Edema syndrome of various origins, incl. for chronic heart failure stage II-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome. Pulmonary edema, cardiac asthma, cerebral edema, eclampsia, forced diuresis, arterial hypertension severe course, some forms hypertensive crisis, hypercalcemia.

Release form of the drug Furosemide

Solution for intravenous and intramuscular injection 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 10, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour pack 10, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, cardboard pack 5;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour plastic packaging (pallets) 5, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour plastic packaging (pallets) 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour plastic packaging (pallets) 5, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard pack 10;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour plastic packaging (pallets) 5, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; 2 ml ampoule with ampoule knife, contour plastic packaging (pallets) 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 1;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, contour pack 5, cardboard pack 2;

Solution for intravenous and intramuscular administration 10 mg/ml; ampoule 2 ml with ampoule knife, cardboard box (box) 10;

Compound
1 ampoule with 2 ml of solution for injection contains furosemide 20 mg; in a box 10 pcs.

1 tablet - 40 mg; in a jar 50 pcs.

Pharmacodynamics of the drug Furosemide

"Loop" diuretic. It disrupts the reabsorption of sodium and chloride ions in the thick segment of the ascending loop of Henle. Due to an increase in the release of sodium ions, secondary (osmotically mediated) bound by water) increased excretion of water and increased secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases.

It has secondary effects caused by the release of intrarenal mediators and redistribution of intrarenal blood flow. In the background course treatment there is no weakening of the effect.

In heart failure, it quickly leads to a decrease in preload on the heart by dilating large veins. It has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in blood volume. The effect of furosemide after intravenous administration occurs within 5-10 minutes; after oral administration - after 30-60 minutes, maximum effect - after 1-2 hours, duration of effect - 2-3 hours (with reduced kidney function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, but after its cessation, the excretion rate decreases below the initial level (rebound or withdrawal syndrome). The phenomenon is caused by a sharp activation of renin-angiotensin and other antinatriuretic neurohumoral regulation units in response to massive diuresis; stimulates arginine vasopressive and sympathetic system. Reduces the level of atrial natriuretic factor in plasma, causing vasoconstriction.

Due to the “ricochet” phenomenon, when taken once a day, it may not have a significant effect on the daily excretion of sodium ions and blood pressure. When administered intravenously, it causes dilatation of peripheral veins, reduces preload, reduces left ventricular filling pressure and blood pressure. pulmonary artery, as well as systemic blood pressure.

The diuretic effect develops 3-4 minutes after IV administration and lasts 1-2 hours; after oral administration - after 20-30 minutes, lasts up to 4 hours.

Pharmacokinetics of the drug Furosemide

After oral administration, absorption is 60-70%. At serious illnesses kidneys or chronic heart failure, the degree of absorption decreases.

Vd is 0.1 l/kg. Binding to plasma proteins (mainly albumin) is 95-99%. Metabolized in the liver. Excreted by the kidneys - 88%, with bile - 12%. T1/2 in patients with normal function kidneys and liver is 0.5-1.5 hours. With anuria, T1/2 can increase to 1.5-2.5 hours, with combined renal and liver failure- until 11-20 o'clock

Use of Furosemide during pregnancy

During pregnancy, the use of furosemide is possible only for a short time and only when the expected benefit of therapy for the mother outweighs the potential risk to the fetus.

Since furosemide can be released from breast milk, as well as suppress lactation, if necessary, use during lactation breast-feeding should be stopped.

Contraindications to the use of the drug Furosemide

Hypokalemia, renal coma, diabetes mellitus, gout, obstruction urinary tract, pregnancy (first half).

Side effects of the drug Furosemide

Nausea, diarrhea, hypotension, skin flushing, itching, tinnitus, dizziness, depression, muscle weakness, convulsions, thirst, hypokalemia, hyperglycemia, uricosuria.

C03CA Sulfonamide diuretics

Dosage form:  solution for intravenous and intramuscular administration Compound:

Active substance: furosemide - 10.0 mg;

Excipients: sodium chloride - 7.5 mg, sodium hydroxide solution 1 M - 32 µl, water for injection - up to 1.0 ml.

Description:

clear, colorless or slightly colored liquid

Pharmacotherapeutic group:diuretic ATX:  

C.03.C.A.01 Furosemide

Pharmacodynamics:

Renal failure with anuria not responding to furosemide.

Hepatic precoma and coma.

Severe hypokalemia.

Severe hyponatremia.

Hypovolemia (with arterial hypotension or without) or dehydration.

