Loopretic

Parenteral therapy reserved for patients unable to take oral medication or in emergency clinical situations. Edema associated w/ CHF, cirrhosis of the liver, & renal disease, including nephrotic syndrome, in adults & ped patients. Adjunctive therapy in acute pulmonary edema.

Adult Edema Initially 20-40 mg as single dose IV (slowly over 1-2 min) or IM. May administer another dose 2 hr later or may increase dose by 20 mg not sooner than 2 hr after previous dose until the desired diuretic effect has been obtained. Give the individually determined single dose once daily or bid. In high-dose parenteral therapy, administer as controlled IV infusion not >4 mg/min. Acute pulmonary edema Initially 40 mg IV inj slowly over 1-2 min, may be increased to 80 mg IV inj slowly over 1-2 min if no satisfactory response occurs w/in 1 hr. Ped patient Initially 1 mg/kg IV/IM slowly, may be increased by 1 mg/kg not sooner than 2 hr after previous dose until the desired diuretic effect has been obtained. Max: 6 mg/kg (1 mg/kg daily for premature infant).

Hypersensitivity. Patients w/ anuria.

Hypersensitivity to sulfonamides. Discontinue use if increasing azotemia & oliguria occur during treatment of severe progressive renal disease. Do not institute therapy in hepatic coma & in states of electrolyte depletion until basic condition is improved. Excessive amounts can lead to profound diuresis w/ water & electrolyte depletion. Caution in patients w/ hepatic cirrhosis & ascites. Reports of tinnitus & reversible or irreversible hearing impairment & deafness; increases in blood glucose & alterations in glucose tolerance tests (w/ abnormalities of the fasting & 2-hr postprandial sugar) & rarely, precipitation of DM. Excessive diuresis may cause dehydration & blood vol reduction w/ circulatory collapse & possibly vascular thrombosis & embolism, particularly in the elderly. Electrolyte depletion may occur especially in higher doses & restricted salt intake. Hypokalemia may develop, especially w/ brisk diuresis, inadequate oral electrolyte intake, presence of cirrhosis, or concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged laxative use. Acute urinary retention in patients w/ severe symptoms of urinary retention. Higher incidence of renal function deterioration in patients at high risk for radiocontrast nephropathy after receiving radiocontrast compared to those who received only IV hydration prior to radiocontrast. Effect may be weakened & ototoxicity potentiated in patients w/ hypoproteinemia (eg, associated w/ nephrotic syndrome). Asymptomatic hyperuricemia can occur & gout may rarely be precipitated. Possible exacerbation or activation of SLE. Observe for signs or symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia); possible occurrence of blood dyscrasias, liver or kidney damage, or other idiosyncratic reactions. Digitalis therapy may exaggerate metabolic effects of hypokalemia, especially myocardial effects. Renal impairment. Use during pregnancy only if potential benefit justifies potential risk to the fetus. Monitor fetal growth during pregnancy. Caution when administering to nursing mother. May inhibit lactation. May precipitate nephrocalcinosis/nephrolithiasis in premature infants & childn <4 yr treated chronically w/ furosemide. May increase risk of persistence of patent ductus arteriosus if administered to premature infants during the 1st wk of life. Elderly.

Hepatic encephalopathy in patients w/ hepatocellular insufficiency, pancreatitis, jaundice (intrahepatic cholestatic jaundice), increased liver enzymes, anorexia, oral & gastric irritation, cramping, diarrhea, constipation, nausea, vomiting; severe anaphylactic or anaphylactoid reactions (eg, w/ shock), systemic vasculitis, interstitial nephritis, necrotizing angiitis; tinnitus & hearing loss, paresthesias, vertigo, dizziness, headache, blurred vision, xanthopsia; aplastic anemia, thrombocytopenia, agranulocytosis, hemolytic anemia, leukopenia, anemia, eosinophilia; exfoliative dermatitis, bullous pemphigoid, erythema multiforme, purpura, photosensitivity, urticaria, rash, pruritus, SJS, TEN; orthostatic hypotension, increased cholesterol & triglyceride serum levels; hyperglycemia, glycosuria, hyperuricemia, muscle spasms, weakness, restlessness, urinary bladder spasm, thrombophlebitis, transient inj site pain following IM inj, fever.

May increase the ototoxic potential of aminoglycoside antibiotics, especially in presence of renal impairment. Possible ototoxicity w/ ethacrynic acid. Possible salicylate toxicity at lower doses of furosemide w/ high doses of salicylates. Risk of ototoxic effects w/ cisplatin. May enhance nephrotoxicity of nephrotoxic drugs (eg, cisplatin) when furosemide is not given in lower doses & w/ +ve fluid balance. May antagonize the skeletal muscle relaxing effect of tubocurarine & potentiate the action of succinylcholine. Reduced renal clearance & increased risk of toxicity of lithium. May lead to severe hypotension & renal function deterioration, including renal failure, w/ ACE inhibitors or ARBs. May add to or potentiate therapeutic effect of other antihypertensives. Potentiation w/ ganglionic or peripheral adrenergic blockers. May decrease arterial responsiveness to norepinephrine. May lead to flushing, sweating attacks, restlessness, nausea, increase in BP & tachycardia w/in 24 hr of taking chloral hydrate. Renal action is interfered directly by phenytoin. Effect may be reduced w/ MTX & other drugs that undergo significant renal tubular secretion. May decrease renal elimination of other drugs that undergo tubular secretion. Increased risk of cephalosporin-induced nephrotoxicity. Increased risk of gouty arthritis w/ cyclosporine. Temporarily reduced CrCl w/ ASA in patients w/ chronic renal insufficiency. Natriuretic & antihypertensive effects may be reduced w/ indomethacin.

Diuretics

C03CA01 - furosemide ; Belongs to the class of high-ceiling sulfonamide diuretics.

Rx