From what pills furosemide. The powerful loop diuretic Furosemide: what is it for and how is it used a medication with an active diuretic effect
Furosemide is a fast-acting diuretic used to combat swelling of the respiratory system and brain, as well as disorders of the systemic circulation. Differs in providing a quick diuretic effect on the body.
The drug contains furosemide at a dosage of 40 mg as an active ingredient. The original drug is Lasix, developed by Sanofi. Furosemide is one of the most potent diuretics and is effective in both oral and parenteral form.
The therapeutic effect is observed within 5-10 minutes if the drug is used in the form of a solution for intravenous injection. In the case of using a tablet formulation, the therapeutic effect is achieved within the first hour.
Clinical and pharmacological group
Diuretic.
Conditions of sale from pharmacies
Can buy with a doctor's prescription.
Price
How much does Furosemide cost in pharmacies? The average price is at 25 rubles.
Composition and form of release
Tablets: flat-cylindrical, round, beveled, white with a brownish or yellowish tinge, 10 pieces in a blister strip made of polyvinyl chloride film and polymer-coated paper or aluminum foil. 1, 2, 3 or 5 cell contour packaging in a cardboard box, 50 tablets in a dark glass jar of the BTS type or a polymer jar of the BP type, with a plastic stretch lid. 1 can in a cardboard box.
Tablet composition:
- active substance: furosemide - 40 mg;
- auxiliary components: lactose monohydrate, potato starch, calcium stearate monohydrate.
Pharmacological effect
The active ingredient Furosemide has a diuretic effect, promoting enhanced excretion of water with a simultaneous increase in the excretion of calcium and magnesium ions.
With the use of Furosemide against the background of heart failure, there is a rapid decrease in preload on the heart, caused by the expansion of large veins. After intravenous administration, the action of Furosemide occurs quickly - after 5-10 minutes, after oral administration - on average after an hour.
The duration of the diuretic effect from taking Furosemide is two to three hours, and with reduced renal function, the effect of the drug can last up to eight hours.
Indications for use
What does it help from? Furosemide confidently copes with edema of various origins, so the range of its use is very wide. He is prescribed for the following problems:
- edema caused by kidney pathology (including nephrotic syndrome), CHF stage II-III or cirrhosis of the liver;
- manifested in the form of pulmonary edema, acute heart failure;
- hypertensive crisis (as a means of monotherapy or in combination with other drugs);
- severe forms of arterial hypertension;
- swelling of the brain;
- hypercalcemia;
- eclampsia.
Also, the drug is used for forced diuresis in case of poisoning with chemicals that are excreted from the body by the kidneys unchanged.
With increased blood pressure, developing against the background of chronic renal failure, Furosemide is resorted to if thiazide diuretics are contraindicated in the patient, and also if Clcr does not exceed 30 ml per minute).
Can Furosemide be used for weight loss?
There are many tips on the Internet regarding the use of diuretics for weight loss. One of the most affordable drugs in this group is Furosemide.
What does the medicine help for? According to the instructions, Furosemide is used for ascites, edema syndrome, hypertension. Thus, the manufacturer does not report anything regarding the possibility of using diet pills. Nevertheless, many women note that with the help of this tool they managed to lose several kilograms rather quickly (in some cases, up to 3 kg per night). However, it is impossible to regard such weight loss as weight loss: the action of the drug is aimed at removing excess fluid, and by no means at breaking down fat.
Why is Furosemide dangerous?
The use of diuretics for weight loss can cause serious health problems, because by removing water, these drugs also disrupt the balance of electrolytes in the body. one of the most common side effects is hypokalemia. Potassium deficiency, in turn, leads to the appearance of muscle cramps, weakness, visual impairment, sweating, loss of appetite, nausea, dizziness.
Arrhythmia is a very dangerous side effect. Studies conducted by SOLVD have shown that treatment with loop diuretics is associated with an increase in mortality among patients. At the same time, both general and cardiovascular mortality rates and the number of sudden deaths increase. Another danger that the uncontrolled use of diuretics for weight loss can entail is impaired renal function. Moreover, it can take more than one month to restore the function of the kidneys and the lymphatic system.
Contraindications
Absolute contraindications:
- hyperuricemia;
- increased central venous pressure (over 10 mm Hg);
- idiopathic hypertrophic subaortic stenosis;
- hepatic coma and precoma;
- decompensated mitral or aortic stenosis;
- violations of the outflow of urine of any etiology (including unilateral urinary tract damage);
- severe hepatic impairment;
- acute glomerulonephritis;
- acute renal failure with anuria (glomerular filtration rate - less than 3-5 ml / min);
- violation of water-electrolyte metabolism, as well as acid-base balance (alkalosis, hypokalemia, hypovolemia, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremia);
- digitalis intoxication;
- hypersensitivity to any component of the drug.
Additionally for tablets:
- acute myocardial infarction;
- pancreatitis;
- dehydration;
- intolerance to galactose;
- precomatous states;
- hyperglycemic coma;
- hypertrophic obstructive cardiomyopathy;
- arterial hypotension;
- glucose-galactose malabsorption or lactase deficiency;
- age up to 3 years.
Patients who are allergic to sulfonylureas or sulfonamide antimicrobials are at risk of developing cross-allergy to Furosemide.
Relative contraindications:
- a history of ventricular arrhythmia;
- hypoproteinemia (risk of developing ototoxicity);
- diarrhea;
- hearing loss;
- systemic lupus erythematosus;
- arterial hypotension - in the presence of conditions in which an excessive decrease in blood pressure can be especially dangerous (stenosing lesions of the coronary or cerebral arteries);
- acute myocardial infarction (due to an increased risk of developing cardiogenic shock);
- overt or latent diabetes mellitus (decreased glucose tolerance);
- hepatorenal syndrome;
- violations of the outflow of urine (hydronephrosis, narrowing of the urethra, benign prostatic hyperplasia);
- gout;
- prematurity in children (due to the risk of the formation of calcium-containing kidney stones and the deposition of calcium salts in the renal parenchyma, constant monitoring of renal function and regular ultrasound examination of the kidneys are necessary).
