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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

FUROSEMIDE
(Lasix(R))

Indication

  • used in the treatment of fluid overload, pulmonary edema, congestive heart failure and hypertension

Pharmacology

  • inhibits the reabsorption of electrolytes in the ascending loop of Henle
  • in the distal renal tubule the reabsorption of Na and Cl is decreased and K excretion is increased
  • the excretion of H, Mg, Ca, bicarbonate and ammonium is also increased
  • excessive losses of K, Cl and H may cause metabolic alkalosis
  • causes a significant increase in urinary excretion of Ca (reabsorption in the loop of Henle is linked to Na reabsorption)
  • bioavailability following oral administration in adults is 60 to 70%
  • the diuretic effect is usually complete by 6 hours, but longer duration of effects has been reported

Side Effects

  • fluid and electrolyte imbalance: hyponatremia, hypocalcemia, hypokalemia, hypochloremia; dehydration, hypotension from hypovolemia
  • potentially ototoxic (risk increases in severe renal impairment, concomitant use of other potentially ototoxic drugs, eg. gentamicin, and administration at too fast a rate)
  • chronic use can cause nephrocalcinosis and hypochloremic metabolic alkalosis

Nursing/Physician Implications

  • closely monitor serum electrolytes
  • monitor intake and output (accurate) (because the diuretic effect is usually complete by 6 hours, it is reasonable, for single dose therapy, to accurately monitor intake and output for a total of 8 hours following a single IV or oral dose)

Dose

  • IV:
  • 1 mg/kg q12-24h by slow IV push over 2 minutes (it may be useful to dilute furosemide with normal saline or D5W for a more accurate delivery of the medication)

  • onset of action is 5 to 15 min
  • PO:
  • 1 to 2 mg/kg q12h, increase slowly if needed.

  • onset of action is 30-60 min

Supplied

  • 10 mg/mL, 2 mL ampoule
  • 10 mg/mL oral solution

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  4. Ford DC, Leist ER and Phelps SJ: Guidelines for administration of intravenous medications to pediatric patients, American Society of Hospital Pharmacists, Bethesda, MD, 1988.

Rev:Mar. 1994




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