Furosemide is an excellent diuretic. Furosemide tablets from what helps

Furosemide, what do these pills help with? The drug is well known for its diuretic properties, allowing you to remove puffiness. The diuretic "Furosemide" instruction for use prescribes to take with edema, heart failure, hypertension.

Composition and form of release

The drug is produced in the form of tablets for internal use, as well as a solution for injection. The active element of the drug "Furosemide", from which it helps with edema, is the substance of the same name. Diuretic tablets include 0.04 g of the active substance, injections contain 10 mg / ml.

Injections are supplied in 2 ml ampoules. Auxiliary components contribute to better absorption of the drug, the list of which depends on the form of release: starch, silicon dioxide, sodium hydroxide, magnesium stearate, sodium chloride, povidone and other components.

Pharmacological properties

Diuretic tablets "Furosemide", from which the medicine helps with kidney diseases, intensively remove water and magnesium and calcium ions from the body. Thus, the diuretic effect of the active element is manifested. When using the remedy for heart failure, the load on the myocardium decreases.

This occurs as a result of the expansion of arteries and veins. The action of the drug is observed after 5 minutes with intravenous injection and an hour later when using tablets. The therapeutic effect lasts for 2-3 hours. With a deterioration in kidney function, the drug acts for 6-8 hours.

The drug "Furosemide": what helps

The drug is prescribed for various types of edematous syndrome. Indications for the use of the drug "Furosemide" include the following diseases and conditions:

heart asthma; excess calcium in the body; pulmonary edema; hypertensive crisis; heart failure; eclampsia; swelling of the brain; complicated arterial hypertension; nephrotic syndrome; cirrhosis of the liver.

The drug is also used when performing forced diuresis.

What helps "Furosemide" in ampoules

The instruction explains that the indications for the use of the injection form are similar to tablets. However, injections work faster. To the question: “What is the Furasemide solution for?”, Physicians answer that intravenous administration can quickly reduce pressure and preload on the myocardium. This plays an important role in emergency conditions of the patient.

Contraindications

The drug "Furosemide" instructions for use prohibits the use of:

hypersensitivity to the active element; stenosis of the urethra; arterial hypotension; digitalis intoxication; pancreatitis; acute glomerulonephritis; hypokalemia; diabetic coma; increased venous pressure; acute kidney failure; hepatic coma; gout; cardiomyopathy; urinary tract stones; liver failure in a complex form; hyperglycemic coma; hyperuricemia; aortic stenosis; alkalosis; precomatose states; acute myocardial infarction.

Caution when using the product should be observed by persons aged, with diabetes mellitus, prostatic hyperplasia, hypoproteinemia, atherosclerosis. Furosemide during pregnancy and breastfeeding can only be used as an emergency aid under the supervision of a physician.

Medicine "Furosemide": instructions for use

The treatment regimen is determined by a specialist depending on the clinical picture of the pathology. Tablets are taken in a volume of 20 to 80 mg per day. The dosage can be gradually increased, bringing the daily use of the drug to 0.6 g. The amount of the drug "Furosemide" for children is calculated based on body weight 1-2 mg per kg, not more than 6 mg per kg.

Instructions for the use of injections "Furosemide"

The volume of intramuscular or intravenous injections should not exceed 0.04 g per day. Doubling the dose is possible. Doctors recommend injecting the drug into a vein infectiously for 2 minutes. It is possible to inject injections into muscle tissue only if it is impossible to use tablets and intravenous injections.

In acute conditions, injections into the muscle are contraindicated.

Drug interaction

The combined use of the drug "Furosemide" and other drugs can cause negative reactions of the body. The combination of the drug with hypoglycemic drugs, cephalosporins, aminoglycosides, indomethacin, NSAIDs, insulin is unacceptable. Do not take the drug together with digitoxin, astemizole, digoxin, ACE inhibitors, cisplatin, cholestyramine, cisapride, phenytoin, colestipol, lithium carbonate.

