From the Guidelines
The effects of Lasix (Furosemide) tablets include increased urine output, potential hypokalemia, and a risk of dehydration, hypotension, and renal function changes, with a typical starting dose of 20-40 mg/day and a maximum dose of 160 mg/day, as recommended in the management of adult patients with ascites due to cirrhosis 1.
Key Effects of Furosemide
- Increased urine output due to inhibition of sodium and chloride reabsorption in the kidneys
- Potential for hypokalemia, requiring monitoring of electrolyte levels
- Risk of dehydration, hypotension, and renal function changes, necessitating careful patient monitoring
Dosage and Administration
- Typical starting dose: 20-40 mg/day
- Maximum dose: 160 mg/day
- Administration: oral, with the option for intravenous use in emergency situations
Clinical Considerations
- Furosemide is commonly used in combination with aldosterone antagonists, such as spironolactone, for the management of ascites in patients with cirrhosis
- Patients with parenchymal renal disease may require adjusted dosing due to the risk of hyperkalemia
- Monitoring of serum sodium, potassium, and creatinine levels is essential to minimize the risk of complications
Recent Guidelines
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends furosemide as a commonly used oral diuretic, with an initial daily dose of 20-40 mg and a maximum total daily dose of 600 mg 1
- The guideline also highlights the importance of monitoring patients for signs of diuretic resistance and adjusting treatment accordingly
From the FDA Drug Label
ADVERSE REACTIONS Adverse reactions are categorized below by organ system and listed by decreasing severity Gastrointestinal System Reactions hepatic encephalopathy in patients with hepato-cellular insufficiency pancreatitis jaundice (intrahepatic cholestatic jaundice) increased liver enzymes anorexia oral and gastric irritation cramping diarrhea constipation nausea vomiting Systemic Hypersensitivity Reactions Severe anaphylactic or anaphylactoid reactions (e. g with shock) systemic vasculitis interstitial nephritis necrotizing angiitis Central Nervous System Reactions tinnitus and hearing loss paresthesias vertigo dizziness headache blurred vision xanthopsia Hematologic Reactions aplastic anemia thrombocytopenia agranulocytosis hemolytic anemia leukopenia anemia eosinophilia Dermatologic-Hypersensitivity Reactions toxic epidermal necrolysis Stevens-Johnson Syndrome erythema multiforme drug rash with eosinophilia and systemic symptoms acute generalized exanthematous pustulosis exfoliative dermatitis bullous pemphigoid purpura photosensitivity rash pruritis urticaria Cardiovascular Reaction Orthostatic hypotension may occur and be aggravated by alcohol, barbiturates or narcotics Increase in cholesterol and triglyceride serum levels Other Reactions hyperglycemia glycosuria hyperuricemia muscle spasm weakness restlessness urinary bladder spasm thrombophlebitis fever
The effects of Lasix (Furosemide) tablets include:
- Gastrointestinal reactions: such as hepatic encephalopathy, pancreatitis, and jaundice
- Systemic hypersensitivity reactions: such as severe anaphylactic reactions and systemic vasculitis
- Central nervous system reactions: such as tinnitus, hearing loss, and dizziness
- Hematologic reactions: such as aplastic anemia and thrombocytopenia
- Dermatologic-hypersensitivity reactions: such as toxic epidermal necrolysis and Stevens-Johnson Syndrome
- Cardiovascular reactions: such as orthostatic hypotension and increased cholesterol and triglyceride serum levels
- Other reactions: such as hyperglycemia, glycosuria, and hyperuricemia 2
PRECAUTIONS General Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients. As with any effective diuretic, electrolyte depletion may occur during Furosemide tablets therapy, especially in patients receiving higher doses and a restricted salt intake Hypokalemia may develop with Furosemide tablets, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives.
Additional effects of Lasix (Furosemide) tablets include:
- Electrolyte depletion: which may occur during therapy, especially in patients receiving higher doses and a restricted salt intake
- Hypokalemia: which may develop, especially with brisk diuresis or inadequate oral electrolyte intake
- Dehydration and blood volume reduction: which may cause circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients 2
From the Research
Effects of Lasix (Furosemide) Tablets
The effects of Lasix (Furosemide) tablets can be understood through various studies that have examined their diuretic and clinical effects in different patient populations.
- The diuretic effect of furosemide has been observed to be significant in congestive heart failure patients, with a peak effect within 60-120 minutes 3.
- Furosemide has also been associated with severe hypokalemia and rhabdomyolysis, particularly when abused or taken in high doses 4.
- In patients with acute decompensation of advanced chronic heart failure, continuous infusion of furosemide has been shown to be more effective than bolus intermittent administration in achieving decongestion and increasing urinary output 5.
- The efficacy of once-daily dosing of furosemide has been questioned due to its short-acting nature, with some studies suggesting that twice-daily dosing may be more effective 6, 7.
- Combining furosemide treatment with a sodium-restricted diet can enhance the effects of the diuretic treatment 6.
- The natriuretic and diuretic effects of single and divided doses of furosemide have been compared, with results showing no significant differences between the two regimens in cumulative 24-hour excretion of sodium, potassium, chloride, or water 7.