Chemical formula: C₁₂H₁₁ClN₂O₅S Molecular mass: 330.744 g/mol PubChem compound: 3440
Furosemide interacts in the following cases:
Concurrent use of furosemide with drugs associated with QT prolongation can result in increased cardiac toxicity by furosemide-induced hypokalaemia and/or hypomagnesaemia.
Concurrent use of furosemide with MAOIs can result in enhanced hypotensive effect.
Concurrent use of furosemide with high doses of beta2 sympathomimetics (such as bambuterol, femoterol, salbutamol, salmeterol and terbutaline) can result in increased risk of hypokalaemia.
There is a risk of a first-dose effect with post-synaptic alpha-blockers e.g. prazosin.
Salicylates effects may be potentiated by furosemide.
Concurrent use of furosemide with phenothiazines can result in enhanced hypotensive effect.
Diuretic effect of furosemide is antagonised (sodium retention) by corticosteroids. There is increased risk of hypokalaemia in co-administration.
Concurrent use of furosemide with TCAs (tricyclic antidepressants) can result in increased risk of postural hypotension.
Concurrent use of furosemide with alcohol can result in enhanced hypotensive effect.
Concurrent use of furosemide with laxatives increases the risk of potassium loss.
Antidiabetics' hypoglycaemic effects antagonised by furosemide.
Furosemide reduces the effect of oral anticoagulants.
In concurrent use of furosemide with cardiac glycosides, hypokalaemia and electrolyte disturbances (including magnesium) increases the risk of cardiac toxicity.
Concurrent use of furosemide with nitrates can result in enhanced hypotensive effect.
Concurrent use of furosemide with antihypertensives can result in enhanced hypotensive effect.
There is an increased risk of hypokalaemia in co-administratiob of furosemide with thiazides.
Concurrent use with ACE inhibitors can result in marked falls in blood pressure. Furosemide should be stopped or the dose reduced before starting an ACE inhibitor. Furosemide may interact with ACE inhibitors causing impaired renal function.
Oestrogens and progestogens antagonize the diuretic effect of furosemide.
Co-administration of furosemide with cephalosporins increases the risk of nephrotoxicity.
Concurrent use of furosemide with aminoglycosides can result in increased risk of ototoxicity and nephrotoxicity.
Concurrent use of furosemide with polymyxins can result in increased risk of ototoxicity.
Concurrent use of furosemide with platinum compounds can result in increased risk of ototoxicity and nephrotoxicity.
Furosemide antagonizes the action of curare muscle relaxants.
General anaesthetic agents may enhance the hypotensive effects of furosemide.
Anti-epileptic drugs reduce the natriuretic effect of furosemide.
Concurrent use of furosemide with dopaminergics can result in enhanced hypotensive effect.
Concurrent use of furosemide with anxiolytics and hypnotics can result in enhanced hypotensive effect.
Concurrent use of furosemide with CNS stimulants can result in hypokalaemia which increases the risk of ventricular arrhythmias.
Concurrent use of furosemide with antihistamines can result in hypokalaemia with increased risk of cardiac toxicity.
Patients who had an increased risk of renal disease from contrast media and were treated with furosemide showed a higher rate of deterioration in renal function after receiving contrast media material compared to high-risk patients who were given only intravenous hydration.
In patients at high risk for radiocontrast nephropathy – it should not be used for diuresis as part of the preventative measures against radiocontrast-induced nephropathy.
Concurrent use of furosemide with NSAIDs can result in increased risk of nephrotoxicity (especially if there is hypovolaemia). In patients with dehydration or hypovolaemia, NSAIDs may cause acute renal insufficiency.
Concurrent use of furosemide with aldesleukin can result in enhanced hypotensive effect.
Aliskiren reduces plasma concentrations of furosemide.
Concurrent use of furosemide with alprostadil can result in enhanced hypotensive effect.
Concomitant administration of furosemide with aminoglutethimide may increase the risk of hyponatraemia.
Concurrent use of furosemide with anti-arrhythmics (including amiodarone, disopyramide, flecainide and sotalol) can result in increased risk of cardiac toxicity (because of furosemide-induced hypokalaemia).
Concurrent use of furosemide with amisulpride or sertindole can result in ncreased risk of ventricular arrhythmias.