Additionally for tablets: stenosing lesions of the coronary or cerebral arteries.
Appointment during pregnancy and lactation
The drug crosses the placental barrier, so it should not be prescribed during pregnancy. If it is necessary to prescribe the drug Furosemide during pregnancy, the ratio of the benefits of using the drug for the mother to the risk for the fetus should be assessed.
Excreted in breast milk. If necessary, drug treatment, breastfeeding should be discontinued.
Dosage and method of administration
As indicated in the instructions for use, Furosemide tablets should be taken on an empty stomach, without chewing and drinking a sufficient amount of liquid.
When prescribing Furosemide, it is recommended to use its lowest dose, sufficient to achieve the desired effect. The maximum daily intake for adults is 1500 mg. The initial single dose in children is determined at the rate of 1-2 mg / kg of body weight / day with a possible increase in the dose to a maximum of 6 mg / kg / day, provided that the drug is taken no more often than after 6 hours.The duration of treatment is determined by the doctor individually, depending on from the testimony.
Dosing regimen in adults:
- ... Furosemide can be used alone or in combination with other antihypertensive drugs. The usual maintenance dose is 20-40 mg / day. When adding furosemide to already prescribed drugs, their dose should be reduced by 2 times. In case of arterial hypertension in combination with chronic renal failure, the use of higher doses of the drug may be required.
- Edema in nephrotic syndrome. The initial dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The daily dose can be taken in one dose or divided into several doses.
- Edematous syndrome in chronic heart failure. The initial dose is 20-80 mg / day. The required dose is selected depending on the diuretic response. It is recommended to divide the daily dose into 2-3 doses.
- Edematous syndrome in chronic renal failure. In patients with chronic renal failure, careful dose selection is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss up to about 2 kg of body weight / day is possible). The recommended starting dose is 40-80 mg / day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken as a single dose or in two divided doses. In patients on hemodialysis, the usual maintenance dose is 250-1500 mg / day.
- Edematous syndrome in liver diseases. Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are not effective enough. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in the electrolyte or acid-base state, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss up to about 0.5 kg of body weight / day is possible). The initial dose is 20-80 mg / day.
Adverse reactions
Furosemide can cause the following side effects:
- Hematopoietic system: aplastic anemia, agranulocytosis, leukopenia and thrombocytopenia.
- Water and electrolyte metabolism: hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia, hypochloremia, hypokalemia.
- Metabolism: hyperglycemia, muscle weakness, convulsions, arterial hypotension, hyperuricemia and dizziness.
- Cardiovascular system: lowering blood pressure, arrhythmia, tachycardia, orthostatic hypotension, collapse.
- Nervous system: drowsiness, myasthenia gravis, apathy, weakness, lethargy, confusion, calf muscle cramps, headache, paresthesia, weakness.
- Sense organs: impaired hearing and vision.
- Gastrointestinal tract: dry mouth, nausea, worsening pancreatitis, thirst, vomiting, decreased appetite, diarrhea or constipation, and cholestatic jaundice.
- Genitourinary system: hematuria, interstitial nephritis, acute urinary retention, decreased potency
- Allergic reactions: exudative erythema multiforme, photosensitivity, pruritus, exfoliative dermatitis, urticaria, vasculitis, purpura, fever, chills, necrotizing angiitis and anaphylactic shock.
Overdose
When the recommended dose is exceeded or long-term uncontrolled use of Furosemide, patients develop signs of an overdose, which are clinically manifested by an increase in the side effects described above, paralysis, respiratory depression, cardiovascular system, the development of a coma, acute renal failure and shock.
Overdose treatment consists in correcting the water-electrolyte balance by diffuse infusions of isotonic sodium chloride solution, gastric lavage, replenishing the circulating blood volume, and carrying out symptomatic treatment.
special instructions
Before you start using the drug, read the special instructions:
- The use of furosemide slows down the excretion of uric acid, which can provoke an exacerbation of the course of gout.
- Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to furosemide.
- If azotemia and oliguria appear or intensify in patients with severe progressive kidney disease, it is recommended to suspend treatment.
- Patients with diabetes mellitus or with reduced glucose tolerance require periodic monitoring of the level of glucose in the blood and urine.
- In unconscious patients with benign prostatic hyperplasia, narrowing of the ureters or hydronephrosis, urinary control is necessary due to the possibility of acute urinary retention.
- The drug contains lactose monohydrate, therefore patients with rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption should not take this drug.
- The preparation contains wheat starch in an amount that is safe for use in patients with celiac disease (gluten enteropathy).
- Patients with wheat allergy (other than celiac disease) should not use this drug.
Before starting therapy with the drug Furosemide Sopharma, the presence of pronounced disorders of the outflow of urine should be excluded, patients with a partial violation of the outflow of urine need careful monitoring. Against the background of the course of treatment, it is necessary to periodically monitor blood pressure, the content of blood plasma electrolytes (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate correction of treatment.
In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is inappropriate to limit the consumption of table salt. For the prevention of hypokalemia, the simultaneous administration of potassium preparations and potassium-sparing diuretics is recommended, as well as adhere to a diet rich in potassium. The selection of the dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in stationary conditions (disturbances in the water-electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.
Compatibility with other drugs
When using the drug, it is necessary to take into account the interaction with other drugs:
- Furosemide may increase the risk of nephropathy after administration of radiopaque contrast agents.
- The combination of the drug with cardiac glycosides increases the risk of developing digitalis intoxication.
- The effect of Furosemide is reduced when used simultaneously with phenobarbital and phenytoin.
