What are the contraindications for Lasix (furosemide)?

From the Guidelines

Lasix (furosemide) should not be used in patients with anuria, severe hypovolemia, or hypersensitivity to furosemide or sulfonamides, and should be used with caution in patients with severe electrolyte imbalances, hepatic cirrhosis, hepatic coma, severe renal impairment, or sulfa allergies. The contraindications and precautions for Lasix use are based on its mechanism of action as a potent diuretic that inhibits sodium and chloride reabsorption in the kidneys, which can worsen fluid depletion in hypovolemic patients or cause dangerous electrolyte imbalances in susceptible individuals 1.

Key Considerations

• Anuria: Lasix cannot work effectively in patients with complete absence of urine production, as it relies on kidney function to induce diuresis.
• Severe hypovolemia: Using Lasix in patients with decreased blood volume can lead to further fluid depletion and potentially life-threatening complications.
• Hypersensitivity: Patients allergic to furosemide or sulfonamides may experience cross-reactivity, leading to allergic reactions ranging from mild to severe.
• Electrolyte imbalances: Lasix can exacerbate existing imbalances, particularly hypokalemia, hyponatremia, or hypocalcemia, by increasing urine output of these electrolytes.
• Hepatic cirrhosis and coma: Patients with liver disease may have altered drug metabolism and increased sensitivity to Lasix's effects, requiring cautious use.
• Severe renal impairment: Lasix's efficacy and safety in patients with significant kidney dysfunction are compromised, necessitating careful consideration of its use.
• Sulfa allergies: The potential for cross-reactivity between sulfonamides and furosemide warrants caution in patients with known sulfa allergies.

Special Populations

• Pregnant women: Lasix should be used only if clearly needed, as it crosses the placental barrier and may affect fetal development.
• Patients with gout, diabetes, or systemic lupus erythematosus: Lasix may exacerbate these conditions, requiring careful monitoring and adjustment of treatment plans.

By understanding the contraindications and precautions for Lasix use, healthcare providers can minimize risks and optimize outcomes for patients requiring diuretic therapy, prioritizing morbidity, mortality, and quality of life as the primary outcomes 1.

From the FDA Drug Label

Furosemide tablets are contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide. Furosemide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.

The contraindications for Lasix (furosemide) are:

• Anuria: patients with no urine production
• Hypersensitivity: patients with a history of hypersensitivity to furosemide 2 3

From the Research

Lasix Contraindications

• The following are potential contraindications for Lasix (furosemide):
  • Hypersensitivity to furosemide 4
  • Anuria 4
  • Severe hepatic impairment 5
  • Renal failure 4, 6
  • Hypovolemia 6
  • Electrolyte disturbances (e.g. hypokalemia) 5
• Patients with cirrhosis of the liver may be at increased risk of adverse reactions to furosemide, including electrolyte disturbances, volume depletion, and hepatic encephalopathy 5
• Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac and indomethacin may suppress the diuretic action of furosemide 7
• Patients with chronic kidney disease undergoing hemodialysis may require careful monitoring of renal function when using furosemide 8

Special Considerations

• Furosemide should be used with caution in patients with:
  • Severe renal impairment 4, 6
  • Hepatic impairment 5, 6
  • Cardiac disease 4
  • Hypertension 4
• Patients should be monitored for signs of electrolyte disturbances, volume depletion, and renal impairment when using furosemide 4, 5, 6, 8