High level view

Furosemide, commonly marketed under the brand Lasix among others, is a loop diuretic that promotes removal of excess fluid by blocking sodium and chloride reabsorption in the loop of Henle in the kidney. The resulting diuresis helps reduce swelling and breathlessness related to fluid overload.

In Australia it is available in several forms, notably oral tablets (for example 40 mg and 100 mg strengths) and liquid preparations for patients unable to swallow tablets. Specific strengths, pack sizes and presentations depend on the manufacturer; speak with your pharmacist for exact product details.

Furosemide is frequently used for edema and as an adjunct in some blood pressure regimens. When blood pressure control alone is the goal, prescribers often consider other drug classes either instead of, or in combination with, a diuretic. Look over the Optional routes and Related Medications section for further options.

Who uses furosemide in patients with edema or heart failure? among heart failure patients?

Prescribers choose furosemide when reducing retained fluid will improve symptoms or outcomes. Common signals include the following:

  • Edema from chronic heart failure or acute decompensation.
  • Fluid accumulation in advanced liver disease such as cirrhosis, and in kidney disorders such as nephrotic syndrome.
  • Adjunctive management for some forms of hypertension where volume overload contributes to elevated pressure.

After an oral dose the diuretic action usually starts within about one hour, peaks at one to two hours and often lasts six to eight hours, so clinicians commonly recommend morning dosing to minimize nocturnal urination. Dosing parameters, please see How to Manage It.

Tips for Taking It

Follow the exact directions given by your prescriber. Do not change the dose or stop treatment without discussing it with your healthcare professional.

  • Adhere to the prescription label and any written instructions from your prescriber or pharmacist.
  • Use a calibrated oral syringe or dosing device for liquid formulations; do not rely on household spoons.
  • Take the medicine at the same times each day if on a regular schedule; morning doses reduce the chance of sleep disturbance from frequent urination.
  • Your clinician may advise on fluid intake, dietary salt, and periodic blood tests to check electrolytes and kidney function. Keep scheduled follow up appointments for system monitoring.

If you are unsure about how to take part the medicine, contact your pharmacist or prescriber. When you miss a dose, refer to the instructions. the What Should You Do If a Dose Is Missed section chunk.

Precautionary Measures and Protective actions and medical grounds for not using this treatment

Furosemide affects fluid balance and electrolyte levels such as potassium, sodium and magnesium. Regular constant monitoring of blood tests and blood pressure is common during therapy.

Tell Your Clinician Before commencing If You Have

  • Markedly reduced kidney function or trouble passing urine.
  • Profound hepatic impairment or episodes of hepatic encephalopathy.
  • A history of gout, since diuretics may raise uric acid levels.
  • An autoimmune disease such as systemic lupus erythematosus.
  • Diabetes, a chronic glucose problem, because diuretics can influence blood glucose readings.
  • A known allergy to sulfonamide medicines; in that case your prescriber may consider ethacrynic acid as an another way forward.

Hydration and Sun Protection

  • Avoid dehydration and follow the fluid plan agreed with your health team.
  • Furosemide can increase sensitivity to sunlight. Use broad spectrum sunscreen, protective clothing and limit prolonged sun exposure.

Pregnancy and nursing

The risks and benefits of furosemide in pregnancy are not fully defined. If you are expectant, planning to conceive, or breastfeeding, discuss treatment options with your prescriber. Furosemide passes into breast milk and could affect a nursing infant.

Secondary adverse effects and Signs to Watch For

Seek urgent medical care if you experience signs of a severe allergic reaction, such as hives, swelling of the face or throat, or difficulty breathing.

Serious unwanted incidental outcomes - Seek Immediate Advice

  • Excessive thirst, very dry mouth, persistent nausea or vomiting.
  • Severe weakness, confusion, fainting or dizziness that could indicate a major electrolyte disturbance or low blood pressure.
  • Rapid, irregular or unusually strong heartbeats.
  • Severe muscle cramps or profound weakness suggesting low potassium.
  • Markedly reduced urine output or inability to pass urine.
  • Unusual bleeding, bruising or blistering rash.
  • New hearing loss or ringing in the ears, particularly with rapid intravenous administration or very high doses.
  • Signs of liver injury such as abdominal pain, yellowing of the skin or eyes, dark urine or pale stools.

