Furosemide - instructions for use (indications for use, dosage regimen and side effects). Powerful loop diuretic Furosemide: what is a medication with an active diuretic effect prescribed for and how to use it

As you know, the problem of obesity has been very acute in recent decades. Official statistics from the World Health Organization (WHO) also support this. In addition, it’s no secret that parting with these ill-fated kilograms is very difficult.

Many of us, perhaps due to weakness of character, or perhaps due to a number of other reasons, find ourselves simply unable to somehow reverse the current situation, once and for all deciding to love ourselves for who we are.

Considering the difficulty of eliminating extra pounds, it is not surprising that many of those suffering dare to use very sophisticated methods of losing weight. Whatever the “hot heads” come up with, includes the use of various cleansing procedures that can cause terrible harm to health, the use of potent medications and many other bizarre techniques.

How is Furosemide useful for weight loss?

Today I will talk about a fairly new method of losing weight, generated by either a desperate person or an absolute ignoramus. This method involves regular use of a diuretic drug called furosemide.

First, you should pay attention to the phrase weight loss. It was not in vain that I used it, since this effect will still be achieved, but at what expense. To begin with, a few words about what kind of drug is at the heart of this technique.

How to take Furosemide for weight loss?

The authors of the method recommend drinking the drug once a day in the morning - 1 tablet (40 mg). Those who are not satisfied with the results can increase the number of doses to two per day. And this, as soon as the weight begins to decrease, the number of doses and the number of tablets must be reduced.

Mechanism of action of Furosemide

As I already said, furosemide is a diuretic drug. What does it mean? It is prescribed for the forced removal of fluid from the body. In populist literature you can find the term diuretic, which, in fact, is synonymous with the word diuretic. How does it affect the human body?

When consuming furosemide, reabsorption, or reuptake of sodium ions in the kidney tubules, is reduced. Taking into account the fact that this element retains water, its excessive loss leads to increased fluid loss. Depending on the dosage of the drug, the volume of the latter can increase greatly, sometimes up to 6 – 8 liters per day.

Side effects of Furosemide

It is not surprising that with such water losses, the body will lose not only liquid, but also vital minerals. I'm talking about potassium and magnesium. If we are talking about the use of furosemide for medical reasons, it should be mentioned that its use is often combined with the introduction of electrolytes into the body.

Many methods of forcing diuresis involve such restorative therapy, but this is if we are talking about professionals. If we talk about self-medication, and there is no other word for using this drug, many “home-grown doctors” do not know about it at all. And therefore they risk getting very serious consequences.

First of all, we are talking about heart rhythm disturbances. The thing is that potassium is vital for the normal transmission of electrical impulses in cardiomyocytes.

If there is a deficiency of it, you can forget about normal heart rhythm. Violations can be of a different nature: in the mildest cases it will be tachycardia, in severe cases it will be more severe symptoms, sometimes even life-threatening.

Magnesium deficiency inevitably leads to disorders of the nervous system. In the mildest cases, this can be expressed in the appearance of unmotivated weakness, severe apathy, and depression.

In severe cases, cramps in the calf muscles, confusion, coma and death may occur. The thing is that magnesium is necessary for the normal transmission of nerve impulses. It is clear that with its acute deficiency, the work of the central and peripheral nervous system will be grossly disrupted.

Even dehydration itself is incredibly harmful to the body. As is known, water content varies quite strongly with age. According to various sources, our body consists of approximately 65 - 75 percent of this substance.

The older a person is, the less fluid there is in his body, but, nevertheless, this indicator cannot fall below a certain limit, upon crossing which irreversible processes can begin in the body. If immediate restorative therapy is not carried out, no doctor will undertake to predict the ending of such a story.

A little common sense

Of course, body weight will be reduced, but at what cost? The only mechanism leading to this effect is fluid loss. The amount of fatty tissue in the body remains unchanged throughout the entire period of taking the drug.

As you know, the human body is a self-regulating system, which means that at the slightest opportunity the body will try to compensate for the missing volumes. Therefore, the loss of mass is exclusively temporary.

