Furosemid

When ATH:
C03CA01

Characteristic.

The white crystalline powder, insoluble.

Pharmacological action.
Diuretic, natriuretic.

Application.

Congestive heart failure, pulmonary edema, hypertensive crisis, edematous-ascitic syndrome in cirrhosis, renal failure, nephrotic syndrome, severe hypernatremia, hypercalcemia and gipermagniemiya.

Contraindications.

Hypersensitivity (incl. to sulfonamides), pechenochnaya coma, severe electrolyte imbalance, kaliopenia, severe lack of liver and kidney function, oliguria for more 24 no, anurija, gout, hyperuricemia, diabetes or breach of tolerance to carbohydrates, mytralnыy decompensated stenosis or aortalnыy, increased pressure in the jugular vein over 10 mm Hg. Art., hypertrophic cardiomyopathy with obstruction of the left ventricular outflow tract, gipotenziya, myocardial infarction, systemic lupus erythematosus, pancreatitis, metabolic alkalosis.

Side effects.

Gipotenziya, incl. postural, collapse, thromboembolism, tromboflebit (mainly in elderly), kaliopenia, gipomagniemiya, giponatriemiya, impaired glucose tolerance, hyperuricemia, gout, increase in LDL cholesterol (at higher doses), KHS violation (hypochloraemic alkalosis), hypercalciuria, abnormal liver function, intrahepatic cholestasis, pancreatitis, diarrhea, constipation, nausea, vomiting, anorexia, the defeat of the inner ear, hearing loss, blurred vision, confusion, nervousness, headache, dizziness, paraesthesia, weakness, muscle spasm, bladder spasm, chills, fever, thrombocytopenia, aplasticheskaya anemia, leukopenia, sistemnыy vasculitis, interstitial nephritis, hematuria, necrotizing vasculitis, exfoliative dermatitis, erythema multiforme, impotence, photosensitivity, hives, itching.

Cooperation.

Aminoglikozidy, ethacrynic acid and cisplatin ototoxicity increase (especially with impaired renal function). It increases the risk of kidney damage on a background of amphotericin B. When high doses of salicylates increases the risk of salitsilizma (competitive renal excretion), cardiac glycosides - hypokalemia and related arrhythmias, corticosteroids - an electrolyte imbalance. Reduces muscle relaxant activity tubokurarina, potentiates the effect of succinylcholine. Decreases renal clearance (and increases the likelihood of intoxication) lithium. Under the influence of furosemide increases the effect of ACE inhibitors and antihypertensives, varfarina, diazoksida, teofillina, weakened - antidiabetic drugs, noradrenaline. Sucralfate and indomethacin (through inhibition of PG synthesis, disorders level of plasma renin and aldosterone excretion) reduce efficiency. Probenecid increases serum concentration (blocks excretion).

Overdose.

Symptoms: gipotenziya, Reduced OCP, hypokalaemia and hypochloraemic alkalosis.

Treatment: maintaining vital functions.

Dosing and Administration.

Inside, a daily dose of 20-60 mg; if necessary, it is possible to increase the dose by 20-40 mg every 6-8 hours (large doses divided into 2-3 reception). / M or I / - Once, 20-40 Mg (if necessary, increase the dose by 20 mg every 2 no). Jet in / in a produce slow, for 1-2 min. In high doses (80–240 mg or more) introduced into / in the drip, at a speed not higher 4 mg / min. The maximum daily dose - 600 mg.

Precautions.

In the presence of ascites without peripheral edema recommended doses, providing additional diuresis in a volume of no more than 700-900 ml / day in order to avoid the development of oliguria, azotemia and electrolyte metabolism disorders. In order to eliminate the phenomenon of "rebound" in the treatment of hypertension appoint at least 2 once a day. It will be appreciated, that long-term use can cause weakness, fatigue, decrease in blood pressure and cardiac output, and excessive diuresis myocardial infarction with stagnation in the pulmonary circulation may contribute to the development of cardiogenic shock. You need to temporarily cancel (for a few days) before prescribing an ACE inhibitor. During the first months of treatment is recommended to monitor blood pressure, electrolytes (especially potassium), CO₂, creatinine, BUN, Uric acid, periodic determination of liver enzymes, of calcium and magnesium, glucose in blood and urine (for patients with diabetes). While maintaining oliguria for 24 h furosemide should be canceled. Should not be used during the drivers of vehicles and people, skills relate to the high concentration of attention.

Cautions.

For breeding should be used isotonic sodium chloride solution or glucose with a pH no lower 5,5.