Swelling after withdrawal of furosemide
In this article, you can read the instructions for using the drug Furosemide. Presented reviews of visitors to the site -consumers of this medication, as well as the opinion of doctors of specialists on the use of Furosemide in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Furosemide in the presence of existing structural analogs. Use of a diuretic for the treatment of edema, arterial hypertension and kidney disease in adults, children, as well as during pregnancy and lactation.
Furosemide - loop diuretic; causes a rapidly advancing,strong and short-term diuresis. It blocks the reabsorption of sodium and chlorine ions in both the proximal and distal sections of the renal tubules and in the thick segment of the ascending part of the Gentle loop. Furosemide has a pronounced diuretic, natriuretic and chlororetic action. Due to the increase in the release of sodium ions, a secondary (osmotically bound water-mediated) enhanced water removal and an increase in the secretion of potassium ions in the distal part of the renal tubule occur. At the same time, the excretion of calcium and magnesium ions increases. Has secondary effects due to the release of intracellular mediators and redistribution of the intrarenal blood flow. Against the background of course treatment there is no weakening of the effect.
With heart failure, furosemide rapidlyreduces preload (by expanding the veins), reduces the pressure in the pulmonary artery and the filling pressure of the left ventricle. It has an antihypertensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of the smooth muscles of the vessels to vasoconstrictive effects and as a result of a decrease in the volume of circulating blood.
After ingestion of 40 mg furosemidediuretic effect begins within 60 minutes and lasts about 3-6 hours (with reduced renal function - up to 8 hours). During the period of action, excretion of sodium ions increases significantly, but after its termination, the elimination rate decreases below the initial level ("rebound" syndrome, or "cancellation"). The phenomenon is caused by a sharp activation of the renin-angiotensin-aldosterone system and other antinatriuretic neurohumoral regulating units in response to massive diuresis; stimulates arginine-vasopressive and sympathetic systems. Reduces the level of the atrial natriuretic factor in the blood plasma, causes vasoconstriction. Due to the syndrome of "ricochet" when taken 1 time per day may not cause a significant effect on the daily release of sodium ions and blood pressure.
Absorption is high. Bioavailability is 60-70%. Penetrates through the placental barrier, excreted in breast milk. It is excreted mainly (88%) by the kidneys in unchanged form and in the form of metabolites; the rest is intestinal.
- with chronic heart failure;
- with chronic renal failure;
- with nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease);
- with liver diseases;
- arterial hypertension;
- some forms of hypertensive crisis;
- pulmonary edema;
- cardiac asthma;
- edema of the brain;
- conducting forced diuresis;
Solution for intravenous and intramuscular injection (injections in ampoules for injection).
Instructions for use and dosage
Tablets should be taken on an empty stomach without chewingand squeezed with enough liquid. When administering Furosemide, it is recommended that its lowest doses be used to achieve the desired effect. The maximum daily intake for adults is 1500 mg. Initial single dose in children is determined from the calculation of 1-2 mg / kg body weight inday with a possible increase in the dose to a maximum of 6 mg / kg per day, subject to taking the drug no more than 6 hours later. The duration of treatment is determined by the doctor individually, depending on the indications.
Dosing regimen in adults
Edema Syndrome in Chronic Heart Failure
The initial dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended to divide the daily dose by 2-3 doses.
Edema Syndrome in Chronic Renal Failure
In patients with chronic renal diseaseInsufficiency requires careful selection of the dose, by gradually increasing it so that the loss of fluid occurs gradually (at the beginning of the treatment, a loss of fluid of up to about 2 kg of body weight per day is possible). The recommended initial dose is 40-80 mg per day. The necessary dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients on hemodialysis, the usual maintenance dose is 250-1500 mg per day.
Edema with nephrotic syndrome
The initial dose is 40-80 mg per day. The necessary dose is selected depending on the diuretic response. The daily dose can be taken at one time or divided into several doses.
