Furetic/Furetic-S

Furetic 40 mg tablet: White, round and flat tablet with "
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" logo on one side and score with "F" on the other.
Each tablet contains Furosemide 40 mg.
Furetic 500 mg tablet: Yellow, round and flat tablet with cross mark on one side and "
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" logo on the other.
Each tablet contains Furosemide 500 mg.
Furetic injection: Clear, colorless sterile solution.
Each mL contains Furosemide 10 mg.

Pharmacology: Pharmacodynamics: Furosemide is a diuretic, inhibits the reabsorption of sodium, chloride and water at ascending limb of the loop of Henle and therefore excretion of sodium and water is increased. Moreover, Furosemide can increase the excretion of potassium at distal tubule with an independent of any inhibitory effect on carbonic anhydrase or aldosterone.
Pharmacokinetics: The drug can cross placenta and distributed into breast milk. Approximately 90-95% of the drug bound to plasma protein. Furosemide is primarily excreted in urine and some portion of the drug is metabolized in liver. The reminder of the drug is eliminated by degradation in liver or excretion of unchanged drug in feces. The half-life of the drug is approximately 120 minutes.
Furosemide is not removed by hemodialysis.
Furetic tablet: Furosemide will be absorbed in gastrointestinal tract after an oral administration with peak plasma concentration reached within 60-120 minutes.

Treatment of edema associated with congestive heart failure, renal insufficiency or hepatic cirrhosis.
Furetic tablet: Treatment of hypertension.
Furetic injection: As an adjunctive therapy in the treatment of hypertensive crises; As an adjunctive therapy in the treatment of pulmonary edema.

Furetic tablet: Dosage in adults: Edema: 20 to 80 mg/day as a single dose. If response is not satisfactory, increase by increments of 20 or 40 mg, no sooner than 6 to 8 hours after previous dose, this dose should then by given once or twice daily (eg. at 8 am and 2 pm). Dosage may be titrated up to 600 mg/day in patients with severe edema.
Hypertension: 40 mg twice a day; adjust according to response. If the patient does not respond, add other antihypertensive agents.
Dosage in children: Edema: Initial dose of 2 mg/kg single dose. If the therapeutic effect is not achieved, the dose can be titrating up to 1-2 mg/kg every 6-8 hours to a maximum dose of 6 mg/kg. The usual given dose is 4 mg/kg once or twice daily.
Hypertension: Initial dose of 0.5-2 mg/kg once or twice daily. The maximum dose is 6 mg/kg/day.
Dosage in patients with impaired renal function: Patients with impaired renal function: Initial dose is 80 mg/day; the dose can be increased up to 80-120 mg/day until the desired effect is achieved. When the immediate diuresis is needed, the dose of 320-400 mg/day is recommended.
Chronic renal failure: Initial oral doses 250 mg, increase dose, if necessary in steps of 250 mg every 4-6 hour. Dose adjustments should be made according to the patient's response. Dosage may be titrated up to 1500 mg/24 hour.
Furetic injection: Preparation for IV injection: Dilute FURETIC INJECTION in compatible solution for injection; such as, sodium chloride injection, lactated Ringer's injection or dextrose 5% injection. Adjust the pH above 5.5.
The drug should be slowly infused over 1-2 minutes.
Do not used if solution is discolored.
Dosage in adults: Edema: The usual dose is 20-40 mg administered by IM or IV. For IV injection of Furosemide should be given slowly over 1-2 minutes. If do not respond to the initial dose of Furosemide may be increased in 20 mg increments and given not more often than every 2 hours until the desired therapeutic effect is achieved.
Hypertensive crises: 40-80 mg IV over 1-2 minutes (administer with other anti-hypertensive agents).
Pulmonary edema: 40 mg injected slowly IV over 1-2 minutes, if the initial dose does not achieved the desired effect within 1 hour, the dose may be increased to 80 mg injected slowly IV over 1-2 minutes. If necessary, may be administered with digitalis, oxygen.
Dosage in children: Initial dose is 1 mg/kg slowly IM or IV; if the therapeutic effect does not achieved, increased the dose by 1 mg/kg at intervals of 6-12 hours until the desired therapeutic effect is achieved.
Maximum dose: 6 mg/kg.
Dosage in patients with impaired renal function: Initial dose is 100 mg-2 g at 2-24 hour intervals until the desired effect was attained.
The maximum IV dose is 6 g daily.

