, 120, 125, 150, 180, 200, 250, 300, 500, 3000, 5000, 7500 or 10000 pcs.Solution, 20 mg / 2 ml - amp. 5 or 10 pcs; 10 mg / ml - 1 ml amp. 5 or 10 pcs; 1% (20 mg / 2 ml) - amp. 10 pieces.
10. Storage conditions
Furosemide should be stored in a dry place away from light and sunlight.11. Composition
1 ml of Furosemide solution:
- furosemide - 10 or 20 mg.
1 tablet:
- furosemide - 40 mg.
12. Terms of dispensing from pharmacies
The drug is dispensed by prescription of the attending physician.Found a bug? Select it and press Ctrl + Enter
* Instructions for medical use to the drug Furosemide is published in free translation. THERE ARE CONTRAINDICATIONS. BEFORE USING IT IS NECESSARY TO CONSULT A SPECIALIST
Probably, many are interested in the drug Furosemide - from what these pills are prescribed and how to take them. This drug is considered a good diuretic, but it is not safe enough to be taken uncontrollably. Some people accept it without paying attention to the instructions (for example, models) and without thinking about the health consequences. Let's be clear about how Furosemide earned this attitude.
What does furosemide help from?
It is a diuretic that can enhance the excretion of certain elements from the body - for example, sodium and chlorine. It dilates peripheral vessels and has a hypotensive effect. Indications for the use of Furosemide:
- edematous syndrome (with heart failure, for example, liver cirrhosis or nephrotic syndrome);
- pulmonary edema;
- swelling of the brain; cardiac asthma;
- high blood pressure;
- hypertensive crisis;
- hypercalcemia.
Is not full list of what the doctors prescribe the medicine Furosemide for.
Application of Furosemide
The doctor sets the required dosage individually for each specific patient - taking into account clinical picture his illness and his age; the dose must also be adjusted during treatment, depending on the patient's condition.
The maximum permissible dose of Furosemide when taken orally: for adults - 600 mg per day; for children - 6 mg / kg. For adult patients, the initial dose is 20-80 mg per day, then it is gradually increased. Children are usually prescribed 1–2 mg per kilogram of body weight.
Contraindications
Basically, contraindications to the use of Furosemide are:
- hypersensitivity to Furosemide;
- the first months of pregnancy;
- hypokalemia (lack of potassium);
- hepatic coma;
- terminal stage (i.e. last stage disease);
- renal failure;
- obstruction urinary tract etc.
You also need to remember that this drug easily penetrates into breast milk, therefore, during treatment, women should stop breastfeeding. In addition, the list of contraindications is supplemented by violations of the genitourinary system (glomerulonephritis, obstruction of the urinary tract, stenosis of the urethra), acute heart attack myocardium, precomatous states, pancreatitis and disorders of water and electrolyte metabolism.
Side effects and overdose
Furosemide is one of those medicines that very often cause side effects. The patient should stop taking the drug if he has:
- lowering blood pressure;
- tachycardia;
- arrhythmia;
- collaptoid state;
- headache or dizziness;
- myasthenia gravis;
- tetany (calf muscle cramps);
- numbness of the limbs;
- apathy;
- a sharp decline in strength;
- general weakness;
- disorders of the organs of vision and hearing;
- constipation or diarrhea;
- nausea and vomiting;
- cholestatic jaundice;
- exacerbation of pancreatitis;
- interstitial nephritis;
- hematuria;
- decreased potency;
- leukopenia and other disorders of the hematopoietic system;
- a decrease in the volume of circulating blood;
- allergic reactions;
- thrombophlebitis, etc.
Compatibility with other drugs
When joint application Furosemide interacts (in most cases negatively) with many drugs:
- increased oto- and nephrotoxic action (antibiotics of the aminoglycoside group, vancomycin, cisplatin);
- impaired renal function, increased risk of increased nephrotoxicity of the drug (antibiotics of the cephalosporin group);
- increased hypokalemia (beta-adrenomimetics and glucocorticosteroids);
- decrease in the effectiveness of funds (hypoglycemic medicines or insulin);
- increased antihypertensive action (ACE inhibitors);
- increased action (non-depolarizing muscle relaxants);
- a decrease in the diuretic effect and a decrease in the antihypertensive effect (non-steroidal anti-inflammatory drugs);
- increased risk of arrhythmia (astemizole);
- a decrease in the diuretic effect of Furosemide itself (cholestyramine, colestipol, phenytoin);
- decrease in renal clearance of Furosemide (probenecid), etc.
The fact that it is recommended to refrain from alcohol during treatment with Furosemide is probably not worth talking: the indications for the use of Furosemide themselves exclude alcohol. Joint intake of alcohol with this drug can have an extremely negative effect on the patient's health - up to and including death.
Now you know what Furosemide should be taken from and from what not. One has only to remind once again about the need to consult a doctor before using this remedy. Be healthy!
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