PO (Adults): 20–80 mg/day as a single dose initially, may repeat in 6–8 hr; may ↑ dose by 20–40 mg every 6–8 hr until desired response. Maintenance doses may be given once or twice daily (doses up to 2.5 g/day have been used in patients with HF or renal disease). Hypertension– 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response; Hypercalcemia– 120 mg/day in 1–3 doses.
PO (Children >1 mo): 2 mg/kg as a single dose; may be ↑ by 1–2 mg/kg every 6–8 hr (maximum dose = 6 mg/kg).
PO (Neonates): 1–4 mg/kg/dose 1–2 times/day.
IM IV (Adults): 20–40 mg, may repeat in 1–2 hr and ↑ by 20 mg every 1–2 hr until response is obtained, maintenance dose may be given every 6–12 hr; Continuous infusion– Bolus 0.1 mg/kg followed by 0.1 mg/kg/hr, double every 2 hr to a maximum of 0.4 mg/kg/hr.
IM IV (Children): 1–2 mg/kg/dose every 6–12 hr; Continuous infusion– 0.05 mg/kg/hr, titrate to clinical effect.
IM IV (Neonates): 1–2 mg/kg/dose every 12–24 hr.
PO (Adults): 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response.
Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
Monitor BP and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension.
Geri: Diuretic use is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention strategies.
Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Patients taking digoxin are at increased risk of digoxin toxicity because of the potassium-depleting effect of the diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.
Assess patient for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs.
Assess for allergy to sulfonamides.
Assess patient for skin rash frequently during therapy. Discontinue furosemide at first sign of rash; may be life-threatening. Stevens-Johnson syndrome, toxic epidermal necrolysis, or erythema multiforme may develop. Treat symptomatically; may recur once treatment is stopped.
Lab Test Considerations:
Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. Commonly ↓ serum potassium. May cause ↓ serum sodium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, serum creatinine, and uric acid levels.
Do not confuse Lasix (furosemide) with Luvox (fluvoxamine).
If administering twice daily, give last dose no later than 5 pm to minimize disruption of sleep cycle.
IV route is preferred over IM route for parenteral administration.
PO May be taken with food or milk to minimize gastric irritation. Tablets may be crushed if patient has difficulty swallowing.
Do not administer discolored solution or tablets.
IV Push: Dilution: Administer undiluted (larger doses may be diluted and administered as intermittent infusion [see below]). Concentration: 10 mg/mL.
Rate: Administer at a rate of 20 mg/min. Pedi: Administer at a maximum rate of 0.5–1 mg/kg/min (for doses <120 mg) with infusion not exceeding 10 min.
Intermittent Infusion: Dilution: Dilute larger doses in 50 mL of D5W, D10W, D20W, D5/0.9% NaCl, D5/LR, 0.9% NaCl, 3% NaCl, or LR. Infusion stable for 24 hr at room temperature. Do not refrigerate. Protect from light. Concentration: 1 mg/mL.
Rate: Administer at a rate not to exceed 4 mg/min (for doses >120 mg) in adults to prevent ototoxicity. Pedi: not to exceed 1 mg/kg/min with infusion not exceeding 10 min. Use an infusion pump to ensure accurate dose.
amphotericin B cholesteryl
amphotericin B lipid complex
amphotericin B liposome
hydrocortisone sodium succinate
vitamin B complex with C
Instruct patient to take furosemide as directed. Take missed doses as soon as possible; do not double doses.
Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension.
Advise patient to contact health care professional if weight gain more than 3 lbs in 1 day.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any OTC medications concurrently with this therapy.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
Advise diabetic patients to monitor blood glucose closely; may cause increased blood glucose levels.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breast feeding. Monitor fetal growth during pregnancy; increased risk for higher birth weights.
Emphasize the importance of routine follow-up examinations.
Geri: Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention.
Advise patients on antihypertensive regimen to continue taking medication even if feeling better. Furosemide controls but does not cure hypertension.
Reinforce the need to continue additional therapies for hypertension (weight loss, exercise, restricted sodium intake, stress reduction, regular exercise, moderation of alcohol consumption, cessation of smoking).
Decrease in edema.
Decrease in abdominal girth and weight.
Increase in urinary output.
Decrease in BP.
furosemide is a sample topic from the Davis's Drug Guide.
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