Side effects

The drug "Furosemide", reviews and instructions confirm this, it can cause negative reactions in the body. Side effects include:

tachycardia, dizziness, hearing impairment; anorexia, oliguria, exfoliative dermatitis; aplastic anemia, dehydration, thrombophlebitis; orthostatic hypotension, muscle weakness; visual disturbances, dry mouth; interstitial nephritis, urticaria; thrombocytopenia, metabolic acidosis; kidney calcification (in newborns); arrhythmia, headache, cholestatic jaundice; hematuria, pruritus, hypochloremia; low blood pressure, tetany, stool disorders; urinary retention, purpura, leukopenia; hyponatremia, collapse, apathy; nausea or vomiting, lethargy, impotence; necrotizing angiitis, agranulocytosis; hypovolemia, confusion; exacerbation of pancreatitis, vasculitis; anaphylactic shock, weakness, drowsiness, erythema.

Price and analogues

Furasemide can be replaced by the following drugs - analogues: Lasix, Torasemide, Trigrim, Furosemide Sopharma. You can buy Furosemide tablets for 16-20 rubles, the price of injections is 25 rubles.

Opinions of patients and doctors

The drug "Furosemide", reviews of experts confirm this fact, is a key tool for the treatment of edematous syndrome in people with heart failure. This is a fast acting drug. Patients say that in addition to helping with edema and hypertension, the medication has side effects and is addictive (it is undesirable to use it for a long time).

Many women use the medicine "Furosemide" for weight loss. This tool allows you to quickly get rid of 3 - 5 kg of excess weight. However, for weight loss, doctors do not advise taking the drug, because it does not break down excess fat, but removes water and other necessary substances. Women claim that when taking more than 2 capsules per week, side effects and addiction appear.

On the forums you can meet the question: Which is better - "Lasix" or "Furosemide"? The pharmacists explain that the drugs are identical and their choice depends on price and availability.

Stagnation, swelling of soft tissues are quite common disorders that occur in many diseases of various organ systems. It is possible to improve the outflow and exit of fluid from the body with the help of drugs, of which there are a huge variety today. And quite often, doctors recommend the drug "Furosemide" to their patients. What does he help? What properties does it have? Are there any contraindications to treatment? Is it possible for side effects to occur? The answers to these questions are of interest to every patient.

The composition and form of release of the drug

The diuretic "Furosemide" is available in the form of tablets, as well as a solution for intravenous or intramuscular administration. There are also granules for the preparation of a suspension - this form of medicine is more suitable for the treatment of children.

The main active substance of the drug is furosemide. One tablet contains 40 mg of this component. In the pharmacy you can buy packs of 20 or 50 tablets. In some cases (especially when it comes to severe edema), it is advisable to use an injection solution - it is sold in 2 ml glass ampoules with a furosemide concentration of 1%. To date, packages of 10, 25 and 50 ampoules are sold.

In fact, in almost every pharmacy you can easily buy the drug "Furosemide". A prescription from a doctor for pills is not needed in this case, although some pharmacies have sales restrictions.

Main pharmacological properties

In modern medicine, the medicine "Furosemide" is very often used. Its use in some cases is simply necessary. This is a fast-acting diuretic that inhibits the reabsorption of chloride and sodium ions in the proximal and distal tubules of the kidney, which accelerates the process of excretion of their body fluid. The drug does not affect glomerular filtration in any way, so it is prescribed even in the presence of renal failure. Furosemide also dilates peripheral vessels, which reduces blood pressure.

After taking the pill, the effect, as a rule, begins to appear after 30-50 minutes. If we are talking about intravenous administration, then an increase in the volume of urine released begins after 15-20 minutes. The effect of the drug lasts about 3-4 hours.

The drug "Furosemide": what is it taken from? Indications for therapy

Everyone experiences health problems from time to time. So in what cases is it advisable to take the drug "Furosemide"? What does he help? The main indication for admission is edematous syndrome. In turn, edema can be a symptom of a variety of diseases.

Of course, often the stagnation of fluid indicates the presence of problems with the kidneys. In such cases, doctors often prescribe Furosemide. Indications for use - edema that has arisen against the background of chronic renal failure, nephrotic syndrome, hypercalcemia. In addition, the drug helps with hypertension, chronic heart failure, eclampsia, cardiac asthma. Also, the medicine helps fight swelling, which is associated with liver diseases. Indications also include pulmonary and cerebral edema.