Edema syndrome with liver diseases
Furosemide is prescribed in addition to treatmentantagonists of aldosterone in the case of their insufficient effectiveness. To prevent the development of complications, such as a violation of orthostatic regulation of blood circulation or a violation of the electrolyte or acid-base state, careful selection of the dose is required so that the fluid loss occurs gradually (at the beginning of the treatment, a liquid loss of up to about 0.5 kg of body weight per day is possible). The initial dose is 20-80 mg per day.
Furosemide can be used in monotherapy orin combination with other antihypertensive agents. The usual maintenance dose is a dose of 20-40 mg per day. When furosemide is added to already prescribed medications, their dose should be reduced 2 times. With arterial hypertension in combination with chronic renal failure may require the use of higher doses of the drug.
With intravenous (jet) or intramuscularthe dose for adults is 20-40 mg once a day, in some cases - 2 times a day. For children, the initial daily dose for parenteral use is 1 mg / kg.
- marked decrease in blood pressure;
- propensity to thrombosis;
- muscle weakness;
- cramps of calf muscles (tetany);
- weakness, lethargy, drowsiness;
- confusion of consciousness;
- impaired vision and hearing;
- noise in ears;
- dryness of the oral mucosa;
- nausea, vomiting;
- acute urinary retention (in patients with benign prostatic hyperplasia);
- interstitial nephritis;
- decreased potency;
- decreased glucose tolerance;
- manifestation of latent diabetes mellitus;
- exfoliative dermatitis;
- anaphylactic shock;
- Stevens-Johnson syndrome;
- toxic epidermal necrolysis;
- leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia;
- hypokalemia, hyponatremia, hypochloraemia, hypocalcemia, hypomagnesemia.
- acute renal failure with anuria;
- severe hepatic insufficiency, "hepatic" coma and precoma;
- acute glomerulonephritis, severe disorders of urinary efflux of any etiology (including unilateral urinary tract damage), hyperuricemia;
- decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (> 10 mm Hg);
- violation of water-electrolyte metabolism (hypovolemia, pronounced hyponatremia and hypokalemia, hypochloraemia, hypocalcemia, hypomagnesemia);
- digitalis intoxication;
- 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 formulation);
- allergy to wheat (not celiac disease);
- hypersensitivity to the active substance and to any of the components of the drug.
Application in pregnancy and lactation
Furosemide penetrates the placental barrier,therefore, it should not be administered during pregnancy. If you need Furosemide in pregnancy, you should evaluate the ratio of the benefits of using the drug for the mother at risk for the fetus. Excreted in breast milk. If it is necessary to treat the drug, breastfeeding should be discontinued.
Before starting therapy with Furosemideit is necessary to exclude the presence of severe violations of urinary outflow, patients with partial disturbance of urinary outflow, need careful monitoring. Against the background of course treatment, it is necessary to periodically monitor blood pressure, the content of plasma electrolytes (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate correction of treatment.
The use of furosemide slows the excretion of uric acid, which can provoke an exacerbation of gout.
It is believed that it can be used to treatobesity and weight loss, although it is an ordinary diuretic, has nothing to do with the diet and simply reduces the weight of a person within the withdrawn liquid.
Patients with increased sensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to furosemide.
Patients receiving high doses of furosemide, inavoid the development of hyponatremia and metabolic alkalosis, it is inappropriate to limit the intake of table salt. For the prevention of hypokalemia, simultaneous administration of potassium and potassium-sparing diuretics is recommended, as well as adherence to a diet rich in potassium. Selection of the dosage regimen for patients with ascites against the background of cirrhosis of the liver should be carried out under stationary conditions (violations of the water-electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular control over the content of plasma electrolytes.
When azotemia and oliguria appear or increase in patients with severe progressive kidney disease, it is recommended to suspend treatment.
In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of the level of glucose in the blood and urine is required.
In patients with unconsciousness, withbenign prostatic hyperplasia, narrowing of the ureters, or hydronephrosis requires monitoring of urination due to the possibility of acute urinary retention.