- The drug is able to increase the concentration of cephalosporin antibiotics and chloramphenicol. At the same time, it increases the risk of developing their nephro- and ototoxic effects. The elimination of antibiotics of the aminoglycoside group slows down when combined with Furosemide, which also increases the likelihood of intoxication.
- Elderly patients often need to take furosemide and drugs from the group of non-steroidal anti-inflammatory drugs. You should be careful with such a combination, as it leads to a decrease in the effectiveness of Furosemide. If salicylates are chosen as NSAIDs, Furosemide may increase their toxic effect.
- The weakening of the effect of Furosemide is observed when taken simultaneously with sucralfate. Increased activity - when combined with other diuretics or antihypertensive drugs, especially ACE inhibitors.
Edema syndrome of various origins, incl. with chronic heart failure stage II-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome. Pulmonary edema, cardiac asthma, cerebral edema, eclampsia, forced diuresis, severe arterial hypertension, some forms of hypertensive crisis, hypercalcemia.
Release form of the drug Furosemide
substance; two-layer polyethylene bag (sack) 5 kg, drum 1;
Substance; bag (sack) polyethylene two-layer 5 kg, drum 2;
Substance; two-layer polyethylene bag (sack) 10 kg, drum 1;
Substance; two-layer polyethylene bag (sack) 10 kg, drum 2;
Substance; two-layer polyethylene bag (sack) 15 kg, drum 1;
Substance; bag (sack) polyethylene two-layer 15 kg, drum 2;
Substance; bag (sack) polyethylene two-layer 20 kg, drum 1;
Substance; bag (sack) polyethylene two-layer 20 kg, drum 2;
Substance; bag (sack) polyethylene two-layer 25 kg, drum 1;
Substance; bag (sack) polyethylene two-layer 25 kg, drum 2;
Substance; two-layer polyethylene bag (sack) 30 kg, drum 1;
Substance; bag (sack) polyethylene two-layer 30 kg, drum 2;
Substance; double-layer polyethylene bag (sack) 40 kg, drum 1;
Substance; two-layer polyethylene bag (sack) 40 kg, drum 2;
Substance; bag (sack) polyethylene two-layer 50 kg, drum 1;
Substance; double-layer polyethylene bag (sack) 50 kg, drum 2;
Pharmacodynamics of the drug Furosemide
"Loop" diuretic. Violates the reabsorption of sodium and chlorine ions in the thick segment of the ascending part of Henle's loop. Due to the increase in the release of sodium ions, there is a secondary (mediated by osmotically bound water) enhanced excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases.
Has secondary effects due to the release of intrarenal mediators and the redistribution of intrarenal blood flow. Against the background of the course of treatment, there is no weakening of the effect.
In heart failure, it quickly leads to a decrease in the preload on the heart through the expansion of large veins. It has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the reaction of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in the BCC. The effect of furosemide after intravenous administration occurs in 5-10 minutes; after oral administration - after 30-60 minutes, maximum action - after 1-2 hours, duration of effect - 2-3 hours (with reduced renal function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, but after its termination, the rate of excretion decreases below the initial level ("rebound" or "cancellation" syndrome). The phenomenon is caused by a sharp activation of the renin-angiotensin and other antinatriuretic neurohumoral regulation links in response to massive diuresis; stimulates the arginine-vasopressive and sympathetic systems. Reduces the level of atrial natriuretic factor in plasma, causes vasoconstriction.
Due to the phenomenon of "rebound" when taken once a day may not have a significant effect on the daily excretion of sodium ions and blood pressure. When administered intravenously, it causes dilatation of peripheral veins, reduces preload, reduces left ventricular filling pressure and pulmonary artery pressure, as well as systemic blood pressure.
The diuretic effect develops 3-4 minutes after intravenous administration and lasts 1-2 hours; after oral administration - after 20-30 minutes, lasts up to 4 hours.
Pharmacokinetics of the drug Furosemide
After oral administration, absorption is 60-70%. In severe kidney disease or chronic heart failure, absorption decreases.
Vd is 0.1 l / kg. Plasma protein binding (mainly albumin) - 95-99%. Metabolized in the liver. It is excreted by the kidneys - 88%, with bile - 12%. T1 / 2 in patients with normal kidney and liver function is 0.5-1.5 hours. With anuria, T1 / 2 may increase to 1.5-2.5 hours, with combined renal and hepatic failure - up to 11-20 hours.
Use of the drug Furosemide during pregnancy
During pregnancy, it is possible only for a short time and only if the intended benefit to the mother outweighs the potential risk to the fetus (passes through the placental barrier). In the case of using furosemide during pregnancy, careful monitoring of the condition of the fetus is necessary.
For the duration of treatment, it is necessary to stop breastfeeding (furosemide passes into breast milk, and can also suppress lactation).
Contraindications to the use of the drug Furosemide
Hypersensitivity (including to sulfonylurea derivatives, sulfonamides), renal failure with anuria, severe hepatic failure, hepatic coma and precoma, severe electrolyte imbalance (including severe hypokalemia and hyponatremia), hypovolemia (with arterial hypotension or without it) or dehydration, a pronounced violation of the outflow of urine of any etiology (including unilateral lesion of the urinary tract), digitalis intoxication, acute glomerulonephritis, decompensated mitral or aortic stenosis, increased pressure in the jugular vein over 10 mm Hg. Art., hypertrophic obstructive cardiomyopathy, hyperuricemia, children under 3 years of age (for tablets).
Side effects of the drug Furosemide
From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): lowering blood pressure, incl. orthostatic hypotension, collapse, tachycardia, arrhythmia, decreased BCC, leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.
