The solution "Furosemide" is a loop diuretic. It contributes to disruption of the reabsorption of chlorine and sodium ions in the thick section of the ascending portion of the Henle loop. Due to the increase in the release of sodium ions, a secondary, i.e. indirectly bound by osmotically bound water, is carried out, more water is excreted, as well as an increase in the secretion of potassium ions of the renal tubule in the distal region. Along with this, the excretion of magnesium and calcium ions also increases.
Secondary Effects
The tool has secondary effects, which are caused by the release of mediators inside the kidneys and the redistribution of blood flow in them. Against the background of course therapy, the effect does not weaken.
Many are interested in how to take "Furosemide" for edema. In case of heart failure, the drug quickly reduces the preload on the main organ - the heart - by expanding large veins. The medication is antihypertensive due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in bcc.
Latin Recipe
Here is the recipe for the Latin solution "Furosemide".
Rp .: Sol. Furosemidi 1% 2 ml
DS Dilute the contents of the ampoule in ten milliliters of an isotonic sodium chloride solution and administer slowly intravenously.
Structure
Furosemide solution is a colorless, clear or slightly yellowish liquid.
Available in the form of ampoules (two milliliters). It contains the active ingredient - 20 mg of furosemide. Excipients: injection water, sodium chloride, sodium hydroxide.
Indications for use
The solution "Furosemide" is prescribed for edematous syndrome against a background of chronic and acute heart failure, chronic kidney failure, nephrotic syndrome (the main disease therapy is in the foreground with this pathology).
Also indicated are:
- hypertensive crisis,
- serious types of arterial hypertension;
- edematous syndrome with liver pathologies;
- support for forced diuresis against the background of poisoning with chemical compounds that are excreted unchanged by the kidneys;
- cerebral edema.
Contraindications
Furosemide injections may not always be given. Contraindications:
- hypersensitivity of the body;
- acute kidney failure with anuria (glomerular filtration rate below 3-5 milliliters per minute);
- acute glomerulonephritis;
- severe liver failure;
- hepatic precoma and coma;
- stenosis of the urination channel;
- stone obstruction of the urinary tract;
- precomatous conditions;
- decompensated aortic or mitral stenosis;
- gout;
- hyperuricemia
- hyperglycemic coma;
- obstructive hypertrophic cardiomyopathy;
- increased central pressure in the veins;
- arterial hypotension, pancreatitis;
- acute myocardial infarction;
- violation of acid-base balance (hypomagnesemia, hypokalemia, hypocalcemia, alkalosis, hypochloraemia, hyponatremia, hypovolemia) and water-electrolyte metabolism;
- digital intoxication.
Careful reception
Precautions for use require prostatic hyperplasia, systemic lupus erythematosus, diabetes mellitus (decreased glucose tolerance), hypoproteinemia (the likelihood of ototoxicity), stenotic atherosclerosis of the cerebral arteries, pregnancy (especially in the early stages, can be used for health reasons), during breastfeeding.
How to take "Furosemide" for edema?
Method of use and dosage
It is determined individually, which depends on the clinical situation, indications, age of the person. During therapy, the dosage regimen is constantly adjusted depending on the dynamics of the state of health and the indicator of diuretic response.
The solution "Furosemide" is prescribed intravenously, in more rare cases, intramuscularly (lower effectiveness). Parenteral administration can be carried out when there is no possibility of oral administration - with a sharply manifesting edematous syndrome or in urgent cases.
Edema syndrome: in children after fifteen years of age and adults, the initial dosage ranges from 20-40 milligrams (that is, one or two ampoules), are administered intravenously, as an exception, intramuscularly. Intravenous administration is carried out for 1-2 minutes. If there is no diuretic response, then every two hours the drug is administered in an increased dose of 50% until normal diuresis is achieved. If the dosage is high (from 80 to 240 milligrams or more) is administered drip intravenously, the speed is not higher than four milligrams per minute. The maximum dose of Furosemide injections during the day is 600 milligrams.
In case of poisoning, forced diuresis: 20-40 milligrams of the drug is additionally added to the electrolyte infusion solution. In the future, treatment is prescribed depending on the indicator of urine output, it should compensate for the lost amount of electrolytes and fluids.
Hypertensive crisis: the desired initial dosage for the use of "Furosemide" intravenously is 20-40 milligrams. It needs to be adjusted in accordance with the clinical response.
For intramuscular and intravenous administration for children under the age of fifteen, the average daily dosage is from 0.5 to 1.5 milligrams per kilogram of weight.
When the desired effect occurs, go to the internal reception.
Side effects of Furosemide
The following adverse reactions may occur during administration:
- Cardiovascular system: orthostatic hypotension, a decrease in blood pressure, a decrease in the amount of circulating blood, arrhythmia, tachycardia, collapse.
- Nervous system: paresthesia, dizziness, drowsiness, adynamia, headache, apathy, lethargy, confusion, weakness.
- Sense organs: hearing and vision defects.
- Digestive system: loss of appetite, thirst, dry mouth, vomiting, constipation, nausea, diarrhea, exacerbation of pancreatitis, cholestatic jaundice.
- Genitourinary system: acute urine retention (in patients with prostatic hypertrophy), oliguria, impaired potency, hematuria, interstitial nephritis. Side effects of Furosemide are rather unpleasant.
- Allergic reactions: urticaria, purpura, exudative erythema multiforme, exfoliative dermatitis, necrotizing angiitis, vasculitis, skin itching, fever, chills, anaphylactic shock, photosensitivity.