R pronounced outflow disturbancesurine of any etiology (including unilateral lesionsurinary tract).

With caution:

• arterial hypotension;
• conditions in which excessive reduction blood pressure is especially dangerous (stenotic lesions of the coronary and/or cerebral arteries);

acute myocardial infarction (increased risk of developing cardiogenic shock), latent or manifested diabetes mellitus;

• gout;
• hepatorenal syndrome (i.e. with functional renal failure associated with liver diseases);
• increased risk of developing disturbances in water-electrolyte balance and acid-base status or in case of significant additional fluid losses (vomiting, diarrhea, profuse sweating) (requires monitoring of water-electrolyte balance and acid-base status and, if necessary, correction of these disorders before starting the use of furosemide);
• hypoproteinemia (for example, in nephrotic syndrome, when a decrease in the diuretic effect and an increase in the risk of developing the ototoxic effect of furosemide is possible, so dose selection in such patients should be carried out with extreme caution);
• partial obstruction of the urinary tract (prostatic hyperplasia, narrowing of the urethra);
• hearing loss,
• pancreatitis,
• history of ventricular arrhythmias,
• systemic lupus erythematosus;
• in premature infants (the possibility of the formation of calcium-containing kidney stones (nephrolithiasis) and the deposition of calcium salts in the kidney parenchyma (nephrocalcinosis), therefore, in such children, regular monitoring of kidney function is required and an ultrasound examination of the kidneys is required).
• with simultaneous use of risperidone in elderly patients with dementia (risk of increased mortality).

Pregnancy and lactation:

Interactions to Consider

Cardiac glycosides, drugs that cause prolongation of the QT interval - if water-electrolytic disturbances (hypokalemia or hypomagnesemia) develop during the administration of furosemide toxic effect cardiac glycosides and drugs that cause prolongation of the QT interval (the risk of developing rhythm disturbances increases).

Glucocorticosteroids, licorice preparations, in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of hypokalemia.

Medicines with nephrotoxic effects - when combined with furosemide, the risk of developing nephrotoxic effects increases. High doses of some cephalosporins (especially those with a predominantly renal route of elimination) - in combination with furosemide, increase the risk of nephrotoxicity. Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, including acetylsalicylic acid, can reduce diuretic effect furosemide In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. may increase the toxicity of salicylates.

Phenytoin - reduces the diuretic effect of furosemide.

Antihypertensive drugs diuretics or other drugs,capable of lowering blood pressure - when combined with furosemide, a more pronounced reduction in blood pressure is expected.

During treatment with the drug, regular monitoring of sodium, potassium and creatinine levels is usually required, especially careful monitoring should be carried out in patients with high risk development of water-electrolyte imbalance in cases of additional loss of fluid and electrolytes (for example, due to vomiting, diarrhea or intense sweating). Before and during treatment with the drug, it is necessary to monitor and, if it occurs, eliminate hypovolemia or dehydration, as well as clinically significant disturbances in water-electrolyte and/or acid-base status, which may require short-term cessation of treatment with the drug. When treating with the drug, it is always advisable to eat food rich in potassium(lean meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). In some cases, taking potassium supplements or prescribing potassium-sparing drugs may be indicated.

In premature babies, regular monitoring of kidney function and ultrasound examination kidneys (possibility of nephrolithiasis and nephrocalcinosis). A higher incidence of deaths was observed in elderly patients receiving and at the same time, compared with those receiving one or one.

The mechanism of this effect is unclear. Concomitant use of risperidone with other diuretics (mainly low-dose thiazide diuretics) was not associated with increased mortality in elderly patients with dementia. In elderly patients with dementia, it is necessary to prescribe with caution, carefully weighing the balance of benefit and risk, and at the same time. Since dehydration is common factor risk of increased mortality, dehydration of the patient should be avoided when deciding to use this combination in elderly patients with dementia.

The selection of a dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in a hospital (impairments in the water-electrolyte state can lead to the development hepatic coma).

Compatibility Notes

Should not be mixed in the same syringe with other medications.

