Furosemide Administration via Intramuscular Route
Yes, furosemide can be administered intramuscularly (IM) as indicated in the FDA drug label, which specifically states that furosemide injection is prepared for both intramuscular and intravenous use. 1
Administration Routes for Furosemide
- Furosemide is available for administration through multiple routes including oral, intravenous (IV), and intramuscular (IM) as indicated in the FDA-approved labeling 1
- The FDA label specifically states that furosemide injection is "a sterile, nonpyrogenic solution of furosemide in Water for Injection prepared for intramuscular (IM) or intravenous (IV) use" 1
Clinical Considerations for IM Administration
Efficacy Considerations
- IM administration is less commonly used than IV or oral routes in clinical practice 2
- Bioavailability from IM administration is more reliable than oral administration, which can be highly variable (oral bioavailability ranges from 20-84% between individuals) 3
- When IV access is unavailable and oral administration is not feasible, IM administration provides an alternative route 4
Practical Considerations
- IM furosemide should be administered at appropriate dosages similar to IV dosing (typically 0.5-2 mg/kg per dose) 5
- When administering furosemide via any parenteral route, careful monitoring is required for:
Alternative Subcutaneous Administration
- Recent evidence suggests that subcutaneous (SC) administration may be an alternative to IM injection 4, 6
- Novel pH-neutral preparations of subcutaneous furosemide have shown similar bioavailability to IV furosemide (99.7-112%) 6
- Standard (non-pH-neutral) furosemide preparations administered subcutaneously have been associated with skin irritation in 3-23% of patients 6
Important Precautions
- Furosemide should be used with caution in patients with intravascular volume depletion as it could induce or worsen hypovolemia 5
- High doses of furosemide (>6 mg/kg/day) should not be given for periods longer than 1 week due to risk of adverse effects 5
- Infusions should be administered over 5-30 minutes to avoid hearing loss when given intravenously; this is less of a concern with IM administration 5
- Furosemide must be stopped in the case of anuria 5
Clinical Scenarios Where IM Administration May Be Appropriate
- When IV access is difficult to obtain or unavailable 4
- In settings with limited resources where IV administration is not feasible 4
- For patients requiring diuresis who cannot take oral medications and do not have IV access 4
- In emergency situations requiring rapid diuresis when IV access cannot be immediately established 4
Remember that while IM administration is FDA-approved, IV administration is generally preferred when rapid diuretic effect is needed, and oral administration is preferred for chronic management when feasible 2.