What are the contraindications for furosemide (Lasix)?

From the Guidelines

Furosemide is contraindicated in patients with anuria, severe hypovolemia, known hypersensitivity to furosemide or sulfonamides, hepatic coma, and states of severe electrolyte depletion until these conditions are improved or corrected. The use of furosemide requires caution in patients with severe renal impairment, hepatic cirrhosis, and those taking other ototoxic drugs as it may enhance ototoxicity 1. Patients with sulfonamide allergies may experience cross-sensitivity, and furosemide should be used carefully in patients with gout or diabetes as it may exacerbate these conditions by increasing uric acid levels and blood glucose, respectively.

According to the most recent guidelines, furosemide should be stopped if there is severe hypokalemia (<3 mmol/L) 1. Additionally, all diuretics, including furosemide, should be discontinued if there is severe hyponatremia (serum sodium concentration <120 mmol/L), progressive renal failure, worsening hepatic encephalopathy, or incapacitating muscle cramps 1.

The American Association for the Study of Liver Diseases recommends that when ascites is adequately mobilized, attempts should be made to taper the diuretics, including furosemide, to the lowest dosages to maintain minimal or no ascites 1. The dose of furosemide may be progressively increased according to the response and tolerability, up to 160 mg/day, which is the generally accepted threshold to determine medical treatment refractoriness 1.

Key considerations for the use of furosemide include:

• Monitoring for diuretic adverse events, such as electrolyte imbalance, worsening hypokalemia, hyperkalemia, serum creatinine, hepatic encephalopathy, and muscle cramps 1
• Caution in patients with severe renal impairment, hepatic cirrhosis, and those taking other ototoxic drugs 1
• Careful monitoring of patients with prostatic hyperplasia or impaired micturition as furosemide-induced diuresis may precipitate acute urinary retention
• Avoidance of furosemide in patients with known hypersensitivity to furosemide or sulfonamides, and use with caution in patients with sulfonamide allergies 1

From the FDA Drug Label

CONTRAINDICATIONS Furosemide tablets are contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide. CONTRAINDICATIONS Furosemide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide. The contraindications for furosemide are:

• Anuria
• Hypersensitivity to furosemide 2 3

From the Research

Contraindications for Furosemide

• Anaphylaxis to intravenous furosemide has been reported, indicating that patients with a history of hypersensitivity to furosemide or related sulfonamide-based drugs should avoid its use 4.
• Furosemide is not beneficial for acute kidney injury (AKI) treatment if kidney-related endpoints are considered, and its use in certain situations may be associated with unfavorable outcomes if euvolemia is not maintained 5.
• Diuretic-induced hypokalaemia is a common and potentially life-threatening adverse drug reaction, and patients with a history of hypokalaemia or those taking other drugs that increase the risk of potassium depletion should be cautious when using furosemide 6.
• The use of furosemide in patients with severe edema or chronic kidney disease requires careful consideration of the dosage and mode of delivery to maximize efficiency and minimize side effects 7.
• Patients with a history of allergic reactions to sulfonamide-based drugs should be monitored closely when using furosemide, as cross-reactivity has been reported 4.