Concurrent use of furosemide with amphotericin can result in increased risk of hypokalaemia.
Concurrent use of furosemide with baclofen can result in enhanced hypotensive effect.
Concurrent use of furosemide with carbamazepine can result in increased risk of hyponatraemia.
Concurrent use of furosemide with cefaloridine can result in increased risk of nephrotoxicity.
Bile acid sequestrants (e.g. colestyramine, colestipol) can result in reduced absorption of furosemide – administer 2 to 3 hours apart.
Co-administration of ciclosporin A with furosemide is associated with an increased risk of gout, secondary to furosemide-induced hyperuricemia, as well as kidney dysfunction of uric acid due to ciclosporin.
Co-administration of furosemide with diazoxide increases the risk of hyperglycaemia.
Indometacin and ketorolac may antagonise the effects of furosemide.
The effects of lidocaine, tocainide or mexiletine may be antagonised by furosemide.
Furosemide reduces lithium excretion with increased plasma lithium concentrations (risk of toxicity). Avoid concomitant administration unless plasma levels are monitored.
Profound diuresis possible when furosemide given with metolazone.
Concurrent use of furosemide with moxisylyte (thymoxamine) or hydralazine can result in enhanced hypotensive effect.
Diuretic effect of furosemide cann be reduced by phenytoin.
Avoid concurrent use of furosemide with pimozide.
Concurrent use of furosemide with probenecid can result in reduced renal clearance of furosemide and decreased diuretic effect.
Concurrent use of furosemide with reboxetine can result in possible increased risk of hypokalaemia.
Sucralfate may decrease the gastro-intestinal absorption of furosemide – the 2 drugs should be taken at least 2 hours apart.
Furosemide enhances the action of succinylcholine.
Concurrent use of furosemide with theophylline can result in enhanced hypotensive effect.
Furosemide increases the pharmacological effects of theophylline.
Concurrent use of furosemide with tizanidine can result in enhanced hypotensive effect.
Concurrent use of furosemide with vancomycin can result in increased risk of ototoxicity. Furosemide can decrease vancomycin serum levels after cardiac surgery.
The teratogenic and embryotoxic potential of furosemide in humans is unknown. There is little evidence of safety of high-dose furosemide in human pregnancy, although the results of animal work, in general, show no hazardous effects.
Furosemide crosses the placental barrier and should not be given during pregnancy unless there are compelling medical reasons. It should only be used for the pathological causes of oedema which are not directly or indirectly linked to the pregnancy. The treatment with diuretics of oedema and hypertension caused by pregnancy is undesirable because placental perfusion can be reduced, so, if used, monitoring of fetal growth is required. However, furosemide has been given after the first trimester of pregnancy for oedema, hypertension and toxaemia of pregnancy without causing fetal or newborn adverse effects.
Furosemide may inhibit lactation or may pass into the breast milk, it should therefore be used with caution in nursing mothers.
Patients should be warned that reduced mental alertness may impair ability to drive or operate dangerous machinery.
Reduced mental alertness, dizziness and blurred vision have been reported, particularly at the start of treatment, with dose changes and in combination with alcohol. Patients should be advised that if affected, they should not drive, operate machinery or take part in activities where these effects could put themselves or others at risk.
Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); Frequency not known (cannot be estimated from the available data).
Uncommon: Aplastic anaemia.
Rare: Bone marrow depression (necessitates withdrawal of treatment), eosinophilia, leucopenia.
Very rare: Haemolytic anaemia, agranulocytosis, thrombocytopenia.
Very common: Dehydration, hyponatraemia, hypochloremic metabolic alkalosis, hypocalcaemia, hypomagnesemia (incidences of the last three are reduced by triamterene).
Common: Hypovolaemia, hypochloraemia.
Uncommon: Impaired glucose tolerance (by hypokalaemia) hyperuricaemia, gout, reduction of serum HDL-cholesterol, elevation of serum LDL-cholesterol, elevation of serum triglycerides, hyperglycaemia.
Very rare: Tetany.
Frequency not known: Aggravated pre-existing metabolic alkalosis (in decompensated cirrhosis of the liver), fluid and electrolyte disturbances, excretion of potassium increased*.