From the side of water and electrolyte metabolism: hypovolemia, hypokalemia, hypomagnesemia, hyponatremia, hypochloremia, hypocalcemia, hypercalciuria, metabolic alkalosis, impaired glucose tolerance, hyperglycemia, hypercholesterolemia, hyperuricemia, gout, increased cholesterol levels, LP thrombosis and thromboembolism, more often in elderly patients).
From the digestive tract: decreased appetite, dryness of the oral mucosa, thirst, nausea, vomiting, constipation / diarrhea, cholestatic jaundice, pancreatitis (exacerbation).
From the nervous system and sensory organs: dizziness, headache, paresthesia, apathy, weakness, weakness, lethargy, drowsiness, confusion, muscle weakness, cramps of the calf muscles (tetany), damage to the inner ear, hearing impairment, blurred vision.
From the genitourinary system: oliguria, acute urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, decreased potency.
Allergic reactions: purpura, photosensitivity, urticaria, pruritus, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing angiitis, anaphylactic shock.
Others: chills, fever; with intravenous administration (additionally) - thrombophlebitis, renal calcification in premature babies.
Precautions for taking Furosemide
In the presence of ascites without peripheral edema, it is recommended to use it in doses that provide additional diuresis in a volume of no more than 700-900 ml / day in order to avoid the development of oliguria, azotemia and electrolyte disturbances. In order to exclude the phenomenon of "rebound" in the treatment of hypertension is prescribed at least 2 times a day. It should be borne in mind that prolonged use can lead to weakness, fatigue, a decrease in blood pressure and cardiac output, and excessive diuresis in myocardial infarction with congestion in the pulmonary circulation can contribute to the development of cardiogenic shock. Temporary cancellation (for several days) is required before prescribing ACE inhibitors. To avoid the development of hypokalemia, it is advisable to combine furosemide with potassium-sparing diuretics, as well as simultaneously prescribe potassium preparations. When treating with furosemide, it is always recommended to follow a diet rich in potassium.
Against the background of a course of treatment, it is recommended to control blood pressure, electrolyte levels (especially potassium), CO2, creatinine, urea nitrogen, uric acid, periodic determination of the activity of liver enzymes, calcium and magnesium levels, blood glucose and urine (in diabetes mellitus). Patients with hypersensitivity to sulfonylurea derivatives and sulfonamides may have cross-sensitivity to furosemide. If oliguria persists for 24 hours, furosemide should be canceled.
It should not be used during work by vehicle drivers and people whose profession is associated with increased concentration of attention.
Storage conditions of the drug Furosemide
List B .:
Shelf life of the drug Furosemide
Furosemide belongs to the ATX classification:
C Cardiovascular system
C03 Diuretics
C03C Loop diuretics
C03CA Sulfonamide diuretics
There are many diseases that may require the use of diuretics. They are necessary for the elimination of stagnant urine in order to eliminate edema in a variety of pathological conditions. It is important that diuretics are used, as a rule, in rather severe cases with severe swelling, acute intoxication of the body and a sharp increase in blood pressure. Furosemide is a powerful, fast-acting, diuretic drug.
In what form is it produced
Furosemide tablets are an oral form. The medicine package contains 50 tablets. The active ingredient (furosemide) each of them contains 40 mg, in addition to this, there are also auxiliary components. These include:
- lactose;
- potato starch;
- magnesium stearate;
- gelatin.
The white tablet has a flat-cylindrical shape. The tablets can be placed in dark glass vials or in polymer containers.
Injection Furosemide solution is a concentrate of this substance. Additional elements:
- sodium chloride;
- sodium hydroxide;
- water for injections.
The drug in this form is packaged in glass ampoules with a capacity of 2 ml of the drug.
Diuretic Furosemide belongs to the group of "loop diuretics". All of them in general and Furosemide in particular have a directed effect on the Gingle loop, which is a renal tubule. It is characterized by the fact that it is directly responsible for the process of reabsorption of the liquid with all the substances dissolved in it.
Furosemide has a pronounced diuretic effect and is characterized by a rapid but short-lived effect.
Doctor's opinion:
“When taking pills, the therapeutic effect occurs after 20-30 minutes, after intravenous administration, the onset of action is halved and is 15-20 minutes. The duration of exposure is purely individual for each individual patient and can range from 3 to 6 hours. The peak of exposure is noted 1-2 hours after taking the pill or within 30 minutes after the drug is administered. It is noteworthy: the more pronounced renal dysfunction - the longer the action of the diuretic ”
The action of the medication is based on a violation of the reabsorption of chloride and sodium ions in the renal tubules. The excretion of magnesium, calcium and phosphates is increased.
If the drug is used for heart failure, then the preload on the heart muscle decreases 20 minutes after ingestion.
Within 2 hours, the tone of the veins and the volume of circulating blood and fluid filling the intercellular spaces decrease - this is how the hemodynamic effect manifests itself.
With a single daily administration of the drug, there is no particular effect on blood pressure or sodium excretion.
The medication is characterized by rapid absorption and bioavailability (60-70% when using tablets). The connection with plasma proteins is 98%, and it is much lower in renal failure.
The breakdown takes place in the liver, and its products enter the renal tubules.
Excretion is carried out mainly by the kidneys (60-70%), the rest - with feces. If the drug was administered intravenously, then 88% is excreted by the kidneys, the rest with feces.
Important!
The agent has a high ability to overcome the placental barrier and be absorbed into breast milk.
In elderly patients, the diuretic effect is significantly lower.
The drug must be taken with caution, since in addition to unnecessary stagnant urine, sodium and chlorine salts are excreted.
Furosemide Sopharma is the same drug released by Sopharma. Many people believe that the drugs of this company are of higher quality, but the indications and medicinal effects of these drugs are absolutely identical.
What is prescribed for: indications for use
The use of tablets is advisable in the following cases:
- Edema of a very different nature, including in renal and heart failure.
