1 vial 250mg

$9.62

1 vial 20mg

59 cents

1 tablet 40mg

1 cent

Diurin, Lasix, Furosemide

  • Fluid retention manifesting as pulmonary or peripheral oedema

  • Hyperkalaemia

PO:
Tablets:
Diurin 40mg tablets (off white), Diurin 500mg tablets (off white)
Oral Solution:
Lasix oral solution 10mg/ml

IV:
IV formulations available are:

  • Frusemide injection 20mg/2ml solution

  • Lasix high dose infusion 250mg in 25ml with 1000mg of mannitol as a stabilising agent

Administer doses of up to 80mg by slow IV injection over 2-5 minutes
For infusion doses of up to 5mg/hr use low dose infusion mixture of 40mg in 40ml of compatible IV fluid; for infusion doses of greater than 5mg/hr use high dose infusion mixture with undiluted Lasix high dose infusion (ie 250mg in 25ml or 500mg in 50ml)
Rate of infusion should not exceed 4mg/min
Compatible with the following IV fluids:
Normal saline Hartmanns
Note: glucose solutions are unsuitable
Store at room temperature; protect from light
Dilutions in compatible IV fluid are stable for 24 hours at room temperature – discard if not used within 24 hours. Do not use if solutions have a yellow colour or contain crystal deposits


ADULT DOSE

PO:
Usual dosage from 10mg daily to 80mg three times a day

IV:
Dosage is highly individualised. 5mg may be sufficient to cause significant diuresis in the frusemide naïve patient. Doses of 100mg/hr by infusion may be required in those with significant renal impairment.

PAEDIATRIC DOSE

IV/ PO:
Usually, 0.5-1mg/kg 6 hourly to four times a day.
IV infusion: 50mg/kg in 50ml of normal saline at 0.1-1 mg/kg/hr (i.e 0.1-1ml/hr)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose in renal impairment [GFR (ml/min)]
<10 dose as in normal renal function; increased doses may be required
10-20 dose as in normal renal function; increased doses may be required
>20-50 dose as in normal renal function

Dose in renal replacement therapy
CAPD not indicated
HD not indicated
CVVHDF rarely indicated; increased doses may be required

Frusemide is a potent diuretic that inhibits the absorption of sodium and chloride in the proximal and distal tubules and the loop of Henle.

CONTRAINDICATIONS:

  • Known hypersensitivity to frusemide


WARNINGS
Allergy to Sulfur drugs
Patients allergic to sulfonamides may also be allergic to frusemide.
Ototoxicity
Cases of tinnitus and reversible or irreversible hearing impairment have been reported. Usually, reports indicate that frusemide ototoxicity is associated with rapid injection, severe renal impairment, doses exceeding several times the usual recommended dose, or concomitant therapy with aminoglycoside antibiotics or other ototoxic drugs.

PRECAUTIONS
General
Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse
As with any effective diuretic, electrolyte depletion may occur during frusemide therapy, especially in patients receiving higher doses and a restricted salt intake. Hypokalaemia may develop with frusemide, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids or ACTH. Digitalis therapy may exaggerate metabolic effects of hypokalaemia, especially myocardial effects.
Asymptomatic hyperuricaemia can occur and gout may rarely be precipitated.

Laboratory Tests:
No tests in addition to routine ICU tests are required.

Drug/Laboratory Test Interactions
None noted.

Frusemide may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination.

Lithium generally should not be given with diuretics because they reduce lithium's renal clearance and add a high risk of lithium toxicity.

Gastrointestinal System Reactions:
Pancreatitis, jaundice (intrahepatic cholestatic jaundice), anorexia, oral and gastric irritation, cramping, diarrhoea, constipation, nausea, and vomiting.
Systemic Hypersensitivity Reactions:
Systemic vasculitis, interstitial nephritis, and necrotising angiitis.
Central Nervous System Reactions:
Tinnitus and hearing loss, paraesthesias, vertigo, dizziness, headache, blurred vision, and xanthopsia.
Haematologic Reactions:
Aplastic anaemia (rare), thrombocytopaenia, agranulocytosis (rare), haemolytic anaemia, leukopaenia, and anaemia.
Dermatologic-Hypersensitivity Reactions:
Exfoliative dermatitis, erythema multiforme, purpura, photosensitivity, urticaria, rash, and pruritus.
Cardiovascular Reaction:
Orthostatic hypotension may occur and be aggravated by alcohol, barbiturates or narcotics.
Other Reactions:
Hyperglycaemia, glycosuria, hyperuricaemia, muscle spasm, weaknesses, restlessness, urinary bladder spasm, thrombophlebitis, and fever.

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