The preparation contains lactose monohydrate, thereforepatients with rare hereditary problems of galactose intolerance, deficiency of lactase lapp or malabsorption of glucose-galactose, should not take this medicine.
The composition of the drug includes 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.
Impact on the ability to drive vehicles and manage mechanisms
During the treatment with Furosemideavoid employment by potentially dangerous activities requiring increased attention and speed of psychomotor reactions (vehicle management and work with mechanisms).
With simultaneous use with phenobarbital and phenytoin, the action of furosemide is reduced.
Increases the concentration and risk of nephro- and ototoxic effects of cephalosporins, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion).
With the simultaneous use of aminoglycosides withfurosemide, there is a slowdown in the excretion of aminoglycosides and an increased risk of their ototoxic and nephrotoxic effects. For this reason, use of this combination of drugs should be avoided, except when necessary for life indications, in which case correction (reduction) of maintenance doses of aminoglycosides is required.
Increases the effectiveness of diazoxide and theophylline, reduces - hypoglycemic agents, allopurinol.
Drugs that block tubularsecretion increased the concentration of furosemide in serum. Medicines with nephrotoxic action - when combined with furosemide, the risk of developing their nephrotoxic effect increases.
Glucocorticosteroids and carbenoxolone combined with furosemide increase the risk of hypokalemia.
With simultaneous use with cardiac glycosides, the risk of developing digital intoxication against a background of water-electrolyte disorders (hypokalemia or hypomagnesemia) increases.
Strengthens the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of nondepolarizing muscle relaxants (tubocurarine).
Nonsteroidal anti-inflammatory drugs(including indomethacin and acetylsalicylic acid) in combination with furosemide may cause a temporary decrease in creatinine clearance and an increase in serum potassium content and reduce the diuretic and antihypertensive effects of furosemide. In patients with hypovolemia and dehydration (including furosemide), NSAIDs can cause acute renal failure. Furosemide can enhance the toxic effect of salicylates (due to competitive renal excretion).
Sucralfate reduces the absorption of furosemide and weakens its effect (these preparations should be taken at intervals of not less than 2 hours).
Combination with carbamazepine may increase the risk of hyponotism.
Antihypertensives, diuretics or other agents that can reduce blood pressure when combined with furosemide can lead to more severe antihypertensive effects.
The administration of ACE inhibitors to patients,previously treated with furosemide, can lead to an excessive decrease in blood pressure with impaired renal function, and in some cases to the development of acute renal failure, therefore, three days before the start of treatment with AIF inhibitors or increasing their dose, it is recommended that furosemide be withdrawn or reduced.
Probenecid, methotrexate and other medicinaldrugs that, like furosemide, are secreted in the renal tubules, can reduce the action of furosemide (the same pathway of kidney secretion); on the other hand, furosemide can lead to a decrease in the excretion of these drugs by the kidneys.
Lithium salts - reduced by furosemidelithium excretion, thereby increasing the serum concentration of lithium and increasing the risk of toxic effects of lithium, including its damaging effects on the heart and nervous system. Therefore, when using this combination, control of serum lithium concentrations is required.
Simultaneous administration of cyclosporin A and furosemide increases the risk of gouty arthritis due to hyperuricemia caused by furosemide and cyclosporine disruption of urate excretion by the kidneys.
Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce efficacy.
Radiopaque substances - in patients witha high risk of developing nephropathy for the introduction of radiocontrast drugs receiving furosemide was associated with a higher incidence of renal dysfunction compared to patients at high risk for developing nephropathy for the introduction of radiopaque preparations that received only intravenous hydration prior to the administration of the radiopaque preparation.
Analogues of the drug Furosemide
Structural analogs for the active substance:
- Furosemide (Mifar);
- Furosemide Lannacher;
- Furosemide Sopharma;
- Furosemide injection 1%;
In the absence of analogues of the drug according to the currentsubstance, you can click on the links below for the diseases, from which the appropriate drug helps and see the available analogs for therapeutic effects.