- Preeclampsia is a form of late toxicosis in pregnant women, which can lead to its thermal stage - eclampsia.
- Gestosis in pregnant women, a pathological condition, often accompanied by edema, increased blood pressure, protein ingestion in the urine.
- A pathological process with generalized edema is a nephrotic syndrome.
- Liver disease (for example, cirrhosis).
- Arterial hypertension (its severe forms) when it is impossible to use thiazide diuretics.
- Hypertensive crisis (both independently and in combination).
- Increased plasma calcium levels (hypercalcemia).
- Cerebral edema.
- Heart failure accompanied by pulmonary edema.
- Intoxication of the body with toxic substances (to ensure forced diuresis).
Furosemide in ampoules is indicated in the same cases. The only difference is the fastest therapeutic effect. Most often it is used when it is necessary to lower blood pressure and preload on the heart as quickly as possible. This is very important when providing emergency care to patients.
Contraindications
The number of contraindications to the use of this drug is quite large. The appointment of the attending physician is very important, because even if there are two conditions from the list, the use of this medication is impossible. Contraindications include the following conditions:
- complete or partial cessation of the flow of urine into the bladder - anuria;
- renal failure in the acute stage;
- a decrease in the amount of excreted urine - oliguria, especially of an unexplained nature;
- blockage of the ureter with calculus;
- hepatic or hyperglycemic coma, conditions preceding coma;
- systemic lupus erythematosus;
- disorder of water-salt metabolism;
- poisoning with cardiac glycosides;
- glomerulonephritis in acute form;
- high levels of uric acid in the blood;
- disruption of the heart in the final stage of progression;
- pathological narrowing of the aorta, mitral valve, urethra;
- thickening of the walls of the ventricles;
- increased venous pressure;
- the first three months of pregnancy;
- lactation;
- severe allergy to any of the constituents, for example, to lactose.
There are a number of conditions that are related to the relative types of contraindications:
- Pancreatitis
- Diarrhea.
- Diabetes.
- Lowered blood pressure.
- Cardiogenic shock;
- Acute heart attack.
- Benign prostatic hyperplasia.
- Decreased protein levels.
- Atherosclerosis.
Important!
Furosemide is rarely prescribed for cystitis and this is due, not least, to the negative effects of this drug.
There are many special medications available to treat this disease. The medication, rather, is used for cystitis as part of self-medication and it is fraught with the development of additional diseases. It should be remembered that even a course of treatment with Furosemide will not rid the bladder of pathogenic microflora, because cystitis is inflammation.
Instructions for use
The drug in tablets is taken from 20 mg per day of a person. If the desired effect is not obtained, then the dose is increased, but the daily maximum is 1.5 g. The tablet is swallowed whole, without chewing, with a small amount of water. The dosage of the drug, as well as the duration of treatment, is selected individually, it depends directly on the age, body weight, the severity of the edema and existing diseases. At least 6 hours should elapse between pills.
Furosemide and alcohol are incompatible. This combination greatly enhances the side effects.
Furosemide instructions for use: a combination of a drug with antihypertensive drugs is allowed - the dose is 20-120 mg per day. Constant monitoring of blood pressure is very important in order to prevent its sharp and significant drop.
If a cardiac, pulmonary or hepatic origin of edema is established, then it is prescribed: in states of moderate severity, 0.5-1 tablets per day, in severe cases - 2-3 tablets per day, sometimes even 4.
Use of this product on children: a dosage of 1-2 mg / kg of body weight is recommended.
Elderly patients require special attention when choosing a dose, it is necessarily minimal.
Furosemide ampoules with solution for injection are used for intravenous infusion. The introduction must be slow, about 1-2 minutes. Only health workers can give such injections. If the daily dosage exceeds 80 ml, then droppers with this drug may be shown. At the first opportunity, the patient should be switched to tablets.
Overdose and side effects
Adverse reactions usually occur with inaccurate dosage. These manifestations include:
- a jump in blood pressure to the lower side, thrombus formation, the occurrence of acute vascular insufficiency;
- weakness and muscle cramps, drowsiness and general lethargy, dizziness;
- sensation of tinnitus;
- feeling of thirst with dry mouth, soreness in the abdomen, nausea and vomiting, reactive pancreatitis;
- a sharp decrease in excreted urine, blood impurities in it, decreased libido and even impotence, proliferation of prostate cells;
- dermatitis, urticaria, in severe cases - Quincke's edema, anaphylactic shock;
- a decrease in the level of leukocytes and platelets in the blood, an increase in the level of eosinophils, anemia;
- lowering the level of potassium, calcium and magnesium ions.
If any of the above effects occur, then either the complete cancellation of the drug or a decrease in its dosage follows. An extensive list of possible side effects indicates how actively a given substance affects the existing organs and systems of a person. For this reason, it is important to exclude the independent appointment of Furosemide, this can cause conditions that pose an immediate threat to the patient's life.
With an incorrect or self-prescribed dosage, there may be cases of drug overdose. Its features include:
- violation of breathing and functioning of the cardiovascular system;
- coma;
- paralysis;
- thromboembolism;
- drowsiness;
- arrhythmias and ventricular fibrillation;
- collapse.
How it interacts with other medications
Interaction features:
- With Phenobarbital, the therapeutic effect of the diuretic is noticeably reduced.
- Furosemide provokes complications from taking antibiotics.
- A medication with aminoglycosides: the excretion of the latter is greatly slowed down.
- Furosemide reduces the therapeutic effect of hypoglycemic agents.
- When taken concomitantly with glucocorticosteroids, the risk of hypokalemia increases.
- Antihypertensive drugs together with a diuretic provoke a sharp drop in blood pressure.
- There is a risk of acute renal failure with ACE inhibitors.
- With the introduction of a radiopaque substance, renal dysfunction may be found.
- This diuretic interferes with the normal excretion of uric acid from the body.