Immediately after stopping taking furosemide, the life-giving moisture will return to its proper place, and with it the lost kilograms will be restored. Alas, this is true. If we “put on the other side of the scale” the risk of potential side effects, a completely reasonable question arises: why is all this necessary?

Honestly, I don't have an answer to this question. The only thing that can force a person to use furosemide without permission is complete medical illiteracy.

Conclusion

Of course, taking Furosemide without medical indications is evil in its purest form. You should never do this under any circumstances. Be realistic, this won't solve the obesity problem, but it might create a few new ones.

Furosemide diuretic tablets are prescribed to eliminate edema of various etiologies. This medicine is aimed at removing excess fluid from the body and increasing urine production. To avoid undesirable negative consequences when treating with Furosemide, you must take the diuretic as prescribed by your doctor, in strictly prescribed dosages.

Furosemide is prescribed for edema of various natures.

general information

The “loop” diuretic “Furosemide” contains the following elements:

• furosemide - 40;
• milk sugar;
• food emulsifier E572;
• corn starch.

The diuretic "Furosemide" activates the kidneys to excrete a large volume of liquid and salts in the urine. This effect of the drug allows patients to get rid of edema that has arisen for various reasons. But, unfortunately, potassium and magnesium ions leave the body along with the urine excreted. That is why specialized experts recommend taking potassium-sparing 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.

After taking the 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 effect. Furosemide is prescribed 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 removal of potassium from the body. It is worth considering that the diuretic effect of Furosemide under the influence of theophylline decreases, while the effect of theophylline increases, which is dangerous for the development of negative consequences.

Contraindications and side effects

Furosemide should not be used by 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;
• threat of renal coma;
• diabetes;
• low blood pressure;
• diarrhea;
• pancreatitis;
• disturbance of urine outflow.

During treatment with this pharmaceutical drug, the following side effects often occur:

• cardiopalmus;
• dry mouth;
• nausea;
• drowsiness;
• a sharp decrease in urination;
• dizziness;
• gagging;
• weakness;
• thirst.

Instructions for use and dosage

Attached to the pharmaceutical product "Furosemide" are instructions for use, which indicate dosages depending on the indications, 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 drug in tablet form is 20-80 mg, drunk once or divided into several doses per day. The injection dose is 20-240 mg. If necessary, dosages can be reviewed by the attending physician and increased.

How to drink during swelling?

Furosemide should be taken for edema caused by dysfunction of the heart muscle, cirrhosis, high blood pressure, and renal failure. When taking the diuretic drug Furosemide, the patient needs to eat properly. The therapeutic diet should be dominated by foods containing 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 high blood pressure

To normalize blood pressure, patients often require complex treatment, which includes not only antihypertensive medications, but also diuretics. Furosemide is effective in the fight against hypertension. In most cases, it is prescribed 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 claim that using “Furosemide for weight loss is inappropriate. Its diuretic effect is aimed at removing excess fluid from the body, which has nothing to do with fat deposits. This medicine with a diuretic effect, which many people mistakenly use to lose weight, with long-term use leads to loss of strength, low blood pressure, problems with urination and disturbances in water-electrolyte balance in the blood.

For impaired renal and liver function

Diuretics are used, in particular Furosemide, for edema syndrome caused by renal and hepatic dysfunction. Patients with these pathologies require individual selection of dosage with its subsequent increase. This treatment regimen is used to ensure the patient gradually loses fluid. In the first days of treatment for kidney problems, the dosage is 40-80 mg per day, which should be taken once or divided into 2 doses.

For renal pathologies, Furosemide with a diuretic effect is used as an additional remedy when aldosterone antagonists are ineffective. The dosage of the drug is selected carefully for each patient individually 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.