Emergency measures during development anaphylactic shock

As a rule, the following measures are recommended: at the first signs (severe weakness, cold sweat, nausea, cyanosis) stop the injection, leaving the needle in the vein. Keep your head and torso low and maintain patency, along with other routine emergency measures. respiratory tract. Emergency medication measures (dosage recommendations are for an adult with normal body weight; when treating children, the dosage should be reduced in proportion to body weight):

Immediate intravenous administration of epinephrine (adrenaline): after diluting 1 ml of a standard solution of epinephrine (adrenaline) 1:1000 to 10 ml, first slowly inject 1 ml of the resulting solution (equal to 0.1 mg of adrenaline) under monitoring heart rate, blood pressure and heart rate). If necessary, the administration of epinephrine (adrenaline) can be continued by intravenous infusion. Simultaneously with the administration of epinephrine (adrenaline), intravenous administration of glucocorticosteroids (250-1000 mg of methylprednisolone or prednisolone) is performed, which can be repeated if necessary. In addition to these measures, intravenous infusion of plasma substitutes and/or electrolyte solutions is performed to replenish the volume of circulating blood.

If necessary: artificial respiration, oxygen inhalation, antihistamines.

Impact on the ability to drive vehicles. Wed and fur.:

Some side effects(for example, a significant decrease in blood pressure) can impair the ability to concentrate and the speed of psychomotor reaction, which can be dangerous when driving or engaging in other potentially dangerous species activities. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use antihypertensive drugs or alcohol.

Release form/dosage:Solution for intravenous and intramuscular administration 10 mg/ml. Package: 2 ml in ampoules of colorless neutral glass type I according to ISO 9187 with a colored break ring or with a colored dot and a notch or without a break ring, a colored dot and a notch. The ampoules may additionally be coated with one, two or three color rings and/or a two-dimensional barcode, and/or alphanumeric coding, or without additional color rings, a two-dimensional barcode, or alphanumeric coding. 5 ampoules per blister film packaging

polyvinyl chloride and varnished aluminum foil or polymer film, or without foil and without film. Or 5 ampoules are placed in a pre-made form (tray) made of cardboard for consumer packaging with cells for laying ampoules.

One or two contour cell packages or cardboard trays, together with instructions for use and a scarifier or ampoule knife, or without a scarifier and ampoule knife, are placed in a cardboard package (pack).

Storage conditions:

In a place protected from light, at a temperature not exceeding 25° C.

Do not freeze.

Keep out of the reach of children.

Best before date:

2 years. Do not use after expiration date.

Conditions for dispensing from pharmacies: By prescription Registration number: LP-002243 Registration date: 23.09.2013 Owner of the Registration Certificate: ATOLL, LLC Russia Manufacturer:   Information update date:   12.11.2015 Illustrated instructions

The drug Furosemide is effective diuretic fast 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 it is prescribed for, how the tablets or solution work and how effective they are.

Characteristics of the product

The drug is available both in the form of tablets and in the form of a solution for injection. First appearance rate positive results treatment with Furosemide depends on the use of one or another dosage form drug. So when intravenous administration 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 hours.

For Furosemide, the indications for use are quite extensive. This medicine is prescribed for diseases such as hypertension, renal and heart failure, nephrotic syndrome, as well as for serious liver disorders (for example, cirrhosis).

Furosemide is also often chosen for cystitis. Unlike many drugs of similar action, it does not reduce glomerular filtration. This allows it to be used in cases of renal failure. The hypotensive effect of the drug expands the scope of its application.

However, this drug may not always be prescribed. Contraindications for Furosemide may include:

The drug must be prescribed by a doctor who first explains how to take Furosemide correctly and how to respond to possible side effects. If symptoms such as nausea, vomiting, attacks of thirst, dizziness, or diarrhea occur, you should immediately inform your doctor. Usually in this case the dosage of the drug is reduced, or Furosemide is replaced with another drug. In addition to those listed, side effects such as various may occur allergic reactions, general weakness etc.

As a rule, Furosemide for edema is prescribed in 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 with an interval of 6 hours (for 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 body weight, namely 1-2 mg of medication per kilogram of weight.

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 primarily affects the mucous membrane of the organ. The causative agents of cystitis are Escherichia coli and Pseudomonas aeruginosa bacteria, staphylococcus and Candida fungi. Once in the bladder, these microorganisms begin to actively multiply, resulting in disruption of the functioning of this organ.

Cystitis, as an indication for the use of Furosemide, is considered because the inflammatory process occurring in the bladder requires the prevention of stagnation of urine, as a condition for its development. Unfortunately, most often cystitis develops into chronic form due to the patient's incorrect approach to treatment. Often the patient independently chooses medicines and methods of therapy, uses means traditional medicine, determines when to stop treatment. In this case, little attention is usually paid to establishing the process of excreting urine in a sufficient volume, and this has a direct impact on suppressing the source of inflammation in the organs of the urinary system in general and the bladder in particular.