- Patients with diabetes mellitus need regular monitoring of glucose in both blood and urine.
- If you are lactose intolerant, the medication cannot be used.
- It is important to discontinue the drug for patients with urinary outflow problems.
- Those who are prescribed high doses are advised not to limit the consumption of table salt and to use a diet rich in potassium.
During pregnancy
The drug has a high ability to penetrate the placenta; during pregnancy, you must either completely abandon the use of this diuretic, or use it only in the most extreme cases. It is contraindicated to use the medication for physiological edema while carrying a child. Doctors do not recommend using this diuretic during this period, because there are many much safer diuretics, even if their cost is much higher. In emergency cases, intravenous administration is considered the safest, because then the drug is quickly excreted from the body and the effect on the fetus will be minimized.
The same applies to the period of breastfeeding: if there is an urgent need for treatment, then the feeding should be suspended until the end of the course of treatment.
With cystitis
Cystitis is an inflammatory disease, therefore anti-inflammatory drugs are prescribed first of all. Treatment with Furosemide is advisable if there is a need to remove excess fluid. With a not too acute course of cystitis, the medication is able to remove the pathogenic microflora from the body, but if the disease has passed into the acute stage, such treatment will not give the expected result.
Analogues and price
The main analogue is the diuretic Lasix, you can also highlight Bufenox, Britomar, Diuver, etc.
Furosemide is a fairly cheap drug, the price for it fluctuates between 20-40 rubles per package. The medication is dispensed with a prescription from your doctor.
Comparison table of drug analogues by cost. The last data update was on 21.10.2019 00:00.
| Name | Price | |
|---|---|---|
| Furosemide | from 19.50 rub. up to 26.00 rub. | |
| Lasix | from 55.00 rub. up to RUB 85.00 | |
| Torasemid | from 104.00 rub. up to RUB 515.00 |
Diuretic tablets "Furosemide" are prescribed to eliminate edema of various etiologies. This medication is aimed at removing excess fluid from the body and increasing urine production. To avoid undesirable negative consequences during treatment with "Furosemide", it is necessary to take a diuretic as prescribed by a doctor, in strictly prescribed dosages.
"Furosemide" is prescribed for edema of various nature.
general information
"Loop" diuretic "Furosemide" contains the following elements:
- furosemide - 40;
- milk sugar;
- food emulsifier E572;
- corn starch.
The diuretic "Furosemide" activates the renal function to excrete a large volume of fluid and salts with urine. This action of the drug allows patients to get rid of edema that has arisen for various reasons. But, unfortunately, along with the excreted urine, potassium and magnesium ions leave the body. That is why specialized experts recommend drinking potassium-saving drugs with "Furosemide". The severity of the diuretic effect of the described drug depends on the dosage that patients take, but in any case, this diuretic is more powerful than thiazide-like diuretics.
Simultaneously with the drug, it is advisable to take potassium-sparing agents After the taken "Furosemide" tablet, the diuretic effect appears in the first 60 minutes, and after the injection, the therapeutic effect is observed after 5 minutes. The disadvantage of this medication is the rapid cessation of the diuretic action. Prescribed "Furosemide" for edema of renal and cardiac origin, as well as for edema of hepatic etiology, but only in complex therapy, which includes a potassium-sparing diuretic. Specialists define potassium-sparing diuretics as drugs whose mechanism of action is aimed at preventing the excretion of potassium from the body. It should be borne in mind that the diuretic effect of "Furosemide" under the influence of theophylline decreases, while the effect of theophylline increases, which is dangerous with the development of negative consequences.
Contraindications and side effects
You should not use "Furosemide" in patients who have the following pathologies:
- oliguria;
- allergic reactions to the components of the described diuretic;
- dehydration;
- hypokalemia;
- hyponatremia;
- glomerulonephritis in the acute phase;
- gout;
- the threat of renal coma;
- diabetes;
- low blood pressure;
- diarrhea;
- pancreatitis;
- violation of the outflow of urine.
In the course of treatment with this pharmaceutical preparation, the following side effects often occur:
Side effects of "Furosemide" will affect the patient's well-being and heart function. - heart palpitations;
- dryness in the mouth;
- nausea;
- drowsiness;
- a sharp decrease in urination;
- dizziness;
- vomiting;
- weakness;
- thirst.
Instructions for use and dosages
Attached to the pharmaceutical product "Furosemide" instructions for use, which indicate dosages depending on the indications, the severity of the disease, the patient's age and other factors that the doctor takes into account before prescribing the medicine to the patient. For adults, the dosage of the medication in tablet form is 20-80 mg, taken once or divided into several doses per day. The injection dose is 20-240 mg. If necessary, the dosage can be revised by the attending physician and increased.
How to drink with edema?
Drinking "Furosemide" should be in case of edema that has arisen against the background of dysfunction of the heart muscle, cirrhosis, high blood pressure, and renal failure. Taking the diuretic drug "Furosemide", the patient needs to eat properly. The diet should be dominated by foods that contain large amounts of potassium and magnesium. Based on this, it is recommended to include dried apricots in the menu, both whole and in the form of compotes. It is useful to combine the described diuretic with baked apples, which, like dried apricots, can saturate the body with potassium and magnesium.
With increased pressure
To normalize blood pressure, patients often require complex treatment, which includes not only antihypertensive medications, but also diuretics. Furosemide is effective in combating hypertension. In most cases, it is prescribed at 20-40 mg per day, but at the same time, the dose of other medications taken is reduced by 2 times.
Diuretic for weight loss
Many people use the described diuretic in the fight against excess weight. However, specialized doctors say that it is inappropriate to use "Furosemide for weight loss." Its diuretic effect is aimed at removing excess fluid from the body, which has nothing to do with body fat. This drug with a diuretic effect, which many people mistakenly use to reduce body weight, with prolonged use leads to a breakdown, low blood pressure, problems with urination and imbalance in water and electrolyte balance in the blood.
