Lasix is a sulfonamide derivative; strong and fast-acting diuretic.
Release form and composition
Lazix dosage forms:
- Solution for intramuscular and intravenous administration: colorless, transparent (2 ml in dark glass ampoules with a break point, 10 ampoules in plastic blisters, 1 package in a carton box);
- Tablets: round, white or almost white in color, on one side “DLI” engraving is higher and lower risks (10 pieces in strips of aluminum foil, 5 strips in a cardboard bundle; 15 pieces in strips of aluminum foil, 3 strips in a carton box).
In 1 ml of solution contains:
- Active ingredient: furosemide - 10 mg;
- Auxiliary components: sodium hydroxide, sodium chloride, water for injection.
1 tablet contains:
- Active ingredient: furosemide - 40 mg;
- Auxiliary components: pregelatinized starch, colloidal silicon dioxide, talc, lactose, magnesium stearate, starch.
Indications for use
For both dosage forms:
- Acute renal failure, including in patients with burns and in pregnant women (to maintain fluid excretion);
- Edematous syndrome in acute or chronic heart failure;
- Edematous syndrome in patients with nephrotic syndrome (in addition to the main therapy);
- Edematous syndrome in liver diseases (as a single agent or as part of combination therapy with aldosterone antagonists).
Additionally for solution:
- Edematous syndrome in chronic renal failure;
- Swelling of the brain;
- Hypertensive crisis;
- Poisoning with chemical compounds that are excreted by the kidneys in unchanged form (to maintain forced diuresis).
Additionally for tablets:
- Arterial hypertension.
For both dosage forms:
- Hypovolemia (including arterial hypotension) or dehydration;
- Severe hyponatremia;
- Severe hypokalemia;
- Hepatic precoma and coma;
- Pronounced violations of the outflow of urine of any origin (including unilateral damage to the urinary tract);
- Renal failure with anuria, not amenable to correction with furosemide;
- Lactation period;
- Hypersensitivity to any component of the drug;
- Allergy to sulfonamides - sulfanilamide antimicrobial agents and sulfonylurea drugs (as cross allergy to furosemide is possible).
Additionally for tablets:
- Digitalis intoxication;
- Acute glomerulonephritis;
- Increased central venous pressure (above 10 mm Hg);
- Hypertrophic obstructive cardiomyopathy, decompensated mitral and aortic stenosis;
- Children age up to 3 years.
Regardless of the form of release with caution Lasix appointed in the following cases:
- Acute myocardial infarction (there is a risk of cardiogenic shock);
- Latent or manifest diabetes mellitus;
- Conditions in which an excessive reduction in blood pressure is especially dangerous (for example, stenotic lesions of the cerebral and / or coronary arteries);
- Hepatorenal syndrome;
- Systemic lupus erythematosus;
- A history of ventricular arrhythmias;
- Hypoproteinemia (for example, in nephrotic syndrome, when there is a likelihood of a decrease in the diuretic effect and an increased risk of the development of the ototoxic effect of furosemide);
- Pancreatitis, diarrhea;
- Hearing loss;
- Violation of urine outflow (hydronephrosis, narrowing of the urethra, prostatic hyperplasia).
In the form of a solution, the drug with caution is also prescribed to premature babies, since they may develop nephrolithiasis and nephrocalcinosis.
Dosing and Administration
Doses of Lasix in each case are selected individually. It is always necessary to use the least effective dose, which is sufficient to achieve the desired therapeutic effect.
The solution is administered mainly intravenously (IV), in very rare cases - intramuscularly (IM). At the same time, intravenous administration is indicated only in those cases when oral administration of furosemide is impossible, the patient has impaired absorption of the drug in the small intestine, or it is necessary to obtain the effect as quickly as possible. As soon as the opportunity arises, the patient is transferred to Lasix in the form of tablets.
The maximum speed on / in the introduction - 4 mg / minute, for patients with severe renal insufficiency - 2.5 mg / minute. To suppress the counter-regulation and achieve optimal efficacy, preferably continuous infusion administration of the drug. If, after one or several bolus intravenous injections in acute conditions, it is not possible to perform a constant intravenous infusion, it is recommended to administer low doses of furosemide at short intervals (approximately 4 hours).
To dilute the solution Lasix, you can use saline. It should be prepared immediately before use.
