Index of drugs

Swelling and / or ascites due to heart or liver disease. Swelling caused by kidney diseases (in the case of nephrotic syndrome, the primary disease should be treated first). Pulmonary edema (eg in the case of acute heart failure). A hypertensive crisis (as a supplement to other therapeutic procedures).

1 ampoule of 2 ml contains 20 mg furosemide.

Diuretic from the group of loop diuretics. It inhibits sodium chloride back-resorption in the ascending arm of the nephron loop, increasing the excretion of sodium. Increases the excretion of potassium, Calcium and magnesium. It lowers blood pressure, reduces the volume of circulating blood and weakens the reaction of the smooth muscle of blood vessels to stimulate contraction. After intravenous administration, the onset of the diuretic occurs within 15 min and maintains about 3 hours. Plasma protein binding is approximately 98%. Furosemide is excreted mainly unchanged. T_0,5 in the blood is 1-1.5 hours and may be prolonged in patients with impaired liver or kidney function. It passes through the placenta barrier and into breast milk.

Hypersensitivity to the preparation ingredients or sulfonamides. Patients with renal failure, oliguria / anuria, unresponsive to furosemide therapy. Renal failure caused by poisoning with hepato- or nephrotoxic substances. Patients in pre-coma or comatose states due to hepatic encephalopathy. Patients with severe hypokalaemia, hyponatraemia, hypovolaemia with or without hypotension or dehydration. Breastfeeding period.

Special care should be taken in patients with partial narrowing of the urinary tract (eg with prostatic hyperplasia); hypotension or with an increased risk of prolonged hypotension (with narrowing of the coronary arteries or narrowing of the arteries of the brain); with overt or latent diabetes or Glucose disturbances (regular monitoring of blood glucose is required); with gout and hyperuricaemia (regular monitoring of uric acid levels in blood serum); with liver diseases or with hepatorenal syndrome; hypoproteinaemia (associated with nephrotic syndrome, the effects of furosemide can be reduced and its ototoxicity increased); when co-administered with lithium salts (monitoring of lithium concentration is required); sharp porphyria. Use with caution in cases of electrolyte disturbances, water management, dehydration, reduction of circulating blood volume (causing cardiovascular collapse and the possibility of thrombosis and embolism, especially in elderly patients, using high doses of the medicinal product), ototoxicity (if the medicinal product is administered at a rate of more than 4 mg / ml, or when co-administered with other ototoxic products, the risk of its occurrence may increase); high doses, in progressive and severe kidney disease, with sorbitol, in lupus erythematosus, with drugs that prolong the QT interval, in premature babies (the possibility of renal calf / kidney stones, renal function and ultrasound should be monitored). There have been reports of hypersensitivity reactions to light associated with the use of thiazide diuretics. If a hypersensitivity reaction occurs during the use of the medicinal product, discontinuation of therapy is recommended. If a thiazide diuretic is necessary, it is recommended to cover the skin surface exposed to sunlight or artificial UVA.

The drug can be used during pregnancy only in the case of important medical indications; use for a short time. Furosemide is contraindicated during breastfeeding.