Typically, during the treatment of cystitis, doctors recommend that patients drink as much fluid as possible, while prescribing various diuretics. Furosemide for cystitis is prescribed precisely in this capacity. This approach ensures the regular outflow of large volumes of urine, which leads to a decrease in inflammation and signs of intoxication.

However, Furosemide for cystitis cannot be the only medicine or form the basis of therapy. It must be remembered that bacterial inflammation requires the use of antibiotics or at least drugs based on medicinal herbs antiseptic action, if we're talking about O initial stage diseases. In the absence of proper treatment, the disease will progress, and in addition to the discomfort when urinating, with which it all began, symptoms such as:

If the symptomatic picture is supplemented with the above signs, the patient will be indicated for 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 is prescribed for cystitis to stimulate urine excretion and increase the volume of circulating fluid, then for edema it is used to eliminate excess liquid from the body. In this case, the patient is usually advised, 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 fluid consumed and output must be equivalent in volume. Otherwise, excess fluid will accumulate in the body. If it begins to be deposited in tissues and cavities, a person may not notice it at first. Only external swelling that forms on the face, limbs, etc. become noticeable immediately.

Edema occurs due to a number of diseases and dysfunctions. For example, due to allergies, liver diseases, due to the use of certain medications. In any case, excess fluid must be removed from the body. In the absence of contraindications, Furosemide can be used for edema.

In this case, it is usually prescribed in a standard dosage - 1 tablet per day (in the morning) every day, as swelling decreases, once every two or three days, until complete cessation of use.

It is noted that a person who has taken the drug once already notices some reduction in swelling, and after a few days they, in most cases, go away completely.

Of course, in this case it is necessary to take other measures, primarily aimed at eliminating the causes that caused the appearance of swelling. If the disease that provoked the formation of edema is not cured, then this symptom after stopping furosemide, it will return again. Meanwhile, this drug should not be abused. It must be used according to the schedule established by the attending physician and only after a prescription has been made.

You should be aware that uncontrolled use of diuretics, including Furosemide, can lead to very severe consequences. In addition, with the fluid removed from the body, especially in large volumes, a lot of useful elements, such as magnesium, calcium, potassium, sodium, etc. If the drug is prescribed by a doctor, he gives recommendations on nutritional correction or prescribes vitamin and mineral complexes.

If for some reason the use of diuretics is impossible, for example, the maximum permissible duration of the course of taking Furosemide has been exceeded, you can use other methods of relieving edema. For example, a light stroking massage, foot baths, and rest help a lot in this case. You can consult with a specialist who can offer additional options for eliminating this symptom.

Any changes in the patient’s condition and therapy for swelling should be monitored by the attending physician, since self-medication can lead to an imbalance in the water balance in the body, which in itself is very dangerous.

each tablet contains: active substance: furosemide - 40 mg; excipients: lactose monohydrate, magnesium stearate, potato starch.

Description

tablets are white or almost white, flat-cylindrical, with a bevel.

Pharmacological action

"Loop" diuretic. In normal therapeutic doses, it disrupts the reabsorption of sodium and chlorine ions in the thick segment of the ascending part of the loop of Henle. Due to an increase in the release of sodium ions, a secondary (mediated by osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions occurs in the distal part of the renal tubule. Furosemide has secondary effects due to the release of intrarenal mediators and redistribution of intrarenal blood flow. These effects increase renal medullary perfusion. Furosemide has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in blood volume. In heart failure, it quickly leads to a decrease in preload on the heart by dilating large veins. The diuretic effect depends on the dose. During the course of treatment, the effect does not weaken. Furosemide does not change the rate glomerular filtration and remains effective at low glomerular filtration rates.

The onset of diuresis is observed within the first hour after oral administration of furosemide. The peak of the diuretic effect occurs in the first two hours after administration, and the duration of the diuretic effect is 6-8 hours.

Pharmacokinetics

Suction:

Oral absorption is rapid but incomplete. Maximum plasma concentration is reached after approximately 60 minutes. Digestive resorption is slowed but not reduced in the presence of food. The bioavailability of furosemide is about 65%.

Distribution:

Plasma protein binding is 96-98%. Plasma protein binding is reduced in liver failure. The apparent volume of distribution is approximately 0.150 l/kg.

Metabolism:

The drug is inactivated in the liver with the formation of glucuronides.

Removal:

The half-life is approximately 50 minutes. Plasma clearance ranges from 2 to 3 ml/min/kg. It occurs through urination and digestive tract(partially with bile). The significantly predominant urinary excretion is rapid and concerns mainly active form furosemide

Furosemide crosses the placental barrier. Furosemide passes into breast milk.