Common or Milder Effects

  • Nausea accompanied by GI upset, constipation or diarrhea.
  • Painful head, light-headedness or transient dizziness.
  • Numbness or tingling in hands or feet.
  • Occasional blurred vision.

If residual effects are persistent or troublesome, discuss additional choices with your pharmacist or prescriber. See Options to consider and Similar Pharmaceuticals for other choices.

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Furosemide interacts with many prescription medicines, over-the-counter products and supplements. Inform your health team about every medicine and supplement you take, including herbal products and vitamins.

  • Sucralfate may reduce absorption of oral furosemide; separate the timing by at least two hours.
  • Other diuretics or antihypertensive agents may enhance blood pressure lowering or fluid loss.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce diuretic effect and impair kidney function.
  • Drugs that alter potassium levels (for example ACE inhibitors, ARBs, potassium supplements or potassium-sparing diuretics) require careful constant monitoring.
  • Ototoxic medications such as high-dose aminoglycoside antibiotics may increase the risk of hearing damage when combined with furosemide.

Before you commence, stopping or changing any medicine talk with your prescriber or pharmacist. For information on sports rules or importation, see Status Under Law and Regulation.

Dose was not taken today

If you miss taking a dose and remember soon after, take it straight away. If the next scheduled dose is near, skip the i failed to take my dose and resume your usual plan. Do not make up for a i failed to take my dose by taking a second dose. Some people use furosemide intermittently under clinical direction; follow the specific advice given by your prescriber.

OD

If you suspect an opioid overdose call emergency services or contact your local Poisons Information Centre immediately. Symptoms indicating opioid overdose may include ringing in the ears, severe weakness, dizzy collapse, confusion or fainting. Prompt medical assessment and supportive care are required.

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  • Store at room temperature, protected from heat, direct sunlight and excess humidity.
  • For oral liquids follow the expiry guidance after opening on the product label; common recommendations range from 60 to 90 days but check the manufacturer instructions.
  • Keep medications away from children, out of their reach and out of their sight.

Further options and Comparable Medications

Which treatment is best depends on the medical problem, kidney function, electrolyte status and other drugs being taken. Regular options considered in Australia include:

  • Other loop diuretics such as bumetanide and torsemide. These share the same the device but differ in potency and duration; they are often more expensive than generic furosemide.
  • Ethacrynic acid is an a different possibility loop diuretic that can be used in patients with severe sulfonamide allergy, though it is less commonly prescribed.
  • Thiazide or thiazide-like diuretics (for example hydrochlorothiazide, indapamide, chlorthalidone) are frequently used for long term blood pressure control and may be combined with loop diuretics in refractory edema.
  • Non-diuretic antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, beta blockers) are options when volume removal is not required as the primary strategy.

Discuss pros, cons, undesired reactions and likely costs under the supervision of your prescriber. For approximate retail prices and subsidy information see Prices denominated in AUD in Australia.

Australian market prices (AUD)

Retail prices vary by brand, pack size, pharmacy and whether the medicine is subsidised via the Pharmaceutical Benefits Scheme (PBS). The figures below are indicative private retail ranges and may change over time.

  • Furosemide a tablet with 40 mg (pack of 100): private prices commonly range from about AUD 6 up to AUD 25 depending on brand and outlet. Eligible patients with PBS concessions will usually pay much less.
  • Furosemide 100 mg tablets: per tablet costs are broadly comparable with 40 mg when calculated by strength, but final pack prices depend on size and brand.
  • Oral liquid formulations: these generally cost more per dose than tablets because of manufacturing and packaging differences.
  • Comparative notes: bumetanide and torsemide are typically pricier than generic furosemide; thiazide diuretics are often inexpensive generics.

For accurate current pricing details and PBS listing status consult your local pharmacy or the PBS website. Pharmacists can suggest the most cost effective therapeutic equivalent and explain permitted brand substitution.

Moment in time snapshot of Facts and Practical Tips

  • Principal applications: reduce edema from heart, liver or kidney disease and as part of some blood pressure regimens.
  • Common tablet strengths: 40 mg and 100 mg; liquid forms are available for those who need them.
  • Take doses in the morning where possible to avoid needing to urinate during the night.
  • Regular real time monitoring of body weight, fluid intake and blood electrolytes helps prevent dehydration and dangerous imbalances.

Additional aspects about Furosemide