In case of impaired renal and liver function
"Furosemide" is also prescribed for liver failure. Diuretics are used, in particular, "Furosemide" for edematous syndrome caused by renal and hepatic dysfunction. Patients with these pathologies require an individual selection of dosage with its subsequent increase. Such a treatment regimen is used to provide the patient with gradual fluid loss. In the first days of therapy for renal dysfunction, the dosage is 40-80 mg per day, which should be drunk once or divided into 2 doses.
In renal pathologies, "Furosemide" with a diuretic effect is used as an additional remedy for the ineffectiveness of aldosterone antagonists. The dosage of the medication is carefully selected for each patient individually in order to prevent sudden weight loss. On the first day of treatment, fluid loss of up to 0.5 kg of body weight is allowed. Initially, the daily dosage is 20-80 mg.
**** * TYUMENSKY KhFZ * * PHARMASYNTEZ JSC * Arla Foods amba Arinco POLFA (POLFARMA Pharmaceutical Plant) PRO. MED. CS Praha a.s ABON BIOPHARM (Hangzhou) Co., LTD Akrikhin KhFK JSC BELMEDPREPARATY, RUE BIOMED Biosynthesis OJSC Biochemist, OJSC Borisov plant of medical preparations, OJSC Borisov plant of medicinal products, RUE BRYTSALOV-A, CJSC Dalkhimpharm OJSC Darnitsa Pharmaceutical. company, CJSC IRBITSKY CHIMPHARMZAVOD, OJSC MILVE pharmaceutical plants AO Moscow endocrine plant, FSUE Moskhimpharmaceuticals FSUE them. Semashko Moskhimpharmaceuticals named after N.A. Semashko, JSC Novosibkhimpharm JSC OZON, LLC Olainfarm JSC Experimental plant GNTSLS, LLC POLYFARM ICN Rospharm LLC ROSFARM, CJSC SAMSON-MED, LLC Sishui Xirkang Pharmasyutical Co., Ltd. Product Ltd / P Sopharma JSC TCFZ ICN Tyumensky KhPZ JSC Ufavita Ufimsky Vitamin Plant JSC Pharmasintez JSC Farmahim Holding EAO, Sopharma JSC Pharmaceutical enterprise "Obolenskoe" JSC Pharmsintez, PJSC Pharmstandard, LLC Pharmstandard-Tomskkhimfarm, JSC FEREINECountry of origin
Belgium Bulgaria China Republic of Belarus Russia UkraineProduct group
Genitourinary systemDiuretic
Release forms
- 10 - contoured cell packages (5) - cardboard packs 50 - polymer bottles (1) - cardboard packs. 10 ampoules of 2.0 in a carton box of 2 ml - ampoules (10) - packs of cardboard 2 ml - ampoules of dark glass (10) - packs of cardboard. 2 ml - dark glass ampoules (10) - cardboard packs. 2 ml - dark glass ampoules (1) - cardboard packs. 2 ml - dark glass ampoules (5) - contoured plastic packaging (1); (2) - packs of cardboard. 20 pcs. - contour cell packaging. 50 tabs per pack solution for intravenous and intramuscular administration, 20mg ampoules, 2ml ampoules - 10 pcs per pack. 40 mg tablets, 50 tablets per pack
Description of the dosage form
- Tablets, white with a creamy shade, flat-cylindrical, with a bevel. round biconvex tablets of white or almost white color. ... Transparent colorless: or slightly colored liquid Solution for intravenous and intravenous administration Solution for injection Solution for injection 1% transparent Tablets
pharmachologic effect
"Loop" diuretic. Violates the reabsorption of sodium and chlorine ions in the thick segment of the ascending part of Henle's loop. Due to the increase in the release of sodium ions, there is a secondary (mediated by osmotically bound water) enhanced excretion of water and an increase in the secretion of potassium ions in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. Has secondary effects due to the release of intrarenal mediators and the redistribution of intrarenal blood flow. Against the background of the course of treatment, there is no weakening of the effect. In heart failure, it quickly leads to a decrease in the preload on the heart through the expansion of large veins. It has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the reaction of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in the BCC. The effect of furosemide after intravenous administration occurs within 5-10 minutes; after oral administration - after 30-60 minutes, maximum action - after 1-2 hours, duration of effect - 2-3 hours (with reduced renal function - up to 8 hours). During the period of action, the excretion of sodium ions increases significantly, however, after its termination, the rate of excretion decreases below the initial level ("rebound" or "cancellation" syndrome). The phenomenon is caused by a sharp activation of the renin-angiotensin and other antinatriuretic neurohumoral regulation links in response to massive diuresis; stimulates the arginine-vasopressive and sympathetic systems. Reduces the level of atrial natriuretic factor in plasma, causes vasoconstriction. Due to the phenomenon of "rebound" when taken 1 time per day may not have a significant effect on the daily excretion of sodium ions and blood pressure. When administered intravenously, it causes dilatation of peripheral veins, reduces preload, reduces left ventricular filling pressure and pulmonary artery pressure, as well as systemic blood pressure. The diuretic effect develops 3-4 minutes after intravenous administration and lasts 1-2 hours; after oral administration - after 20-30 minutes, lasts up to 4 hours.Pharmacokinetics
Absorption is high, Cmax is observed in blood plasma when taken orally after 1 hour. Bioavailability is 60-70%. The relative Vd is 0.2 l / kg. Plasma protein binding - 98%. Penetrates through the placental barrier, excreted in breast milk. It is metabolized in the liver to form 4-chloro-5-sulfamoylanthranilic acid. It is secreted into the lumen of the renal tubules through the anion transport system existing in the proximal nephron. It is excreted mainly (88%) by the kidneys unchanged and in the form of metabolites; the rest is by the intestines. T1 / 2 - 1-1.5 hours. Features of pharmacokinetics in certain groups of patients With renal failure, the excretion of furosemide slows down, and T1 / 2 increases; in severe renal failure, the final T1 / 2 can increase up to 24 hours. In nephrotic syndrome, a decrease in plasma protein concentrations leads to an increase in the concentration of unbound furosemide (its free fraction), therefore, the risk of developing an ototoxic effect increases. On the other hand, the diuretic effect of furosemide in these patients may be reduced due to the binding of furosemide to albumin in the tubules and a decrease in the tubular secretion of furosemide. With hemodialysis, peritoneal dialysis and continuous ambulatory peritoneal dialysis, furosemide is excreted slightly. In hepatic impairment, T1 / 2 of furosemide increases by 30-90%, mainly due to an increase in the relative volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly. In heart failure, severe arterial hypertension and in elderly patients, the elimination of furosemide is slowed down due to a decrease in renal function.Special conditions