The drug "Furosemide": instructions

These tablets, as mentioned earlier, can be freely bought at the pharmacy. If you have any problems, however, you should first consult a doctor. Only a specialist can prescribe you the drug "Furosemide". How to take pills, what is the maximum daily dose, how long will the treatment last - you will find answers to all these questions from your doctor. The instructions for use contain only general recommendations.

As a rule, the initial dose of the drug for adults is 40 mg of furosemide (one tablet). If there are no changes after taking the medicine, the doctor can increase the dose by 80-120 mg every 6-8 hours until a normal diuretic effect appears. However, there are some restrictions. No more than four tablets (160 mg) can be taken at a time. The maximum daily dose is 300 mg, but in such quantities the drug cannot be used for maintenance therapy, only as an emergency measure.

Often, patients suffering from edema and arterial hypertension are prescribed the drug Furosemide. How to take it in such cases? Most often, doctors recommend drinking one tablet twice a day. The duration of therapy is determined individually. As soon as the swelling begins to disappear, the dose of the drug is gradually reduced.

Intravenous and intramuscular administration is advisable only for persistent edema, as well as in cases where oral administration is not possible. If we are talking about the treatment of children, then the daily dose is 1-2 mg of furosemide per kilogram of weight.

Doctors often prescribe Furosemide (tablets) to their patients. The instructions for use contain some specific recommendations. Against the background of a long-term course of taking the drug, it is very important to control blood pressure all the time, as well as monitor the concentration of electrolytes in the plasma. Also, some patients are advised to take potassium supplements and eat a diet rich in this and other minerals.

Are there contraindications?

Many people are interested in the question of whether all categories of patients are allowed to take the drug "Furosemide" (tablets). Instructions for use confirms that there are some contraindications in this case. Each patient should familiarize themselves with their list even before the start of therapy.

To begin with, it is worth saying that the drug is not prescribed for a patient with hypokalemia, since the tablets can further reduce the level of potassium in the blood, which will affect the work of the whole organism, especially the cardiovascular system. Contraindications also include hypersensitivity to any of the components of the drug, lactose intolerance, lactase deficiency and wheat allergy.

The drug should not be prescribed in the presence of severe renal or hepatic insufficiency, hepatic coma. Also, contraindications include acute glomerulonephritis, in which there is a violation of the outflow of urine. The drug should not be taken by patients with impaired water and electrolyte balance, decompensated aortic and mitral stenosis, increased venous pressure, hypertrophic obstructive cardiomyopathy. The tablets are not intended for the treatment of children under the age of three.

Many people need to take the drug Furosemide. Indications for therapy are most often puffiness, and it is no secret to anyone that many pregnant women face a similar problem. It is immediately worth noting that taking this medication in the first trimester is strictly prohibited. In the second half of pregnancy, therapy is possible, but only under medical supervision. By the way, during lactation, the drug affects the functioning of the mammary glands, causing a decrease in the amount of milk (due to the removal of fluid). If therapy is still necessary, then it is better to stop breastfeeding for the duration of treatment.

Main Side Effects

Many people are interested in questions about what Furosemide is, what it is used for, etc. But no less important aspect is the presence of side effects. Statistical studies have shown that complications in most cases are the result of incorrect or too long medication. If you follow all the doctor's recommendations, the likelihood of side effects is minimal.

Against the background of therapy, hypotension, interstitial nephritis may develop. It is also possible to reduce the level of potassium in the blood, increase the level of glucose and uric acid, which is associated with increased diuresis. Sometimes there are reactions from the digestive (nausea, vomiting) and nervous systems (dizziness, headaches, fatigue, depression, confusion). It is also possible the appearance of strong thirst, dryness of the mucous membranes. Some patients develop allergic skin reactions.

Interaction with other drugs

Diuretic "Furosemide" is not recommended to be taken together with cephalosporins, ethacrynic acid, amphotericins and other drugs that have a nephrotoxic effect. This drug also increases the activity of theophylline and diazoxide, reduces the effect of allopurinol, non-depolarizing muscle relaxants. Be sure to tell your doctor about all medications you are taking. During therapy, it is strictly forbidden to drink alcohol.