Features of pharmacokinetics in elderly people:

The binding of furosemide to albumin may be reduced in older adults. Elementary diuretic effect in older patients less than in younger people. Furosemide excretion in urine decreases in proportion to gradually progressing age-related changes functions of the tubules.

Features of pharmacokinetics in patients with renal failure:

Bioavailability after oral administration decreases. In case of renal failure, renal excretion is compensated by its excretion in bile and in people with absent (non-functioning) kidneys it can reach 86-98% of the excreted amount. Furosemide is poorly dialyzable.

Features of pharmacokinetics in newborns:

Bioavailability when taken orally is reduced. In neonates, the half-life is prolonged (up to 7 hours) because the apparent volume of distribution is increased and plasma clearance is reduced. In premature infants, the half-life is increased to 20 hours due to decreased urinary excretion.

Indications for use

Edema of cardiac or renal origin. Edema of hepatic origin, usually in combination with potassium-sparing diuretics. Arterial hypertension in patients with chronic renal failure for whom the use of thiazide diuretics is contraindicated (especially when creatinine clearance is below 30 ml/min).

Contraindications

Hypersensitivity to active substance or to any of excipients drug; increased sensitivity to sulfonamides due to possible manifestation cross allergies to furosemide;

Acute renal failure;

Hepatic encephalopathy;

Obstruction of the urinary tract;

Hypovolemia or dehydration;

Decompensated hypokalemia;

Decompensated hyponatremia;

Breast-feeding;

Galactosemia, glucose-galactose malabsorption syndrome, lactase deficiency;

Hepatitis and hepatocellular failure in patients on hemodialysis with severe renal failure (creatinine clearance<30 мл/мин), в связи с риском накопления фуросемида, экскреция которого осуществляется преимущественно с желчью.

Pregnancy and lactation

There are currently insufficient clinical data to evaluate the potential teratogenic effects of furosemide when taken during pregnancy. Furosemide should be avoided in pregnant women and the drug should never be prescribed to treat physiological edema during pregnancy. Diuretics can cause placental ischemia with the risk of fetal malnutrition. Careful monitoring of fetal growth is necessary. Since furosemide can be excreted in breast milk and also suppress lactation, if it is necessary to use the drug during lactation, breastfeeding should be discontinued.

Directions for use and doses

The drug is taken orally before meals. The dose depends on the course and severity of the disease.

Adults. For edema of cardiac, renal or hepatic origin:

Moderate condition: 1/2 -1 tablet per day;

Severe condition: 2-3 tablets per day in 1 or 2 divided doses, or 3-4 tablets per day in 2 divided doses.

For high blood pressure in patients with chronic renal failure: in combination with other antihypertensive agents (antagonists of the renin-angiotensin system) the usual recommended dose is 20-120 mg per day in 1 or 2 divided doses. Changes in blood pressure should be carefully monitored when furosemide is used in conjunction with other antihypertensive drugs, especially during initial therapy. To prevent an excessive drop in blood pressure, the dose of other antihypertensive drugs should be reduced by at least 50% when furosemide is added to the main treatment.

Children. For the treatment of edema, the daily dose is 1-2 mg/kg body weight in 1-2 doses.

Use in elderly patients. Dose selection and adjustment in elderly patients should be done with caution, usually starting at the lower end of the therapeutic dose range.

Side effect

From the cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased circulating blood volume.

From the nervous system: dizziness, headache, muscle weakness, calf muscle cramps (tetany), apathy, adynamia, weakness, lethargy, drowsiness, confusion.

From the senses: visual and hearing impairment (hearing loss and tinnitus, usually short-term, appear in rare cases, especially in patients with renal failure, hypoproteinemia (for example, nephrotic syndrome)).

From the digestive system: hepatic encephalopathy in patients with hepatic cell failure, increased transaminases, anorexia, dry mouth, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation).

From the genitourinary system: oliguria, acute urinary retention (in patients with prostate adenoma), muscle spasm, bladder spasm, interstitial nephritis, hematuria, decreased potency.

Allergic reactions: urticaria, eosinophilia, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing angitis, pruritus, chills, fever, photosensitivity, anaphylactic and/or anaphylactoid reactions, purpura, paresthesia (burning, pain), bullous reactions (bullous pemphigoid, erythema), syndrome Stevens-Johnson, toxic epidermal necrolysis.

From the hematopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.

From the side of water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.

