International generic name

Furosemide

Drug form and composition

Solution for injection. One ampoule of 2 ml contains 20 mg Furosemide (10 mg /ml). Tablets. One tablet contains 40 mg Furosemide.

Indications

Edema, due to cardiac, hepatal and renal diseases; preeclamsia and eclamsia edema; chronic cardiovascular failure; swelling in burns; arterial hypertension (when saluretics are contraindicated); in intoxications, in order to cause forced diuresis; in complex treatment of the pulmonary and intracranial edema.

Dosage and administration

Tablets: The initial dose in adults is 40 mg (1 tablet) Furosemid; in case of lack of diuretic effect 6-8 hours later additional 80-120 mg (2-3 tablets) may be administered. Usual daily maintaining dose is 40-80 mg. Maximal dose should not exceed 300 mg/24 h. In treatment of the arterial hypertension the preparation is used in low doses - 10-20 mg daily. In children the preparation is used in daily dose 1-2 mg per kg body weight. Solution for injection: Parenteral therapy in adults is usually started with 20-40 mg Furosemid, intravenously or intramuscularly. In patients with pulmonary edema the initial dose is 40 mg intravenously; the same dose can be repeated with 20 minutes interval. In intoxication with barbiturates 40 mg Furosemid are injected, followed by 1-hour infusion of 500 ml saline. In intracranial edema 20-40 mg Furosemid are injected 1-3 times daily. In children Furosemid is applied intravenously or intramuscularly in dose 1-3 mg per kg body weight.

Contraindications

Severe liver failure (hepatal coma); acute intoxication with salicilate; renal failure, accompanied by anuria or oliguria; severe hypokaliemia; hypovolemia with or without hypotension.

Special warnings and precautions

Before the treatment with Furosemid existing hypokalemia, hyponatremia, hypovolemia and hypotension should be corrected. During the treatment a potassium-rich diet is advisable. Furosemid should be used with care in patients with auditory disorders, allergy to sulphonamydes, and micturiton disorders. In pregnant women Furosemid should be administered only after precise indications consideration. It should be kept in mind that in nursing women the preparation passes in the mother milk and depresses lactation. In such cases is advisable to stop the nursing. In drivers and machinery operating persons Furosemid may disturb capabilities to normal professional activity.

Drug interactions

Furosemid reduces the therapeutic effect of vasopressor amines and anti-diabetic medicines; potentiates the nephrotoxic effect of the cephalosporins, the ototoxic effect of aminoglycosides, and cardio- and neurotoxic effects of the lithium; potentiates effects of antihypertensive drugs and tubocurarine. In combined treatment with cardiac glycosides the preparation increases sensitivity of the myocardium to digitalis. In concomitant treatment with high dose salicylates salicylate intoxication is possibly to develop. Indometacin reduces diuretic and antihypertensive effects of Furosemid.

Adverse reactions

In high dose hypokalemia, hyponatremia, hypocalcemia, hypovolemia, dehydration, thrombosis and other violation of water-electrolyte balance may develop; in predisposed patients allergy skin rash may be seen; blood count changes (leucopenia, agranulocytosis, thrombocytopenia). In elderly patients with high dosesis is possibly to develop a circulatory collapse.

Pharmacological mechanisms

Furosemide exerts a powerful diuretic effect, causing a high (20-30%) glomerular excretion of sodium and water. It acts on the medullar portion of the ascending limb of Henle loop, where are absorbed chloride and sodium ions, but not water, blocking predominantly the active chloride transport. The sodium reabsorption inhibition is a secondary effect. The preparation increases the selective elimination of the sodium up to 35%, and, depending on the dose, stimulates renin - angiotensin - aldosterone system. This leads to reducing of the cortical-papillary osmotic gradient and significant decrease of the concentration capabilities of the kidney. Before the diuretic effect become evident Furosemid reduces the heart preload by dilation of the capacitive vessels, in case the renal function is normal and no significant edemas exist.

Supplied

10 or 100 ampoules of 2 ml (10 mg). 20 or 2500 tablets of 40 mg.

Expiry

Solution for injection - 3 years. Tablets - 5 years