Overdose and its consequences

Today, many patients are faced with the need to take the drug "Furosemide". Indications for its use are swelling and stagnation of fluid, which, alas, some people encounter very often. Unfortunately, too high doses of this drug can lead to dangerous consequences, in particular, hypovolemia, a condition that is accompanied by a decrease in circulating blood volume. Against the background of such a disorder, a sharp decrease in blood pressure is possible, as well as orthostatic collapse. The patient after an overdose urgently needs to be taken to the hospital. First of all, he needs to enter an electrolyte solution in order to restore blood volume. If necessary, further symptomatic therapy is carried out.

How much does the medicine cost?

So, we found out what the instruction tells about the drug "Furosemide". Tablets, their composition and properties are certainly very interesting. But no less important factor for many is the price of the medicine.

So how much will the drug cost? In fact, Furosemide stands out among other diuretics not only for its high efficiency, but also for its affordable cost. A package of 50 tablets with a dose of the active substance of 40 mg costs about 30-40 rubles. But 10 ampoules of this medicine will cost 25-30 rubles, which, you see, is not so much. Of course, the figure may vary depending on the city of residence of the patient, the pharmacy, the services of which he decided to use, and many other factors.

Drug analogues

In some cases, for a number of reasons, this or that medicine is not suitable for patients. Therefore, many are interested in whether it is possible to replace Furosemide with something. Analogues of this drug, of course, exist. The modern pharmaceutical market offers a huge selection of diuretics.

For example, Lasix is ​​considered a pretty good substitute. Also, the doctor may recommend taking drugs such as Furon or Frusemide. These are structural analogues that contain the same active substance and, accordingly, have a similar effect.

There are other diuretics that contain different ingredients but provide the same effect. Doctors often prescribe to their patients drugs such as "Urea", "Mannitol", "Trifas", "Clopamide", "Uregit". These are quite strong drugs that help to quickly solve the problem with edema. There are milder agents, the list of which includes Cyclomethiazide, Hypothiazid, Pterofen, Diakarb, Veroshpiron.

In any case, it should be understood that you cannot independently look for a substitute for the drug Furosemide. Analogues can only be selected by the attending physician, since everything here depends on the patient's state of health, his age, the characteristics of the disease and individual needs. Uncontrolled intake of diuretics can lead to dangerous consequences.

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 chamfer.

pharmachologic effect

"Loop" diuretic. In normal therapeutic doses, it disrupts the reabsorption of sodium and chloride ions in the thick segment of the ascending limb of the loop of Henle. Due to the increase in the release of sodium ions, there is a secondary (mediated by osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. Furosemide has secondary effects due to the release of intrarenal mediators and the redistribution of intrarenal blood flow. These effects increase the perfusion of the medullary layer of the kidneys. 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 BCC. In heart failure, it quickly leads to a decrease in the preload on the heart through the expansion of large veins. The diuretic effect is dose dependent. Against the background of course treatment, the weakening of the effect does not occur. Furosemide does not change the glomerular filtration rate and remains effective at a low glomerular filtration rate.

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

Pharmacokinetics

Suction:

Oral absorption is rapid but incomplete. Peak plasma concentration is reached after approximately 60 minutes. Digestive resorption is slowed down 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 about 0.150 l/kg.

Metabolism:

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

Derivation:

The half-life is about 50 minutes. Plasma clearance is 2 to 3 ml/min/kg. It is carried out through the urination and through the digestive tract (partly with bile). The significantly predominant urinary excretion is rapid and concerns mainly the active form of furosemide.

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

Features of pharmacokinetics in the elderly:

The binding of furosemide to albumin may be reduced in the elderly. The initial diuretic effect in elderly patients is less than in young people. Urinary excretion of furosemide decreases in proportion to gradually progressive age-related changes in tubular function.

Features of pharmacokinetics in patients with renal insufficiency:

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

Features of pharmacokinetics in newborns:

Oral bioavailability is reduced. In newborns, the elimination half-life is prolonged (up to 7 hours), since 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 a decrease in 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 who are contraindicated in the appointment of thiazide diuretics (especially with creatinine clearance below 30 ml / min).