Effect on laboratory parameters: hyperglycemia, increased levels of cholesterol, low-density lipoproteins (when taking large doses of the drug), hyperuricemia, glucosuria, hypercalciuria, increased creatinine levels in the blood.

If adverse reactions occur, the dose should be reduced or the drug discontinued.

Overdose

Symptoms: marked decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including atrioventricular block, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy, hypokalemia and hypochloremic alkalosis.

Treatment: correction of water-salt balance and acid-base status, replenishment of circulating blood volume, symptomatic treatment, maintenance of vital functions. There is no specific antidote.

Interaction with other drugs

Hypokalemia

With the simultaneous use of glucocorticosteroids, amphotericin B, laxatives, the risk of developing hypokalemia increases, and with cardiac glycosides the risk of developing digitalis intoxication due to hypokalemia increases.

Hyponatremia

Taking diuretics, desmopressin, antidepressants that inhibit serotonin reuptake, carbamazepine and oxcarbazepine increases the risk of developing hyponatremia.

Ototoxicity

The ototoxicity of aminoglycosides, glycopeptides such as vancomycin and teicoplanin, and other ototoxic drugs may be increased by concomitant use of furosemide. Since this can lead to irreversible hearing damage, these drugs are used concomitantly with furosemide only in exceptional cases.

The simultaneous use of furosemide and lithium preparations is not recommended. The level of lithium in the blood serum increases with signs of overdose, the renal clearance of lithium preparations decreases and the toxicity of lithium preparations increases. If concomitant use of drugs cannot be avoided, careful monitoring of serum lithium levels and lithium dosage adjustment is necessary.

Combinations requiring special caution:

Furosemide should be used with caution in combination with risperidone, as there may be an increase in mortality in elderly patients. The need for combined use should be justified taking into account the risks and benefits of the combination. The risk of mortality increases with the presence of dehydration.

Anti-inflammatory non-steroidal drugs, including aspirin, anti-inflammatory doses of acetylsalicylic acid ≥1 g per dose and/or ≥3 g per day) or analgesics in antipyretic doses (≥500 mg per dose and/or<3 г в день): риск развития острой почечной недостаточности, особенно у пациентов группы риска (пожилые пациенты, пациенты с дегидратацией), снижение антигипертензивного эффекта. Необходим контроль функции почек в начале исследования, гидратация пациента.

Medicines that increase the risk of hypokalemia: monitoring of serum potassium levels is necessary.

Digitalis preparations: hypokalemia increases the cardiac toxicity of digitalis preparations.

Potassium-sparing diuretics, alone or in combination (amiloride, potassium canrenoate, eplerenone, spironolactone, triamterene): the possibility of hypokalemia cannot be excluded. Monitoring serum potassium levels and ECG is recommended.

Aminoglycosides: potentiation of nephrotoxic and ototoxic effects of drugs.

Phenytoin: reduction of the diuretic effect by up to 50%. It is possible to use higher doses of furosemide.

Carbamazepine: risk of symptomatic hyponatremia.

Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonistsII: risk of sudden arterial hypotension and/or acute renal failure. It is recommended to temporarily discontinue the use of furosemide or reduce its dose 3 days before starting treatment with ACE inhibitors/angiotensin II receptor antagonists. For congestive heart failure, it is recommended to begin treatment with low doses of ACE inhibitors. It is recommended to monitor renal function (creatinine determination) in the first weeks of treatment with ACE inhibitors/angiotensin II receptor antagonists.

Medicines, the use of which increases the risk of ventricular arrhythmia;

Antiarrhythmic drugs class Ia (quinidine, hydroquinidine, disopyramide), class III (amiodarone, sotalol, ibutilide, dofetilide);

Some neuroleptics: phenothiazines (aminazine, cyamemazine, fluphenazine, levomepromazine, pipothiazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol, pipamrenon), other neuroleptics (pimozide, sertindole, flupenthixol, zuclopenthixol);

Other drugs: bepridil, cisapride, difemanil, dolasetron IV, dronedarone, spiramycin, erythromycin IV, mizolastine, levofloxacin, halofantrine, lumefantrine, pentamidine, vincamine IV, moxifloxacin, mequitazine, methadone, toremifene, citalopram, escitalopram and others.

Concomitant use of furosemide with these drugs may increase the risk of developing ventricular arrhythmia, including potentially dangerous torsades de pointes (hypokalemia is a predisposing factor). Before taking the drug, monitoring of electrolyte and electrocardiographic parameters is recommended.

Metformin: possible development of lactic acidosis. Metformin should not be used if creatinine levels exceed 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women.