Rare: Psychiatric disorder NOC.
Rare: Paraesthesia, confusion, headache.
Not known: Dizziness, fainting and loss of consciousness (caused by symptomatic hypotension).
Uncommon: Visual disturbance, blurred vision, yellow vision.
Uncommon: Deafness (sometimes irreversible).
Rare: Tinnitus and reversible or irreversible loss of hearing (although usually transitory, particularly in patients with renal failure, hypoproteinaemia (e.g. in nephritic syndrome).
Uncommon: Orthostatic intolerance, cardiac arrhythmias, increased risk or persistence of patent ductus arteriosus in premature infants.
Very common: Hypotension, (which, if pronounced may cause signs and symptoms such as impairment of concentration and reactions, light-headedness, sensations of pressure in the head, headache, drowsiness, weakness, disorders of vision, dry mouth, orthostatic intolerance).
Rare: Vasculitis, thrombosis, shock.
Uncommon: Dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhoea, constipation.
Rare: Acute pancreatitis (in long-term diuretic treatment, including furosemide).
Rare: Pure intrahepatic cholestasis (jaundice), hepatic function abnormal.
Rare: Rash, pruritus, photosensitivity, toxic epidermal necrolysis.
Frequency not known: Urticaria, erythema multiforme, purpura, exfoliative dermatitis, itching, allergic reactions, such as skin rashes, various forms of dermatitis including urticaria, bullous lesions, acute generalised exanthematous pustulosis (AGEP). When these occur treatment should be withdrawn, Stevens-Johnson syndrome.
Uncommon: Muscle cramps, muscle weakness.
Very common: Nephrocalcinosis in infants.
Uncommon: Reduced diuresis, urinary incontinence, urinary obstruction (in patients with hyperplasia of the prostate, bladder inability to empty, urethral stricture unspecified).
Rare: Acute renal failure.
Very rare: Interstitial nephritis.
Rare: Patent ductus arteriosus.
Uncommon: Fatigue.
Rare: Malaise, fever, severe anaphylactoid or anaphylactic reactions (e.g. with shock).
Common: Creatinine increased, blood urea increased.
Rare: Transaminases increased, blood.
* Potassium deficiency manifests itself in neuromuscular symptoms (muscular weakness, paralysis), intestinal symptoms (vomiting, constipation, meterorism), renal symptoms (polyuria) or cardiac symptoms. Severe potassium depletion can result in paralytic ileus or confusion, which can result in coma.
Undesirable effects can occur with the following frequencies: Very common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1,000 to <1/100), Rare (≥1/10,000 to <1/1,000), Very rare (<1/10,000, including isolated reports), not known (cannot be estimated from the available data).
Uncommon: Thrombocytopenia
Rare: Eosinophilia, Leukopenia, Bone marrow depression (necessitates withdrawal of treatment). The haemopoietic status should be therefore be regularly monitored.
Very Rare: Aplastic anaemia or haemolytic anaemia, Agranulocytosis
Rare: Paraesthesia, Hyperosmolar coma
Not known: Dizziness, fainting and loss of consciousness (caused by symptomatic hypotension).
Glucose tolerance may decrease with furosemide. In patients with diabetes mellitus this may lead to a deterioration of metabolic control; latent diabetes mellitus may become manifest. Insulin requirements of diabetic patients may increase.
Uncommon: Visual disturbance
Hearing disorders and tinnitus, although usually transitory, may occur in rare cases, particularly in patients with renal failure, hypoproteinaemia (e.g. in nephritic syndrome) and/or when intravenons furosemide has been given too rapidly.
Uncommon: Deafness (sometimes irreversible)
Uncommon: Cardiac arrhythmias
Furosemide may cause a reduction in blood pressure which, if pronounced may cause signs and symptoms such as impairment of concentration and reactions, light headedness, sensations of pressure in the head, headache, dizziness, drowsiness, weakness, disorders of vision, dry mouth, orthostatic intolerance. The diuretic effect of furosemide can result in hypovolaemia and dehydration, especially in the elderly. There is an increased risk of thrombosis.
In isolated cases, intrahepatic cholestasis, an increase in liver transaminases or acute pancreatitis may develop.