Contraindications

Hypersensitivity to the active substance or to any of the excipients of the drug; hypersensitivity to sulfonamides due to the possible manifestation of cross-allergy 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 insufficiency 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 assess the potential teratogenicity of furosemide when taken during pregnancy. Furosemide should be avoided in pregnant women and should never be used to treat physiological edema in 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, as well as suppress lactation, if necessary, the use of the drug during lactation, breastfeeding should be discontinued.

Dosage and administration

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

Adults. With 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 doses, or 3-4 tablets per day in 2 doses.

With high blood pressure in patients with chronic renal failure: in combination with other antihypertensive agents (antagonists of the renin-angiotensin system), the recommended usual doses are 20-120 mg per day in 1 or 2 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 fall 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 of body weight in 1-2 doses.

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

Side effect

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

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

From the sense organs: visual and hearing impairment (hearing loss and tinnitus, usually transient, appear in rare cases, especially in patients with renal insufficiency, hypoproteinemia (for example, with nephrotic syndrome)).

From the digestive system: hepatic encephalopathy in patients with hepatocellular insufficiency, 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, reduced potency.

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

From the side of 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.

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

If adverse reactions occur, reduce the dose or discontinue the drug.

Overdose

Symptoms: pronounced decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including atrioventricular blockade, 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 state, 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, with cardiac glycosides, the risk of developing digitalis intoxication due to hypokalemia increases.

Hyponatremia

Use of diuretics, desmopressin, antidepressants that inhibit serotonin reuptake, carbamazepine, and oxcarbazepine increases the risk of 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 loss, 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 co-administration of medicinal products cannot be avoided, careful monitoring of serum lithium levels and dose adjustment of lithium is necessary.

Combinations requiring special care:

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

Anti-inflammatory nonsteroidal drugs, including aspirin, at anti-inflammatory doses of acetylsalicylic acid ≥1 g per dose and/or ≥3 g per day) or analgesics at 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 the level of potassium in the blood serum 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 ruled out. Serum potassium and ECG monitoring is recommended.

Aminoglycosides: potentiation of nephrotoxic and ototoxic effects of drugs.

Phenytoin: decrease in diuretic effect up to 50%. Higher doses of furosemide may be used.

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 stop the use of furosemide or reduce its dose 3 days before the start of treatment with ACE inhibitors / angiotensin II receptor antagonists. In congestive heart failure, it is recommended to start treatment with low doses of ACE inhibitors. It is recommended to monitor kidney function (determination of creatinine) in the first weeks of treatment with ACE inhibitors / angiotensin II receptor antagonists.

Medicines that increase the risk of ventricular arrhythmia;

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

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

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

The simultaneous 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, electrocardiographic parameters is recommended.

Metformin: development of lactic acidosis is possible. 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 the antihypertensive drug.

Significant interactions of furosemide with other drugs:

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

Antipsychotics, 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 preparations: risk of ototoxicity and/or nephrotoxicity.

Precautionary measures

In the presence of ascites without peripheral edema, it is recommended to use furosemide in doses that provide additional diuresis in a volume of not more than 700-900 ml per day in order to avoid the development of oliguria, azotemia and electrolyte disturbances.

Long-term use can lead to weakness, fatigue, decreased blood pressure and cardiac output, and excessive diuresis in 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 intake of table salt. For the prevention of hypokalemia, the simultaneous administration of potassium preparations and potassium-sparing diuretics is recommended, as well as a diet rich in potassium.

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

Accidental use of the drug can lead to hypovolemia, dehydration.

In hepatocellular insufficiency, treatment should be carried out with caution, under strict control of electrolytes, given 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. Diuresis should be closely monitored, especially at the start of treatment with furosemide.

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

When using thiazide diuretics, there have been cases of photosensitivity reactions. If photosensitivity reactions occur, furosemide should be discontinued. If necessary, it is recommended to protect exposed areas of the skin exposed to sunlight or ultraviolet radiation from artificial sources.

Since the medicinal product contains lactose, its use is not recommended in 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: a possible decrease in 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 can lead to a transient increase in creatinine, cholesterol, triglycerides.