- Hematopoietic organs: thrombocytopenia, leukopenia, aplastic anemia, agranulocytosis.
- Water-electrolyte metabolism: metabolic alkalosis, hypovolemia, hypomagnesemia, dehydration (the likelihood of thromboembolism and thrombosis), hypocalcemia, hypokalemia, hypochloraemia, hyponatremia.
- Other reactions to the use of Furosemide: muscle weakness, tetany (convulsive contractions of the calf muscles).
- Laboratory indicators: glucosuria, hypercalciuria, hyperuricemia, hypercholesterolemia, hyperglycemia.
- If additionally administered intravenously: renal calcification in premature babies, thrombophlebitis.
Overdose
Signs of an overdose of Furosemide solution 1%: a marked decrease in blood pressure, shock, collapse, dehydration, hypovolemia, arrhythmias (including ventricular fibrillation and AV block), blood concentration, dehydration, acute kidney failure with anuria, thromboembolism, thrombosis, thrombosis , drowsiness, apathy, flaccid paralysis.
Overdose therapy: correction of the acid-base state and water-salt balance, replenishment of the amount of circulating blood and further symptomatic treatment. There is no specific antidote.
Interaction with different drugs
The combined use of chloral hydrate and Furosemide is not recommended. It increases the concentration and the likelihood of the development of the oto- and nephrotoxic effects of cephalosporins, amphotericin B, aminoglycosides, cisplatin, ethacrylic acid, chloramphenicol (due to competitive excretion by the kidneys).
It enhances the effectiveness of theophylline and diazoxide, reduces allopurinol, hypoglycemic drugs.
"Furosemide" and pressor amines mutually contribute to a decrease in efficiency.
Drugs that block the secretion of tubules increase the content of the drug in the blood serum.
With the simultaneous use of amphotericin B, glucocorticosteroids, the likelihood of developing hypokalemia is increased, and with cardiac glycosides, the risk of digitalis intoxication due to hypokalemia (refers to low-polar and high-polar glycosides of the heart) and longer half-life (for low-polar) increases.
Reduces renal clearance of lithium and increases the likelihood of intoxication.
Non-steroidal anti-inflammatory drugs, sucralfate reduce the diuretic effect due to inhibition of Pg synthesis, a defect in the content of renin in the blood plasma, as well as aldosterone excretion.
The hypotensive effect of antihypertensive drugs, the neuromuscular blockade of suxamethonium chloride (a depolarizing muscle relaxant) are enhanced, the effect of tubocurarine (a non-depolarizing muscle relaxant) is weakened.
The simultaneous use of large amounts of salicylates in the treatment with Furosemide injection solution increases the likelihood of their toxicity due to competitive excretion by the kidneys.
Very carefully you need to combine Furosemide with risperidone.
Simultaneous administration with cyclosporine can cause the appearance of gouty arthritis due to hyperuricemia provoked by Furasemide, as well as impaired renal excretion of cyclosporine by urates.
People with a high likelihood of developing nephropathy as a reaction to the administration of radiopaque drugs to which Furosemide was administered had a higher number of cases of impaired renal function compared to patients with a high risk of nephropathy with the same radiopaque agents receiving only intravenous hydration directly before the radiopaque drug.
According to the instructions for use, "Furosemide" in ampoules, administered intravenously, has a slightly alkaline reaction, and therefore it can not be mixed with agents whose pH is lower than 5.5.
Specifics of use
During the course of therapy, it is necessary to periodically monitor blood pressure, the concentration of plasma electrolytes (including Mg, K, Ca, Na), the acid-base state, creatinine, residual nitrogen, liver function, uric acid and make the necessary adjustments to the treatment if necessary (for patients with frequent vomiting with a greater frequency, as well as with parenteral fluids).
Patients with increased susceptibility to sulfonylurea derivatives and sulfonamides may have cross-sensitivity to the drug.
Patients receiving high dosages of Furosemide from the list of loop diuretics should not limit salt intake to avoid the occurrence of metabolic alkalosis and hyponatremia.
To prevent hypokalemia, it is advisable to prescribe potassium-sparing diuretics (primarily spironolactone) and potassium products at the same time, as well as adhere to a potassium-rich diet.
An increased likelihood of developing defects in water-electrolyte balance is observed in patients with renal failure.
It is necessary to select a dosage regimen for people with ascites with cirrhosis only in a hospital (defects in the water-electrolyte balance can cause the appearance of a hepatic coma). This category of patients is shown to constantly monitor the plasma concentration of electrolytes.
If oliguria or azotemia appears or intensifies in people with severe progressive renal disease, it is advisable to suspend the therapeutic course.
In patients with reduced glucose tolerance or diabetes, the degree of glucose in the urine and blood should be periodically monitored.
Patients with prostatic hypertrophy, hydronephrosis, narrowing of the ureters and in an unconscious state need to regulate urination due to the likelihood of acute urine retention.
Analogs
The list of loop diuretics that can be replaced with Furosemide:
- Britomar;
- "Ethacrylic acid";
- Bufenox;
- "Diuver";
- Lasix.
Reviews
Excellent loop diuretic with fast action. It is used with efficiency in narcology, urgent psychiatry, in various comorbid somatic conditions. There may be pain in the lumbar region during injections. Hypokalemia may occur. Prevention is required.
We reviewed the instructions for use with Furosemide in ampoules.