Uncommon: thrombocytopenia (may become symptomatic, especially with an increased tendency to bleed), itching, skin and mucosal reactions (eg bullous rash, rash, urticaria, purpura, erythema multiforme, exfoliative dermatitis, hypersensitivity to light ).Rare: increased serum cholesterol and triglycerides: eosinophilia, leukopenia, bone marrow suppression (if symptoms occur, treatment should be discontinued), paresthesia, diarrheal headache, dizziness, drowsiness, confusion, feeling of pressure in the head , blurred vision, blurred vision with symptoms of hypovolaemia, which in severe cases may lead to dehydration, impaired hearing and / or ringing in the ears (the probability of occurrence is greater in the case of rapid intravenous administration, especially in patients with renal insufficiency or hypoproteinemia, e.g. nephrotic syndrome), tinnitus, nausea, vomiting and diarrhea, anorexia, stomach disorders, constipation, dry mouth, interstitial nephritis, vasculitis, exacerbation or the appearance of lupus erythematosus, muscle spasms legs, a decrease in plasma calcium (in very rare cases, a tetany was observed), chronic arthritis, febrile states; after intramuscular administration, a local reaction may occur, e.g. pain, severe anaphylactic and anaphylactoid reactions, such as anaphylactic shock. Very rare: hemolytic anemia, aplastic anemia, agranulocytosis, acute pancreatitis. In addition, in the initial period of treatment and in elderly patients, very strong diuresis may lead to a decrease in blood pressure, which, if it is long-lasting, may lead to signs and symptoms, such as: orthostatic hypotension, severe hypotension, tightness in the head, dizziness headache, circulatory collapse, thrombophlebitis or sudden death (after intramuscular or intravenous administration). The diuretic effect of furosemide may lead to, or contribute to, hypovolaemia and dehydration, especially in elderly patients. A significant reduction in intravascular volume may cause blood thickening with a tendency to form blood clots. Diuretics may exacerbate or reveal symptoms of acute urinary retention (bladder emptying disorder, prostatic hyperplasia or urethral stricture), vasculitis, glycosuria, transient increases in creatinine and urea in the blood. Furosemide may reduce glucose tolerance. In patients with diabetes, this may lead to worsening of metabolic parameters; latent diabetes may appear. Water-electrolyte imbalance may occur (hypokalemia, hyponatraemia and metabolic alkalosis), especially in the case of long-term treatment or when high doses are used. There may be a decrease in potassium concentration, especially when using a diet low in this element. Especially in the case of a simultaneous reduced supply of potassium and / or increased extra-renal loss (eg due to vomiting or chronic diarrhea), hypokalaemia may occur, due to increased urinary excretion of potassium. There are neuromuscular symptoms (muscle weakness, paresthesia, paresis), intestinal (vomiting, constipation, bloating), renal (polyuria, excessive thirst) and cardiac (arrhythmia and conduction). Significant loss of potassium can lead to paralytic intestinal obstruction or impaired consciousness, with coma in extreme cases. In addition, existing diseases (eg cirrhosis or heart failure), concomitant medicinal products and diet can cause potassium deficiency. Due to the increased excretion of sodium in the urine, hyponatraemia with accompanying symptoms may occur, especially when using a low-sodium diet. Increased calcium loss in the urine can lead to hypocalcaemia, which may in rare cases cause tetany. In patients with increased Magnesium loss in the urine, tartar or cardiac arrhythmias due to hypomagnesaemia may rarely occur. Some patients may have increased uric acid levels and gout attacks. Metabolic alkalosis or pre-existing metabolic alkalosis (eg in decompensated cirrhosis) may be more severe. In premature babies treated with Furosemide, kidney stones and / or kidney calcium may occur due to calcium deposition in kidney tissue. In premature babies with respiratory distress syndrome, the risk of persistent Botal ductus arteriosus may increase. There have been reports of intrahepatic cholestasis, cholestatic jaundice, hepatic ischemia, and increased hepatic transaminase levels.

Parenteral administration of furosemide is indicated in cases in which fast and effective diuresis is required, and oral administration is impossible or ineffective. It is recommended to start oral administration as soon as possible. To achieve maximum effectiveness and prevent the opposite effect, it is recommended to administer furosemide in a continuous infusion instead of repeated bolus infusions. When it is impossible to administer furosemide in a continuous infusion, to continue treatment after one or several doses in a rapid bolus, it is preferable to administer several small doses in short intervals (approximately every 4 hours) than to administer bolus doses at longer intervals . Intravenously furosemide should be administered no faster than 4 mg / min. and do not administer other medicinal products in the same syringe. Intramuscular administration of furosemide must be limited only to exceptional cases where oral or intravenous administration of the preparation is impossible. The intramuscular administration is not suitable in acute conditions, such as pulmonary edema. Intravenous use. Adults and adolescents over 15 years of age: 20-40 mg at a time, at a rate of not more than 4 mg / min, if necessary, the dose should be increased once by 20 mg and repeated every 2 hours to achieve the appropriate therapeutic effect; the maximum daily dose is 1500 mg. Children under 15: in exceptional cases, 0.5-1 mg / kg / day; the maximum daily dose is 20 mg. In elderly patients, the starting dose is 20 mg per day, then increased gradually to achieve the desired response. In severe renal failure, the dose should be infused at a rate of not more than 2.5 mg / min. In edema associated with congestive heart failure, liver disease and kidney disease: initially 20-40 mg once or in several divided doses; if necessary, in the case of edema associated with kidney disease, the drug should be given as a continuous infusion at the initial rate of 50-100 mg / h; in dialysis patients, the maintenance dose is 250-1500 mg / day. In pulmonary edema: initially 40 mg intravenously, after 30-60 min a further dose of 20-40 mg can be given. At hypertensive crisis: 20-40 mg by intravenous injection in the form of a bolus. If it is absolutely necessary to administer the preparation intravenously to people with liver disease, the initial dose should be 20-40 mg. The dose can be adjusted depending on the patient's response to treatment. The total daily dose may be administered in a single dose or in several divided doses. Furosemide can be used in combination with aldosterone antagonists in cases where these medicinal products are ineffective as monotherapy.