Name:

Furosemide (Furosemiduin)

Pharmacological
action:

Fast acting diuretic(saluretic) - a diuretic that enhances the excretion of sodium and chlorine. The diuretic (diuretic) effect is associated with inhibition of reabsorption (reabsorption) of Na and C1 ions in both the proximal (located in the central part of the kidney) and distal (located on the periphery of the kidney) sections of the convoluted tubules and in the ascending parts of the loop of Henle. Potassium reabsorption is inhibited to a lesser extent. The drug is equally effective in conditions of acidosis (acidification) and alkalosis (dehydration) of the blood. Furosemide does not reduce glomerular filtration, and therefore it can be used in renal failure. Due to the dilation of peripheral blood vessels and the diuretic effect, the drug has a hypotensive (lowering blood pressure) effect.
When administered intravenously the diuretic effect is observed after 15-20 minutes and lasts for 3 hours, when taken orally - after 30-50 minutes, lasts up to 4 hours.

Indications for
application:

Congestion in the pulmonary and systemic circulation associated with heart failure; liver cirrhosis with portal hypertension (increased pressure in the liver portal vein system), chronic and acute renal failure, pulmonary and cerebral edema, barbiturate poisoning, eclampsia (late toxicosis of pregnancy).
Furosemide is indicated for patients with severe forms of hypertension (persistent increase in blood pressure), in which other diuretics are not effective, as well as for relieving (relieving) severe hypertensive crises (rapid and sharp rise in blood pressure).

– edematous syndrome of various origins, incl. for chronic heart failure stages IIB-III, liver cirrhosis (portal hypertension syndrome), nephrotic syndrome;
- pulmonary edema;
– post-traumatic cerebral edema;
– some forms of hypertensive crisis;
– eclampsia;
– premenstrual tension syndrome;
– program of forced diuresis for barbiturate poisoning.

Mode of application:

Prescribed orally, intramuscularly or intravenously.
Inside Usually take 40 mg 1 time per day (in the morning). If necessary, the daily dose can be increased to 80-160 mg; in this case, the drug is taken 1-2 times a day. day with an interval of 6 hours.
For severe renal failure the dose can be increased to 240-320 mg/day. After swelling decreases, the dose is gradually reduced to the minimum effective, and the intervals between doses are increased to 1-2 days. For hypertension, furosemide Prescribe 20-40 mg 1 time per day; when combined with heart failure, the dose can be increased to 80 mg.
If it is impossible or impractical to prescribe furosemide orally, the drug is administered intramuscularly or intravenously(slow stream) 20-60 mg 1-2 times a day, if necessary, the dose can be increased to 120 mg. The drug is administered for 7-10 days or more. Then they switch to taking the drug orally.
For children a single dose of the drug is 1-2 mg/kg; the maximum daily dose is 6 mg/kg.

Side effects:

From the side of water-electrolyte balance and acid-base balance: with long-term use or prescription in high doses - hypovolemia, dehydration, hypokalemia, hyponatremia, hypochloremia, alkalosis; in some cases - hypocalcemia.
From the cardiovascular system: arterial hypotension, heart rhythm disturbances.
From the side of the central nervous system: dizziness, muscle weakness, cramps; in some cases, when using the drug in high doses in patients with severe impairment of renal excretory function - hearing impairment, vision impairment, paresthesia.
From the digestive system: dry mouth; rarely - nausea, vomiting, diarrhea.
Metabolism: transient hyperuricemia (with exacerbation of gout), increased levels of urea and creatinine; in some cases - hyperglycemia.
Dermatological reactions: dermatitis.
Others: in some cases - anaphylactic shock, changes in the peripheral blood picture.

Contraindications:

– renal failure with anuria;
– hepatic coma and precoma;
– disorders of water-salt metabolism: hypokalemia, hyponatremia, hypovolemia (including with hypotension) or dehydration;
– I and II trimesters of pregnancy;
– hypersensitivity to sulfonamides.

special instructions
Prescribe the drug with caution when severe cardiovascular failure, with prolonged therapy with cardiac glycosides, as well as in elderly patients with severe atherosclerosis. Before starting treatment, serious disturbances in water and electrolyte balance should be compensated.
Control of laboratory parameters
During treatment, electrolyte levels should be regularly monitored. carbonates, urea (especially when using doses above 80 mg).
Impact on the ability to drive vehicles and control of mechanisms
The question of the possibility of engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions should be decided after assessing the patient’s individual reaction, due to a possible decrease in the ability to concentrate.

