From the Guidelines
Lasix (furosemide) is contraindicated in patients with anuria, severe hypovolemia, or known hypersensitivity to furosemide or sulfonamides, as well as in those with severe hypokalemia, hyponatremia, or metabolic alkalosis, according to the most recent guidance. When considering the use of Lasix, it's crucial to evaluate the patient's overall clinical condition, including their renal function, electrolyte balance, and volume status.
- Key considerations include:
- Anuria, which is the complete absence of urine production, as Lasix will not be effective and may worsen the patient's condition 1.
- Severe hypovolemia, where the use of Lasix could lead to further dehydration and potentially life-threatening complications.
- Known hypersensitivity to furosemide or sulfonamides, as this could result in an allergic reaction.
- Severe electrolyte imbalances, such as hypokalemia, hyponatremia, or metabolic alkalosis, which Lasix can exacerbate. In patients with hepatic cirrhosis, such as those discussed in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1, Lasix should be used cautiously, especially when managing ascites, as the medication can affect renal function and electrolyte balance.
- Important points to consider in the management of ascites include:
- The classification of ascites into different grades based on the amount of fluid accumulation and response to treatment, as outlined in Table 5 of the guidance 1.
- The use of diuretics, such as spironolactone and furosemide, in the treatment of ascites, with careful monitoring of the patient's response and potential adverse effects. It's also essential to be aware of the potential interactions between Lasix and other medications, such as lithium, and to monitor patients closely for signs of toxicity or adverse effects.
- Patients with certain conditions, such as gout or hyperuricemia, should be treated with caution, as Lasix can increase uric acid levels and worsen these conditions. Overall, the use of Lasix requires careful consideration of the patient's individual clinical circumstances and close monitoring for potential adverse effects, in order to minimize risks and optimize outcomes.
From the FDA Drug Label
Furosemide tablets are contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide. The contraindications for Lasix (furosemide) are:
- Anuria
- Hypersensitivity to furosemide 2
From the Research
Contraindications for Lasix (Furosemide)
- The following are potential contraindications for Lasix (Furosemide) based on available evidence:
- Hepatic encephalopathy: Furosemide-induced coma occurred in 20 (11.6%) patients and was more frequent in patients with prior hepatic encephalopathy 3
- Severe renal impairment: Furosemide may cause azotemia in patients with ascites, independently of induced volume depletion 4
- Hypovolemia: Furosemide can cause volume depletion, which may lead to hypotension and decreased renal perfusion 3, 5
- Electrolyte disturbances: Furosemide can cause electrolyte disturbances, including hypokalemia, which may be exacerbated by concomitant use of other medications 3
- Pregnancy and lactation: Although not explicitly stated in the provided evidence, furosemide is generally considered to be contraindicated in pregnancy and lactation due to potential risks to the fetus and neonate
- Special precautions should be taken when using furosemide in certain patient populations, including:
- Elderly patients: Furosemide prescription rate increases with age, and age is associated with a decrease in recommended heart failure therapeutic prescriptions 6
- Patients with cirrhosis: Furosemide may cause adverse reactions, including hepatic encephalopathy, in patients with cirrhosis 3
- Patients with heart failure: Furosemide may cause hypotension and decreased renal perfusion, which may worsen heart failure symptoms 5
- It is essential to carefully evaluate the potential benefits and risks of furosemide use in individual patients and to monitor them closely for adverse effects.