"Powerful diuretic" furosemide, what are the drugs at home and abroad?

*For medical professionals only

Ultra-complete precautions for furosemide

When it comes to diuretics, we have to mention the famous furosemide.

Furosemide is a potent diuretic with clinical indications for edematous diseases, including congestive heart failure, cirrhosis, and renal disease (nephritis, nephropathy, and acute and chronic renal failure due to various causes), especially when other diuretics are ineffective [1-2].

So, looking at the Chinese and foreign drug instructions of furosemide, what precautions must be understood for its use?

01 Contraindications

Furosemide is contraindicated in patients with auria and in patients with a history of allergy to furosemide [3-5].

02 Domestic instructions precautions[1-2]

1

Cross allergies

People who are allergic to sulfonamides and thiazide diuretics may also be allergic to this drug.

2

Interference with the diagnosis

May cause elevated blood glucose and positive urine glucose, especially in patients with diabetes mellitus or prediabetes. Excessive dehydration can temporarily increase blood uric acid and urea nitrogen levels. Blood concentrations of Na+, Cl-, K+, Ca2+, and Mg2+ decreased.

3

Use with caution in the following cases

Patients with no urine or severe renal impairment, the latter need to increase the dose, so the interval between medications should be extended to avoid side effects such as ototoxicity;

Diabetes mellitus;

Hyperuricemia or a history of gout;

In patients with severe liver function impairment, hepatic coma can be induced due to water and electrolyte disorders;

Acute myocardial infarction, excessive diuresis can induce shock;

Pancreatitis or those with a history of this disease;

Patients with a tendency to hypokalemia, especially those with digitalis or ventricular arrhythmias;

Lupus erythematosus, a drug that can aggravate the condition or induce activity;

Enlarged prostate.

4

Follow-up examination

Blood electrolytes, especially those with combined digitalis drugs or corticosteroids, liver and kidney function impairment;

blood pressure, especially for antihypertensive, high-dose application or for the elderly;

Renal function;

Liver function;

Blood glucose;

Blood uric acid;

Acid-base balance;

hearing.

The dose of the drug should start from the minimum effective dose, and then adjust the dose according to the diuretic response to reduce the occurrence of side effects such as water and electrolyte imbalances.

5

Injectable parenteral medication should be given intravenously and intramuscularly

The time for intravenous injection in conventional doses should exceed 1-2 minutes, and the time for intravenous injection in large doses should not exceed 4 mg per minute. The same effect can be achieved at 1/2 of the intravenous dose.

6

This drug is a sodium salt injection made of alkali, which is highly alkaline, so it should be diluted with sodium chloride injection when intravenous injection, rather than diluted with glucose injection

7

In the presence of hypokalemia or a predisposition to hypokalemia, care should be taken to supplement potassium salts

8

When combined with antihypertensive drugs, the latter dose should be adjusted as appropriate

9

Patients with oliguria or anuria should discontinue the drug if they are ineffective 24 hours after the maximum dose

10

Athletes use with caution

03 Precautions for foreign instructions[3-5]

The U.S. Food and Drug Administration (FDA) approved furosemide drug instructions have similar parts to domestic drug instructions, but some adverse reactions and related mechanisms are described in more detail, and the translation of small drugs is as follows for reference.

■ 1. Excessive diuresis may lead to dehydration and volume depletion, the appearance of circulatory failure, and may lead to thrombosis and embolism, especially in elderly patients.

■ 2. As with any effective diuretic, electrolyte depletion may occur during furosemide treatment, especially in patients receiving higher doses and restricting salt intake.

■ 3. Hypokalemia may occur with the use of furosemide, especially when accompanied by rapid diuresis, inadequate oral electrolyte intake, cirrhosis of the liver, or simultaneous use of corticosteroids, adrenocorticotropic hormone (ACTH) or long-term use of laxatives.

4. All patients receiving furosemide treatment should be observed for signs or symptoms of these fluid or electrolyte imbalances (hyponatremia, hypochlorine alkalosis, hypokalemia, hypomagnesemia or hypocalcemia): dry mouth, thirst, fatigue, lethargy, irritability, muscle pain or spasms, muscle fatigue, hypotension, oliguria, tachycardia, arrhythmia or nausea, vomiting and other gastrointestinal disorders.

■ 5. There have been reports of increased blood glucose and glucose tolerance test changes (abnormalities in blood glucose on an empty stomach and 2 hours after a meal), but there have been few reports of diabetes.

■ 6. For patients with severe symptoms of urinary retention (because of the possibility of bladder emptying disorders, prostatic hyperplasia, urethral stenosis), taking furosemide can cause acute urinary retention, which is related to the production of urine and increased retention. Therefore, these patients require careful monitoring, especially in the initial stages of treatment.

■ 7. For patients at high risk of contrast nephropathy, furosemide can lead to a higher incidence of deterioration of renal function after receiving contrast agent compared with high-risk patients who only receive intravenous fluids before receiving contrast agents.

■ 8. In patients with hypoproteinemia (such as associated with nephrotic syndrome), the effect of furosemide may be weakened, and its ototoxicity will also be enhanced.

■9. Asymptomatic hyperuricemia may occur, and gout rarely occurs.

■ 10. Patients who are allergic to sulfonamides may also be allergic to furosemide. There is a possibility of exacerbating or activating systemic lupus erythematosus.

11. As with many other drugs, patients should be regularly observed for the possibility of bloody cachexia, liver or kidney damage, or other specific reactions.

04 FDA Black Box Warning [3-5]

It is worth noting that in the U.S. Food and Drug Administration (FDA)-approved furosemide drug instructions, a black box warning for furosemide is also marked at the beginning, which reads:

Figure 1 Screenshot of the FDA drug instructions for furosemide

warn:

Furosemide is a potent diuretic that, if administered in excessive amounts, can lead to severe diuresis, accompanied by consumption of water and electrolytes. Therefore, careful medical supervision is required and the dose must be adjusted according to the individual needs of the patient.