Before starting therapy with the drug Furosemide Sopharma, the presence of pronounced disorders of the outflow of urine should be excluded, patients with a partial violation of the outflow of urine need careful monitoring. Against the background of the course of treatment, it is necessary to periodically monitor blood pressure, the content of blood plasma electrolytes (including sodium, calcium, potassium, magnesium ions), acid-base state, residual nitrogen, creatinine, uric acid, liver function and, if necessary, appropriate correction of treatment. The use of furosemide slows down the excretion of uric acid, which can provoke an exacerbation of the course of gout. Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to furosemide. In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is inappropriate to limit the consumption of table salt. For the prevention of hypokalemia, the simultaneous administration of potassium preparations and potassium-sparing diuretics is recommended, as well as adhere to a diet rich in potassium. The selection of the dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in stationary conditions (disturbances in the water and electrolyte balance can lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes. If azotemia and oliguria appear or increase in patients with severe progressive kidney disease, it is recommended to suspend treatment. Patients with diabetes mellitus or with impaired glucose tolerance require periodic monitoring of the level of glucose concentration in the blood and urine. In unconscious patients with benign prostatic hyperplasia, narrowing of the ureters or hydronephrosis, urinary control is necessary due to the possibility of acute urinary retention. The drug contains lactose monohydrate, therefore patients with rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption should not take this drug. The preparation contains wheat starch in an amount that is safe for use in patients with celiac disease (gluten enteropathy). Patients with wheat allergy (other than celiac disease) should not use this medication. Influence on the ability to drive vehicles and control mechanisms During the period of treatment with Furosemide Sopharma, you should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving vehicles and working with mechanisms). Overdose Symptoms: marked decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including AV blockade, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis apathy. Treatment: correction of water-electrolyte balance and acid-base state, replenishment of circulating blood volume, gastric lavage, intake of activated carbon, symptomatic treatment. There is no specific antidote.Composition
- 1 amp. furosemide 20 mg 1 amp. furosemide 20 mg 1 tab. furosemide 40 mg 1 tablet contains: active substance: furosemide - 40 mg; excipients: milk sugar, potato starch, magnesium stearate. 1 ml 1 amp. furosemide 10 mg 20 mg 1 tab. furosemide 40 mg Furosemide 40 mg; Auxiliary substances: milk sugar, potato starch, magnesium stearate
Furosemide indications for use
- Edema syndrome of various origins, incl. with chronic heart failure stage II-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome. Pulmonary edema, cardiac asthma, cerebral edema, eclampsia, forced diuresis, severe arterial hypertension, some forms of hypertensive crisis, hypercalcemia.
Furosemide contraindications
- Acute glomerulonephritis, stenosis of the urethra, obstruction of the urinary tract with a stone, acute renal failure with anuria, hypokalemia, alkalosis, precomatous conditions, severe hepatic failure, hepatic coma and precoma, diabetic coma, precomatose conditions, hyperglycemic or coma, decompensated coma, hyperglycemic or coma aortic stenosis, hypertrophic obstructive cardiomyopathy, increased central venous pressure (more than 10 mm Hg), arterial hypotension, acute myocardial infarction, pancreatitis, impaired water and electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, hypochloremia, hypocalcemia), hypomigiesiaemia intoxication, hypersensitivity to furosemide. During pregnancy, the use of furosemide is possible only for a short time and only if the intended benefit of therapy to the mother outweighs the potential risk to the fetus. See instructions for details.
Furosemide dosage
- 0.04 g 1% 10 mg / ml 20 mg / 2 ml 40 mg 40 mg
Furosemide side effects
- From the side of the cardiovascular system: a pronounced decrease in blood pressure, collapse, tachycardia, arrhythmias, a tendency to thrombosis, a decrease in the volume of circulating blood. From the side of the central nervous system: dizziness, headache, muscle weakness, cramps of the calf muscles (tetany), paresthesia, apathy, weakness, weakness, lethargy, drowsiness, confusion. From the senses: impaired vision and hearing, tinnitus. From the digestive system: anorexia, dryness of the oral mucosa, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation), hepatic encephalopathy. From the genitourinary system: oliguria, acute urinary retention (in patients with benign prostatic hyperplasia), interstitial nephritis, hematuria, decreased potency. From the endocrine system: decreased glucose tolerance, manifestation of latent diabetes mellitus. Allergic reactions: purpura, urticaria, exfoliative dermatitis, exudative erythema multiforme, vasculitis, necrotizing angiitis, pruritus, chills, fever, photosensitivity, anaphylactic shock, Stevens-Johnson syndrome, epidermal bullous pemphigole, necrotizing. From the side of hematopoiesis: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, eosinophilia. From the side of water and electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis. Laboratory indicators: hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalciuria, increased activity of hepatic transaminases, eosinophilia.