Interaction
other medicinal
by other means:

with cardiac glycosides the risk of developing glycoside intoxication increases, and when used in combination with GCS, the risk of developing hypokalemia.
With simultaneous use, Furosemide potentiates the effect muscle relaxants.
With simultaneous use of Furosemide with aminoglycosides or cephalosporins and cisplatin, it is possible to increase their concentration in the blood plasma, which can lead to the development of nephro- and ototoxic effects.
When used simultaneously NSAIDs may reduce the diuretic effect of Furosemide.
With the simultaneous use of Furosemide and antihypertensive drugs the hypotensive effect is potentiated.
When used simultaneously with Furosemide, the effect hypoglycemic drugs and pressor amines may be weakened.

Furosemide is a fast-acting diuretic used to combat swelling of the respiratory system and brain, as well as disorders of the systemic circulation. It is distinguished by its rapid diuretic effect on the body.

As an active ingredient, the drug contains furosemide in a dosage of 40 mg. The original drug is Lasix, developed by Sanofi. Furosemide is one of the most powerful diuretics, and it is effective in both oral and parenteral forms.

The therapeutic effect is observed within 5-10 minutes if the drug is used in the form of a solution for intravenous injection. When using a tablet formulation, the therapeutic effect is achieved within the first hour.

Clinical and pharmacological group

Diuretic.

Terms of sale from pharmacies

Can buy according to a doctor's prescription.

Price

How much does Furosemide cost in pharmacies? The average price is 25 rubles.

Composition and release form

Tablets: flat-cylindrical, round, chamfered, white with a brownish or yellowish tint, 10 pieces in a blister pack made of polyvinyl chloride film and polymer-coated paper or aluminum foil. 1, 2, 3 or 5 blisters 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 pull-on lid. 1 can in a cardboard box.

Composition of the tablet:

• active substance: furosemide – 40 mg;
• auxiliary components: lactose monohydrate, potato starch, calcium stearate monohydrate.

Pharmacological effect

The active component Furosemide has a diuretic effect, promoting increased excretion of water while simultaneously increasing the excretion of calcium and magnesium ions.

When Furosemide is used against the background of heart failure, a rapid decrease in preload on the heart occurs, caused by the dilation of large veins. After intravenous administration, the effect of Furosemide occurs quickly - within 5-10 minutes, after oral administration - on average within 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 with? Furosemide confidently copes with edema of various origins, so its range of use is very wide. It is prescribed for the following problems:

• edema, the causes of which are kidney pathologies (including nephrotic syndrome), stage II-III CHF or cirrhosis of the liver;
• manifested as pulmonary edema of acute heart failure;
• hypertensive crisis (as monotherapy or in combination with other drugs);
• severe forms of arterial hypertension;
• cerebral edema;
• hypercalcemia;
• eclampsia.

The drug is also used for forced diuresis in case of poisoning with chemicals that are excreted from the body unchanged by the kidneys.

With elevated blood pressure developing against the background of chronic renal failure, furosemide is prescribed if the patient is contraindicated in thiazide diuretics, and also if Clcr does not exceed 30 ml per minute).

Can Furosemide be used for weight loss?

There is a lot of advice on the Internet regarding the use of diuretics for weight loss. One of the most accessible drugs in this group is Furosemide.

What does the medicine help with? According to the instructions, Furosemide is used for ascites, edema syndrome, and hypertension. Thus, the manufacturer does not report anything regarding the possibility of using diet pills. However, many women note that with the help of this remedy they were able to quickly lose several kilograms (in some cases, up to 3 kg per night). However, such weight loss cannot be regarded as weight loss: the action of the drug is aimed at removing excess fluid, and not at all at breaking down fat.

Why is Furosemide dangerous?

The use of diuretics for weight loss can cause serious health problems, since by removing water, these drugs also upset the balance of electrolytes in the body. One of the most common side effects is hypokalemia. Potassium deficiency, in turn, leads to muscle cramps, weakness, blurred vision, sweating, loss of appetite, nausea, and dizziness.