There have been several cases of kidney stones in premature infants receiving high doses of furosemide injections due to the development of hypercalciuria. Electrolyte balance:

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

Potassium. When using loop diuretics, a decrease in sodium levels with hypokalemia is possible. 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 release of uric acid decreases, therefore, with hyperuricemia and especially gout, the use is not recommended.

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

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

Influence 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 ruled out, therefore, driving vehicles and other activities that require increased attention and reaction speed are not recommended.

Release form

10 tablets in a blister pack made of PVC film and aluminum foil; 50 tablets in a jar. Each jar or one, five contour packs, together 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.

Terms of dispensing from pharmacies

On prescription.

Self-medication can be harmful to your health.
It is necessary to consult a doctor, and also read the instructions before use.

Photo of the drug

Latin name: Furosemide

ATX Code: C03CA01

Active substance: Furosemide (Furosemide)

Producer: Borisov Plant of Medical Preparations (Republic of Belarus), Novosibkhimfarm, Dalchimpharm, Biochemist, Binnopharm CJSC, Ozon Pharm LLC (Russia), Mangalam Drugs & Organics Ltd, Ipca Laboratories (India)

The description applies to: 01.11.17

Furosemide is a medicinal diuretic drug for the removal of edematous syndrome. This tool enhances the excretion of water from the body, as well as magnesium and calcium ions.

Active substance

Furosemide (Furosemide).

Release form and composition

Available in the form of tablets and solution for intramuscular and intravenous administration.

Indications for use

The main indication is edematous syndrome of various origins. The tool is shown with:

• nephrotic syndrome;
• chronic heart failure of the second and third degree;
• cirrhosis of the liver.

It is used in the following pathological conditions:

• pulmonary edema;
• swelling of the brain;
• cardiac asthma;
• eclampsia;
• hypercalcemia;
• severe arterial hypertension;
• some forms of hypertensive crisis.

The above medication is used when conducting forced diuresis.

Contraindications

Contraindicated in:

• acute glomerulonephritis;
• stenosis of the urethra;
• hyperuricemia;
• obstruction of the urinary tract by a stone;
• acute renal failure, accompanied by anuria;
• alkalosis;
• hypokalemia;
• acute myocardial infarction;
• severe liver failure;
• diabetic coma;
• hepatic precoma and coma;
• arterial hypotension;
• gout;
• decompensated aortic and mitral stenosis;
• hyperglycemic coma;
• hypertrophic obstructive cardiomyopathy;
• high central venous pressure;
• digitalis intoxication;
• pancreatitis;
• violation of water and electrolyte metabolism (hypomagnesemia, hypocalcemia, hyponatremia, hypochloremia, hypokalemia, hypovolemia);
• hypersensitivity to the drug;
• in precomatose states.

With extreme caution prescribed to women during pregnancy and breastfeeding, the elderly, as well as patients suffering from severe atherosclerosis, hypoproteinemia, diabetes mellitus and prostatic hyperplasia.

Instructions for use Furosemide (method and dosage)

The dosage and form of the drug is selected individually depending on the indications, the severity of the disease and the age of the patient. If necessary, the dosage may be adjusted during therapy.

Pills

Furosemide tablets are taken orally in the morning before breakfast.

The initial dosage for adults is 20-40 mg per day. If necessary, the dose is increased to 80-160 mg per day, which are taken in 2-3 doses with an interval of 6 hours. The maximum daily dosage is 600 mg. After elimination of puffiness, the dosage is reduced and the drug is taken at intervals of 1-2 days.

For the treatment of edema in CHF, 20-80 mg of furosemide per day is prescribed. The recommended dose is divided into 2-3 doses with an equal interval.

To eliminate edema in chronic kidney disease, the initial dosage is 40-80 mg per day. The drug is taken once or divided into 2 equivalent doses. In the future, the dosage is adjusted depending on the diuretic response. Maintenance therapy for patients on hemodialysis is 250-1500 mg per day.

For the treatment of arterial hypertension, 20-40 mg per day is prescribed. To achieve the maximum effect, Furosemide should be combined with antihypertensive drugs.