Symptoms: Fluids and electrolyte imbalance, weakness, dizziness, confusion, anorexia and cramping.
Treatment: Adequate fluids and electrolyte replacement and symptomatic treatment.
Furosemide is not removed by hemodialysis.

The drug is contraindicated in patients with a history of hypersensitivity to the drug.
Furosemide is contraindicated in patients with anuria.

Furetic injection: Hypersensitivity to this medicine and children under 2 years should be avoided.
The drug may cause hepatic and renal function impairment.
Pregnant women, especially during the third trimester and breast feeding should be avoided because the drug may cause hyperbilirubinemia in the infant.
If rash and a flu-like syndrome occur, use should be discontinued and consult physician.
Caution should be used in patients with G6PD deficiency.
If they have fever, red rash, skin blisters, the skin peels away in sheets and the mucous membranes inflame such as oral throat, nose, reproductive organs and eyes, use should be discontinued and consult physician because Stevens-Johnson syndrome may occur.
Bluish color in the skin and weakness occur, use should be discontinued because methemoglobinemia may occur.

The drug should be used with caution in patients with known sulfonamide sensitivity as it may show allergic actions to Furosemide.
Long term use of diuretics include Furosemide may result in dehydration and reduction of blood volume with circulatory collapse and possibly vascular thrombosis and embolism, especially in elderly.
Electrolyte imbalance may occur after a long term used of Furosemide. Therefore, periodic determinations of serum electrolytes, for signs of fluid or electrolyte imbalance such as hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis.
The drug should be used with caution in patients with hepatic cirrhosis as sudden alterations of electrolyte balance may precipitate and leads to coma.
The treatment with Furosemide can increase the level of serum uric acid and therefore may cause an exacerbation of hyperuricemia.
The drug can cause hearing impairment (such as tinnitus) and ototoxicity.

There are the studies reported that the drug can cross placenta. However, there are no adequate studies on the use of the drug in pregnant women. Therefore it should be used only if the possible risk justifies the potential benefits to the fetus.
The drug can be distributed into breast milk and if the treatment is necessary, therefore it is recommended to discontinue the nursing.

The adverse reactions that can occur during the use of the drug are: Gastrointestinal tract: anorexia, nausea, vomiting, diarrhea, abdominal cramp, pancreatitis, jaundice.
CNS: headache, dizziness, blurred vision, hearing loss or impairment, weakness.
Hematology: anemia, leucopenia, thrombocytopenia.
Dermatology: photosensitivity, urticaria, rash, (irritation and pain at injection site-for Furetic injection only).
Cardiovascular: orthostatic hypotension.
Other: muscle spasm, weakness, fever, hyperuricemia, hyperglycemia, urinary bladder spasm, urinary frequency.

Administration of Furosemide with insulin or anti-diabetic agents; such as sulfonylureas, may interfere with the hypoglycemic effect. Therefore, plasma glucose level should be closely monitored when coadministration is used.
The use of Furosemide with other antihypertensive agents may potentiate the hypotensive effects, causing orthostatic hypotension. Therefore, the dose should be adjusted when there is a concomitant used.
Coadministration of the drug with thiazide diuretics will result in electrolyte abnormalities and therefore the drug should be used with caution.
Administration of Furosemide with digitalis may cause potassium depletion (resulting in increasing sensitivity of cardiac muscle to digitalis) and cardiac arrhythmias.
Coadministration of Furosemide with glucocorticoid, corticosteroid, corticotrophin and amphotericin B will decrease potassium level.
Concomitant use of Furosemide with aminoglycosides may increase ototoxicity. Therefore, avoid coadministration.
Administration of Furosemide with phenytoin or indomethacin and other NSAIDs may reduce the efficacy of Furosemide.
The use of Furosemide with lithium is contraindicated as diuretics will reduce the clearance of lithium, resulting in lithium toxicities.
The use of Furosemide with beta blocker such as propranolol may increase the plasma level of propranolol. Therefore, the drug should be used with caution.

Store below 30°C, protect from light.

Diuretics

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

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