The maximum daily dose for IV administration is: for adults - 1500 mg, for children - 1 mg / kg, but not more than 20 mg / day.
The duration of treatment in each case is determined by the doctor.
Special recommendations on the dosage regimen for adults:
- Edematous syndrome in acute heart failure, hypertensive crisis, swelling of the brain: the initial dose is 20-40 mg in the form of intravenous bolus administration. In the future, the dose is adjusted depending on the therapeutic effect;
- Edematous syndrome in chronic heart failure: the initial dose is 20-80 mg per day, the required dose is determined depending on the diuretic effect and is divided into 2-3 injections;
- Edema in nephrotic syndrome: the initial daily dose is 20-40 mg, then it is selected taking into account the diuretic response;
- Acute renal failure: the initial dose is 40 mg. If there is no necessary diuretic effect, the drug is administered as a continuous intravenous infusion at a rate of 50-100 mg / hour;
- Edematous syndrome in chronic renal failure: requires particularly careful selection of doses, starting with the minimum and gradually increasing them. Treatment begins with a drip in / in the introduction at a rate of 0.1 mg / minute and increase it every 30 minutes, depending on the therapeutic effect. Typically, the daily maintenance dose for patients on hemodialysis is 250-1500 mg;
- Edematous syndrome in diseases of the liver (only if the / in the introduction is absolutely necessary): the initial dose - 20-40 mg;
- Maintenance of forced diuresis in case of poisoning (after IV infusion of electrolyte solutions): the initial dose is 20-40 mg.
Tablets Lasix should be taken orally, without chewing and drinking water, on an empty stomach.
The maximum daily dose for oral administration: for adults - 1500 mg, for children - 2 mg / kg, but not more than 40 mg / day. The duration of treatment is determined by the doctor depending on the evidence.
Special recommendations on the dosage regimen for adults:
- Edematous syndrome in chronic heart failure and liver diseases: the initial daily dose is 20-80 mg in 2-3 doses;
- Edema syndrome in chronic renal failure, edema in nephrotic syndrome: the initial daily dose is 40-80 mg in 1-2 doses. For hemodialysis patients, the maintenance dose is usually from 250 to 1500 mg per day;
- Acute renal failure: the dose in tablets depends on the selected intravenous dose;
- Arterial hypertension: supporting daily dose - 20-40 mg. If the disease is combined with chronic renal failure, higher doses of furosemide may be required.
Possible side effects caused by the use of Lasix:
- Water-electrolyte and acid-base balance: metabolic alkalosis, hypokalemia, hypochloremia, hypomagneemia, hyponatremia, hypocalcemia (accompanied by symptoms such as headache, muscle weakness, convulsions, confusion, tetany, dyspepsia, cardiac rhythm disorders), hypovolemia (more often in older people);
- Cardiovascular system: excessive decrease in blood pressure (manifested, especially in elderly patients, such symptoms: feeling of "emptiness" in the head, feeling of pressure in the head, impaired reaction and concentration, drowsiness, headache, weakness, dizziness, dry mouth , visual disorders, violation of orthostatic regulation of blood circulation), arrhythmias, tachycardia, collapse, decrease in circulating blood volume;
- Metabolism: reduced glucose tolerance (possible manifestation of latent diabetes mellitus), a transient increase in urea and creatinine levels in the blood, increased serum concentrations of triglycerides and cholesterol, increased serum concentrations of uric acid, which can increase the symptoms or cause gout;
- Urinary system: increased or the appearance of symptoms due to partial obstruction of the urinary tract; rarely, interstitial nephritis, nephrolithiasis / nephrocalcinosis in premature babies;
- The digestive system: rarely - diarrhea, vomiting, nausea; in some cases - intrahepatic cholestasis, increased levels of liver enzymes, acute pancreatitis;
- Central nervous system, organ of hearing: rarely - paresthesia, hearing impairment (usually reversible), tinnitus (especially in patients with nephrotic syndrome and renal failure, or in the case of rapid intravenous administration of Lazix);
- Peripheral blood: rarely - thrombocytopenia, eosinophilia, leukopenia; in some cases - aplastic or hemolytic anemia, agranulocytosis;
- Skin, allergic reactions: rarely - skin manifestations: itching, polymorphic erythema, urticaria, bullous skin lesions or other types of rash, purpura, vasculitis, exfoliative dermatitis, photosensitization, fever; extremely rarely - severe anaphylactoid or anaphylactic reactions, up to shock (were noted only after intravenous administration);
- Local reactions with the / m introduction - pain at the injection site;
- Other: in premature babies in the first weeks of life - the risk of preserving the Botallova duct.