With nephrotic syndrome, 40-80 mg per day is prescribed. In the future, the dosage is adjusted depending on the body's response to ongoing therapy.

The initial dosage for children is 1-2 mg per kilogram of body weight. The maximum allowable dose is 6 mg/kg.

Injection

With jet intravenous or intramuscular administration of the drug, the recommended dose for adult patients is 20-40 mg per day. In rare cases, it is possible to increase the dosage by 2 times, which are administered twice a day.

Side effects

Furosemide may cause the following side effects:

• Cardiovascular system: lowering blood pressure, arrhythmia, tachycardia, orthostatic hypotension, collapse.
• Nervous system: drowsiness, myasthenia gravis, apathy, weakness, lethargy, confusion, convulsions of the calf muscles, headache, paresthesia, adynamia.
• Sense organs: impaired hearing and vision.
• Gastrointestinal tract: dry mouth, nausea, exacerbation of pancreatitis, thirst, vomiting, loss of appetite, diarrhea or constipation and cholestatic jaundice.
• Genitourinary system: hematuria, interstitial nephritis, acute urinary retention, reduced potency.
• Hematopoietic system: aplastic anemia, agranulocytosis, leukopenia and thrombocytopenia.
• Water and electrolyte metabolism: hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia, hypochloremia, hypokalemia.
• Metabolism: hyperglycemia, muscle weakness, convulsions, arterial hypotension, hyperuricemia and dizziness.
• Allergic reactions: erythema multiforme exudative, photosensitivity, pruritus, exfoliative dermatitis, urticaria, vasculitis, purpura, fever, chills, necrotizing angiitis and anaphylactic shock.

Overdose

In case of an overdose, there is a pronounced decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias, acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy.

Treatment requires normalization of water and electrolyte balance and acid-base status, replenishment of circulating blood volume, gastric lavage, activated charcoal, symptomatic treatment. There is no specific antidote.

Analogues

Furosemide analogues according to the ATC code: Lasix, Furon, Furosemide injection solution, Fursemide.

Do not make the decision to change the drug yourself, consult your doctor.

pharmachologic effect

The active component of this drug has a diuretic effect, helping to increase the excretion of water from the body with magnesium and calcium ions.

The use of Furosemide in heart failure leads to a rapid decrease in the preload on the heart caused by the expansion of large veins.

The effect of the drug after intravenous administration occurs very quickly - after five to ten minutes, and after oral use - after an hour. The duration of the diuretic action of Furosemide varies from two to three hours. With reduced kidney function, the therapeutic effect of the drug lasts up to eight hours.

special instructions

Before starting treatment, you should make sure that the urinary system is functioning normally and that there is no violation of the outflow of urine.

Patients undergoing treatment with Furosemide require periodic monitoring of blood pressure, uric acid, plasma electrolytes, creatinine, kidney and liver function, and glucose levels.

While taking the drug, you should refuse to drive a vehicle and work with complex mechanisms that require increased concentration and reaction speed.

Furosemide solution for intravenous or intramuscular injection should not be mixed in the same syringe with other drugs.

During pregnancy and breastfeeding

Furosemide is contraindicated during pregnancy and breastfeeding.

In childhood

Contraindicated in children under the age of 3 years.

In old age

It is prescribed with caution to elderly patients.

For impaired renal function

Patients with chronic renal failure require careful selection of the dosage of the drug. Furosemide is contraindicated in acute glomerulonephritis and acute renal failure with anuria.

For impaired liver function

It is prescribed with extreme caution to patients with severe liver dysfunction. Requires selection of the dosage of the drug. Furosemide is contraindicated in patients with severe hepatic impairment, hepatic coma and precoma.

Furosemide is an effective fast-acting diuretic used for excessive accumulation of fluid in the organs of the urinary system, as a diuretic for edema, etc. Let us consider in more detail the drug Furosemide - why it is prescribed, how the tablets or solution work and how effective they are.