Hepatic encephalopathy in patients with hepatocellular insufficiency may occur.
Rare: Vasculitis
Uncommon: Photosensitivity
Rare: Skin and mucous membrane reactions may occasionally occur, e.g. itching, urticaria, other rashes or bullous lesions, fever, hypersensitivity to light, exsudative erythema multiforme (Lyell’s syndrome and Stevens-Johnson syndrome), bullous exanthema, exfoliative dermatitis, purpura, AGEP (acute generalized exanthematous pustulosis) and DRESS (Drug rash with eosinophilia and systemic symptoms).
Not Known: Bullous Pemphigoid
As with other diuretics, electrolytes and water balance may be disturbed as a result of diuresis after prolonged therapy. Furosemide leads to increased excretion of sodium and chloride and consequently increase excretion of water. In addition, excretion of other electrolytes (in particular potassium, calcium and magnesium) is increased.
Metabolic acidosis can also occur. The risk of this abnormality increases at higher dosages and is influenced by the underlying disorder (e.g. cirrhosis of the liver, heart failure), concomitant medication and diet.
Symptomatic electrolyte disturbances and metabolic alkalosis may develop in the form of a gradually increasing electrolyte deficit or e.g. where higher furosemide doses are administered to patients with normal renal function, acute severe electrolyte losses
Symptoms of electrolyte imbalance depend on the type of disturbance:
Sodium deficiency can occur; this can manifest itself in the form of confusion, muscle cramps, muscle weakness, loss of appetite, dizziness, drowsiness and vomiting.
Potassium deficiency manifests itself in neuromuscular symptoms (muscular weakness, paralysis), intestinal symptoms (vomiting, constipation, meterorism), renal symptoms (polyuria) or cardiac symptoms. Severe potassium depletion can result in paralytic ileus or confusion, which can result in coma.
Magnesium and calcium deficiency result very rarely in tetany and heart rhythm disturbances.
Serum calcium levels may be reduced; in very rare cases tetany has been observed.
Nephrocalcinosis/Nephrolithiasis has been reported in premature infants.
Serum cholesterol (reduction of serum HDL-cholesterol, elevation of serum LDL-cholesterol) and triglyceride levels may rise during furosemide treatment. During long term therapy they will usually return to normal within six months
As with other diuretics, treatment with furosemide may lead to transitory increase in blood creatinine and urea levels. Serum levels of uric acid may increase and attacks of gout may occur.
The diuretic action of furosemide may lead to or contribute to hypovolaemia and dehydration, especially in elderly patients. Severe fluid depletion may lead to haemoconcentration with a tendency for thromboses to develop.
Increased production of urine may provoke or aggravate complaints in patients with an obstruction of urinary outflow. Thus, acute retention of urine with possible secondary complications may occur. For example, in patients with bladder-emptying disorders, prostatic hyperplasia or narrowing of the urethra.
If furosemide is administered to premature infants during the first weeks of life, it may increase the risk of persistence of patent ductus arteriosus.
Uncommon: Fatigue
Rare: Severe anaphylactic or anaphylactoid reactions (e.g. with shock) occurs rarely, Fever, Malaise
Uncommon: Dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhea, constipation.
Rare: Acute Pancreatitis, Gastro-intestinal disorders such as nausea, malaise or gastric upset (vomiting or diarrhoea) and constipation may occur but not usually severe enough to necessitate withdrawal of treatment.
Uncommon: Serum creatinine and urea levels can be temporarily elevated during treatment with furosemide.
Rare: Interstitial nephritis, acute renal failure.
Increased urine production, urinary incontinence, can be caused or symptoms can be exacerbated in patients with urinary tract obstruction. Acute urine retention, possibly accompanied by complications, can occur for example in patients with bladder disorders, prostatic hyperplasia or narrowing of the urethra.
In premature infants with respiratory distress syndrome, administration of Furosemide in the initial weeks after birth entails an increased risk of a persistent patent ductus arteriosus.
In premature infants, furosemide can be precipitated as nephrocalcinosis/kidney stones.
Rare complications may include minor psychiatric disturbances.
Pre-existing metabolic alkalosis (e.g. in decompensated cirrhosis of the liver) may be aggravated by furosemide treatment.
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