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Furosemide – Effects, Dosage and Side Effects
Furosemide is a potent loop diuretic used to treat fluid retention and high blood pressure. It increases urine output, relieving strain on the heart and circulatory system.
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Furosemide is a potent loop diuretic used to treat fluid retention and high blood pressure. It increases urine output, relieving strain on the heart and circulatory system.
What is Furosemide?
Furosemide is a medication belonging to the class of loop diuretics. It is one of the most widely used drugs in internal medicine and cardiology. Furosemide is prescribed to remove excess fluid from the body, lower blood pressure, and reduce the workload on the heart. It is marketed under several brand names, the most well-known being Lasix.
Mechanism of Action
Furosemide acts in the ascending limb of the loop of Henle in the kidneys. It inhibits the Na⁺-K⁺-2Cl⁻ cotransporter, which normally reabsorbs sodium, potassium, and chloride back into the bloodstream. By blocking this transporter, more salts and water remain in the urine, resulting in a significantly increased urine output. The diuretic effect sets in rapidly – within minutes when administered intravenously.
Indications
- Edema (fluid retention) associated with heart failure
- Edema caused by kidney disease or liver disease (e.g., cirrhosis)
- High blood pressure (arterial hypertension), particularly when other treatments are insufficient
- Acute pulmonary edema as emergency treatment
- Hypercalcemia and hypercalcemic crises (in combination with fluid replacement)
Dosage and Administration
Furosemide is available as tablets, injection solutions, and infusions. The dosage depends on the underlying condition, kidney function, and individual response. Typical oral doses for adults range from 20 mg to 80 mg per day, but may be significantly higher in patients with severe renal impairment. The medication should always be taken as directed by a physician, since both under- and overdosing can have serious consequences.
Side Effects
Due to the powerful diuretic effect, important electrolytes may be lost. Common side effects include:
- Hypokalemia (low potassium) – can lead to cardiac arrhythmias
- Hyponatremia (low sodium) – weakness, confusion
- Dehydration – dizziness, drop in blood pressure
- Elevated uric acid levels – may trigger gout attacks
- Blood glucose disturbances
- Hearing loss (ototoxicity) – especially at high doses or when combined with other ototoxic drugs
- Increased skin sensitivity to sunlight (photosensitivity)
Drug Interactions
Furosemide can interact with a range of other medications:
- Cardiac glycosides (digoxin): Potassium depletion caused by furosemide increases the risk of digitalis toxicity
- ACE inhibitors and ARBs: Risk of excessive blood pressure drop
- Aminoglycosides and cisplatin: Increased risk of ototoxicity
- NSAIDs (non-steroidal anti-inflammatory drugs): Reduced diuretic effect
- Lithium: Risk of elevated lithium plasma levels
Contraindications
Furosemide should not be used, or used only with extreme caution, in the following situations:
- Anuria (absence of urine production) without a confirmed reversible cause
- Severe hypovolemia or dehydration
- Known hypersensitivity to sulfonamides (possible cross-reactivity)
- Pregnancy and breastfeeding (only when strictly indicated)
References
- Brunton, L. L. et al. – Goodman and Gilman's The Pharmacological Basis of Therapeutics. 13th edition. McGraw-Hill Education, 2018.
- European Medicines Agency (EMA) – Furosemide: Summary of Product Characteristics. Available at: https://www.ema.europa.eu (accessed 2024).
- Fauci, A. S. et al. – Harrison's Principles of Internal Medicine. 21st edition. McGraw-Hill Education, 2022.
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