Feature of the product

The drug is produced both in the form of tablets and in the form of a solution for injection. The rate of appearance of the first positive results of treatment with Furosemide depends on the use of one or another dosage form of the drug. So, when administered intravenously, it can quickly cause the desired effect and has a diuretic effect after 15 minutes, when using a tablet form - after half an hour. In this case, the effect persists for quite a long time, up to four hours.

For Furosemide, the indications for use are quite extensive. This medicine is prescribed for diseases such as hypertension, kidney and heart failure, nephrotic syndrome, as well as for serious disorders of the liver (for example, with 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 renal failure. The hypotensive effect of the drug expands the scope of its application.

However, this drug may not always be prescribed. For Furosemide, contraindications may be:

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

As a rule, Furosemide for edema is prescribed at 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 (in 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.

Furosemide for cystitis

In order to understand why Furosemide is prescribed for cystitis, you need to know what this disease is. Cystitis is an inflammatory process that occurs in the bladder, which is of a bacterial nature and primarily affects the mucous membrane of the organ. The causative agents of cystitis are the bacteria Escherichia and Pseudomonas aeruginosa, staphylococcus and Candida fungi. Once in the bladder, these microorganisms begin to multiply actively, as a result of which the order of the work of this organ is disrupted.

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

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

However, Furosemide for cystitis cannot be the only drug or form the basis of therapy. It must be remembered that inflammation of a bacterial nature requires the use of antibiotics or at least antiseptic herbal preparations, if we are talking about the initial stage of the disease. In the absence of a full-fledged treatment, the disease will progress, and symptoms such as:

If the symptomatic picture is replenished with the above signs, the patient will be shown 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 the excretion of urine and increase the volume of circulating fluid, then for edema it is used to remove excess fluid 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 excreted must be equivalent in volume. Otherwise, excess fluid will accumulate in the body. If at the same time it begins to be deposited in tissues and cavities, a person may not notice this at first. Only external edema formed on the face, limbs, etc. become noticeable immediately.

Edema occurs due to a number of diseases and dysfunctions. For example, due to allergies, liver disease, due to the use of certain drugs. 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) daily, as swelling decreases, 1 time in two or three days, until the complete cessation of use.

It is noted that a person who has taken the drug once already notices a slight decrease in edema, and after a few days they, in most cases, disappear altogether.

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

You should be aware that the uncontrolled use of diuretics, including Furosemide, can lead to very serious consequences. In addition, with the liquid excreted from the body, especially in large volumes, many useful elements are washed out, such as magnesium, calcium, potassium, sodium, etc. If the drug is prescribed by a doctor, he gives recommendations for correcting nutrition or prescribes vitamin-mineral complexes.

If, for some reason, the use of diuretics is not possible, for example, the maximum allowable duration of the course of taking Furosemide is exceeded, you can use other methods to relieve 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 body's water balance, which in itself is very dangerous.

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

Since the uncontrolled use of Furosemide can cause a decrease in the level of potassium in the body, it is recommended to take drugs that prevent this in parallel.

Release form and mechanism of action

Furosemide is produced in the form of tablets of 40 mg, 10 pcs in a blister. There are 5 blisters in the package. Or in the form of ampoules of 10 mg 2 ml.

Furosemide belongs to the class of diuretics.. It is a fast-acting loop diuretic. Its effect is short and strong.

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

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

When taking tablets, the effect occurs within an hour and lasts 4 hours.. With intravenous administration of Furosemide, the onset of the 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;
• Edema with liver problems.

Method of application 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 severe renal failure, it can be increased to 320 mg.

After the disappearance of edema, the dose is reduced to a minimum, and a break is taken between taking 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. Intramuscularly, the drug is rarely administered, when other methods of administration are inappropriate. Furosemide injections are made for no more than 7 days, then the patient is transferred to tablets.

Side effects

When using Furosemide, the following side effects may occur:

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

Contraindications

The drug has contraindications, be careful!

With increased sensitivity to its components;

• With hypokalemia;
• With hypovolemia;
• With anuria;
• In case of poisoning with hepatotoxic or nephrotoxic drugs, as a result of which renal failure develops;
• Precomatous and coma 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, a decrease in the action of Furosemide is possible;
• With the simultaneous use of the drug and high doses of cephalosporins, renal dysfunction may occur.

special instructions