Baclofen: increased risk of arterial hypotension, including orthostatic hypotension. It is recommended to monitor blood pressure and, if necessary, adjust the dose of antihypertensive drugs.

Significant interactions of furosemide with other drugs:

Cyclosporine: risk of increasing blood creatinine levels, risk of hyperuricemia and gout;

Neuroleptics, tricyclic antidepressants, amifostine, nitrates: increased risk of arterial hypotension, including orthostatic hypotension;

Alpha blockers used in urology (alfuzosin, doxazosin, prazosin, terazosin, tamsulosin), antihypertensive alpha blockers: increased hypotensive effect, increased risk of orthostatic hypotension;

Platinum drugs: risk of ototoxicity and/or nephrotoxicity.

Precautions

In the presence of ascites without peripheral edema, it is recommended to use furosemide in doses that provide additional diuresis in a volume of no more than 700-900 ml per day in order to avoid the development of oliguria, azotemia and disturbances in electrolyte metabolism.

Long-term use can lead to weakness, fatigue, decreased blood pressure and cardiac output, and excessive diuresis during myocardial infarction with congestion in the pulmonary circulation can contribute to the development of cardiogenic shock.

In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit the consumption of table salt. To prevent hypokalemia, it is recommended to simultaneously administer potassium supplements and potassium-sparing diuretics, as well as adhere to a diet rich in potassium.

Increased diuresis causes dehydration and hypovolemia, which can lead to arterial thrombosis, especially in elderly patients. All patients receiving furosemide should be monitored for signs of electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia): dry mouth, thirst, weakness, drowsiness, muscle pain, muscle spasms, muscle weakness, hypotension, oliguria, tachycardia, arrhythmia, gastrointestinal disorders.

Accidental administration of the drug can lead to hypovolemia and dehydration.

In case of hepatocellular failure, treatment should be carried out with caution, under strict monitoring of electrolytes, taking into account the risk of hepatic encephalopathy. If necessary, treatment should be stopped immediately.

Taking furosemide in case of partial obstruction of the urinary tract can lead to urinary retention. Careful monitoring of urine output should be ensured, especially at the start of furosemide treatment.

Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitization to furosemide.

Cases of photosensitivity reactions have been reported with the use of thiazide diuretics. If photosensitivity reactions occur, it is recommended to discontinue furosemide. If necessary, it is recommended to protect exposed skin exposed to sunlight or artificial ultraviolet radiation.

Since the drug contains lactose, its use is not recommended for patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.

When treating with furosemide, careful monitoring and dose adjustment is required in the following cases:

In patients at risk of cerebral, coronary ischemia or other ischemia associated with circulatory failure;

In patients with hepatorenal syndrome (renal failure associated with severe liver disease);

In patients with hypoproteinemia in the case of nephrotic syndrome: possible reduction of the effect of furosemide and potentiation; side effects, especially ototoxicity.

Increased urine output may cause or worsen urinary retention in patients with urinary tract obstruction.

Treatment with furosemide may lead to a transient increase in creatinine, cholesterol, and triglyceride levels.

Several cases of kidney stones have been observed in premature infants receiving high-dose furosemide injections due to the development of hypercalciuria. Electrolyte balance:

Natremia. It is necessary to monitor sodium levels before starting therapy and regularly monitor them thereafter. Treatment with diuretics may cause hyponatremia. A decrease in sodium levels in the blood is initially asymptomatic; regular monitoring should be more frequent in patients at risk: advanced age, cachexia (malnutrition) or cirrhosis.

Kalemia. When using loop diuretics, a decrease in sodium levels with hypokalemia may occur. Risk of sudden hypokalemia (<3,5 ммоль/л) должен мониторироваться у пациентов групп риска: пожилой возраст и/или недоедание, и/или политерапия, в случае цирроза и асцита, у больных с сердечной недостаточностью. Гипокалиемия увеличивает сердечную токсичность препаратов дигиталиса и риск расстройств ритма. У пациентов с удлиненным интервалом QT врожденного или медикаментозного происхождения, гипокалиемия способствует расстройству ритма (потенциально летальная пируэтная тахикардия или брадикардия). Во всех случаях необходим частый контроль калиемии. Первый контроль калия в плазме должен быть вьшолнен в течение недели после начала терапии.

Glycemia. The frequency of glycemia is low, however, in diabetes mellitus it is necessary to systematically monitor the level of glucose in the blood and urine.

Uricemia. The secretion of uric acid is reduced, so use is not recommended for hyperuricemia and especially gout.