Before starting treatment with Lasix, it is necessary to exclude the presence of pronounced violations of urine outflow, even unilateral ones. Patients with a partial violation of the outflow of urine should be under close supervision.
Before and during the use of the drug should be monitored and, in the case of development, to eliminate dehydration or hypovolemia, as well as clinically significant violations of the acid-base and / or electrolyte state. Sometimes this requires a brief cancellation of furosemide.
During therapy, it is necessary to regularly monitor serum concentrations of potassium, creatinine and sodium, especially in patients with a high risk of developing electrolyte imbalances due to additional fluid and electrolyte losses, for example, due to diarrhea, vomiting, or intense sweating.
During treatment it is recommended to eat foods rich in potassium, for example, potatoes, meat, tomatoes, spinach, cauliflower, bananas, dried fruits. In some cases, an additional prescribed potassium or potassium-sparing drugs.
Premature babies require regular ultrasound examination of the kidneys and control of their function, since There is a possibility of nephrolithiasis and nephrocalcinosis.
Selection of doses to patients with ascites, developed on the background of cirrhosis of the liver, is carried out in the hospital, since violations of the water-electrolyte state can lead to hepatic coma.
Lasix Solution should not be mixed in the same syringe with other drugs.
Some side effects (for example, symptoms accompanying a significant reduction in blood pressure) can disrupt the reaction rate and ability to concentrate, which can be dangerous when working with mechanisms and driving vehicles. Especially it concerns the beginning of treatment and the period of increasing the dose, as well as the cases of concomitant use of antihypertensive drugs or alcoholic beverages.
Possible interaction reactions with the simultaneous use of Lasix with other drugs:
- Cardiac glycosides and drugs that prolong the QT interval - enhancing their toxic effects in patients with electrolyte disorders (hypokalemia or hypomagnesaemia);
- Long-lasting laxatives, large quantities of licorice, glucocorticosteroids and carbenoxolone - the risk of hypokalemia;
- Aminoglycosides - slowing their elimination, increasing the risk of nephrotoxic and ototoxic effects;
- High doses of some cephalosporins (especially those with predominantly renal excretion), drugs with a nephrotoxic effect - the likelihood of their nephrotoxic effect;
- Cisplatin - the risk of its ototoxic action, and when taking furosemide in a dose of more than 40 mg - the probability of the nephrotoxic effect of cisplatin;
- Nonsteroidal anti-inflammatory drugs (including acetylsalicylic acid) - reducing the diuretic effect of furosemide; in patients with hypovolemia and dehydration (including those developed as a result of the use of Lasix) - the development of acute renal failure; increased toxic effects of salicylates;
- Phenytoin - reducing the effectiveness of furosemide;
- Antihypertensive drugs, diuretics, or other means capable of lowering blood pressure - enhancing their hypotensive action;
- Hypoglycemic agents, pressor amines (norepinephrine and epinephrine) - reducing their effectiveness;
- Angiotensin-converting enzyme (ACE) inhibitors - excessive reduction of blood pressure and deterioration of renal function, in some cases - the development of acute renal failure;
- Methotrexate, probenicid and other drugs secreted in the renal tubules - reducing their excretion by the kidneys, reducing the effectiveness of furosemide;
- Curariform muscle relaxants, diazoxide, theophylline - enhancing their effects;
- Lithium salts - reducing the excretion of lithium, increasing its serum concentration and the development of toxic effects, including damaging effects on the nervous system and heart;
- Sucralfate - reducing the absorption of furosemide and weakening its effect;
- Cyclosporin A - an increased risk of impaired urate excretion of the urate by the kidneys and the development of gouty arthritis due to hyperuricemia caused by furosemide;
- Radiocontrast agents - the risk of renal dysfunction.
Terms and conditions of storage
Store in a dark place, out of the reach of children, at a temperature: solution - up to 25 ºС, tablets - up to 30 ºС.
The shelf life of the solution - 3 years, tablets - 4 years.