Creatinine. Regular monitoring of serum creatinine is recommended during treatment with furosemide.

Careful monitoring of patients at high risk of developing electrolyte disorders (vomiting, diarrhea, sweating) is necessary. Dehydration, hypovolemia or acid-base imbalance require treatment adjustment and/or temporary cessation of treatment.

Athletes. The presence of furosemide gives positive tests during anti-doping control.

Newborns and premature babies. In newborns and premature infants, long-term use of high doses of furosemide increases the risk of developing nephrocalcinosis and/or nephrolithiasis. Ultrasound monitoring of the kidneys is recommended.

Impact on the ability to drive vehicles and other potentially dangerous mechanisms. When using furosemide, the possibility of a decrease in the ability to concentrate cannot be excluded, therefore driving and other activities that require increased attention and reaction speed are not recommended.

Release form

10 tablets each in a blister pack made of polyvinyl chloride film and aluminum foil; 50 tablets per jar. Each jar or one or five contour packages along with instructions for medical use are placed in a pack.

Storage conditions

In a place protected from light, at a temperature not exceeding 25 ° C.
Keep out of the reach of children.

Best before date

2 years.
Do not use the medicine after the expiration date.

Conditions for dispensing from pharmacies

According to the recipe.

Self-medication can be harmful to your health.
You should consult your doctor and read the instructions before use.

Contents of the article: classList.toggle()">toggle

Furosemide is one of the most popular diuretic drugs. In addition to the fact that it acts quite quickly and effectively, the drug is notable for its low price, which is its significant advantage over other drugs in this group.

Since uncontrolled use of Furosemide can cause a decrease in potassium levels in the body, it is simultaneously recommended to take medications that prevent this.

Release form and mechanism of action

Furosemide is produced in the form of tablets of 40 mg, 10 pieces in a blister. The package contains 5 blisters. Or in the form of ampoules of 10 mg 2 ml.

Furosemide belongs to the group of diuretics. It is a fast-acting loop diuretic. The effect of its use is short and strong.

Its effect is associated with inhibition of the reabsorption of sodium and potassium in all parts of the kidney.

Furosemide is effective in both alkalizing and acidifying the blood. Due to the fact that it dilates peripheral blood vessels, Furosemide lowers blood pressure.

When taking the tablets, the effect occurs within an hour and lasts 4 hours. With intravenous administration of Furosemide, the onset of effect is observed after 20 minutes. In this case, the drug acts for about 3 hours.

Indications for use

• Edema that appears due to chronic heart failure or chronic renal failure;
• Acute renal failure (including during pregnancy and childbirth);
• Arterial hypertension;
• Swelling due to liver problems.

Directions for use and dosage

Tablets are taken once a day, in the morning, on an empty stomach at a dosage of 40 mg (1 tablet). The maximum daily dose is 160 mg, divided into 2 or 3 doses. In case of severe renal failure, it can be increased to 320 mg.

After swelling disappears, the dose is reduced to a minimum, and a break is taken between doses of the drug for 1 or 2 days.

Furosemide solution is administered intravenously, slowly at 20–60 mg per day. If necessary, the dose can be increased to 120 mg, in this case divided by 2 times. The drug is rarely administered intramuscularly when other methods of administration are inappropriate. Furosemide injections are given for no more than 7 days, then the patient is transferred to tablets.

Side effects

The following side effects may occur when using Furosemide:

• From the side of metabolism: electrolyte imbalance, dehydration, hypokalemia, increased cholesterol or creatinine levels in the blood;
• From the genitourinary system: increased amount of urine, increased sodium or chloride levels, urinary retention, kidney failure;
• From the senses: hearing impairment or tinnitus;
• From the immune system: urticaria, bullous dermatitis, anaphylactic reactions;
• From the digestive tract: acute pancreatitis;
• Vascular disorders: vasculitis, thrombosis, low blood pressure;
• Local reactions: increased body temperature.

Contraindications

The drug has contraindications, be careful!

In case of hypersensitivity to its components;

• For hypokalemia;
• With hypovolemia;
• With anuria;
• In case of poisoning with hepatotoxic or nephrotoxic drugs, as a result of which renal failure develops;
• Precomatose and comatose states due to hepatic encephalopathy.

Interactions with other drugs

• It is not recommended to combine Furosemide with Gentamicin, as this may cause hearing loss;
• When taken simultaneously with non-steroidal anti-inflammatory drugs, the effect of Furosemide may be reduced;
• With simultaneous use of the drug and high doses of cephalosporins, renal dysfunction may occur.

Special instructions