A very dangerous side effect is arrhythmia. SOLVD studies have shown that treatment with loop diuretics is associated with increased mortality among patients. At the same time, both the rates of general and cardiovascular mortality and the number of sudden deaths are increasing. Another danger that can result from the uncontrolled use of diuretics for weight loss is impaired kidney function. Moreover, it may take more than one month to restore the function of the kidneys and 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;
• disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract);
• severe liver failure;
• acute glomerulonephritis;
• acute renal failure with anuria (glomerular filtration rate less than 3–5 ml/min);
• disturbance of water-electrolyte metabolism, as well as acid-base balance (alkalosis, hypokalemia, hypovolemia, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremia);
• digitalis intoxication;
• increased sensitivity to any of the components of the drug.

Additionally for tablets:

• acute myocardial infarction;
• pancreatitis;
• dehydration;
• galactose intolerance;
• precomatose states;
• hyperglycemic coma;
• hypertrophic obstructive cardiomyopathy;
• arterial hypotension;
• glucose-galactose malabsorption or lactase deficiency;
• age up to 3 years.

Patients with allergies to sulfonylureas or sulfonamide antimicrobials are at risk of developing cross-allergy to Furosemide.

Relative contraindications:

• 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 (stenotic lesions of the coronary or cerebral arteries);
• acute myocardial infarction (due to an increased risk of developing cardiogenic shock);
• manifested or latent diabetes mellitus (decreased glucose tolerance);
• hepatorenal syndrome;
• disturbances in 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 kidney parenchyma, constant monitoring of kidney function and regular ultrasound examination of the kidneys are necessary).

Additionally for tablets: stenotic lesions of the coronary or cerebral arteries.

Prescription during pregnancy and lactation

The medicine crosses the placental barrier, so it should not be prescribed during pregnancy. If it is necessary to prescribe 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 treatment with the drug is necessary, breastfeeding should be stopped.

Dosage and method of administration

As indicated in the instructions for use, Furosemide tablets should be taken on an empty stomach, without chewing and with a sufficient amount of liquid.

When prescribing Furosemide, it is recommended to use the smallest doses sufficient to achieve the desired effect. The maximum daily dose for adults is 1500 mg. The initial single dose in children is determined at the rate of 1-2 mg/kg 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 every 6 hours. The duration of treatment is determined by the doctor individually depending on from the testimony.

Dosage regimen for adults:

1. . Furosemide can be used in monotherapy or in combination with other antihypertensive drugs. The usual maintenance dose is 20-40 mg/day. When adding furosemide to already prescribed medications, their dose should be reduced by 2 times. In case of arterial hypertension in combination with chronic renal failure, higher doses of the drug may be required.
2. 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 at one time or divided into several doses.
3. Edema 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.
4. Edema syndrome in chronic renal failure. In patients with chronic renal failure, careful selection of the dose is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 kg of body weight / day is possible). The recommended initial dose is 40-80 mg/day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients on hemodialysis, the maintenance dose is usually 250-1500 mg/day.
5. Edema syndrome in liver diseases. Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in electrolyte or acid-base status, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of body weight/day is possible). The initial dose is 20-80 mg/day.

Adverse reactions

Furosemide may cause the following side effects:.

1. Hematopoietic system: aplastic anemia, agranulocytosis, leukopenia and thrombocytopenia.
2. Water-electrolyte metabolism: hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia, hypochloremia, hypokalemia.
3. Metabolism: hyperglycemia, muscle weakness, cramps, hypotension, hyperuricemia and dizziness.
4. Cardiovascular system: decreased blood pressure, arrhythmia, tachycardia, orthostatic hypotension, collapse.
5. Nervous system: drowsiness, myasthenia gravis, apathy, weakness, lethargy, confusion, calf muscle cramps, headache, paresthesia, adynamia.
6. Sense organs: hearing and vision impairment.
7. Gastrointestinal tract: dry mouth, nausea, exacerbation of pancreatitis, thirst, vomiting, decreased appetite, diarrhea or constipation and cholestatic jaundice.
8. Genitourinary system: hematuria, interstitial nephritis, acute urinary retention, decreased potency
9. Allergic reactions: erythema multiforme exudative, photosensitivity, pruritus, exfoliative dermatitis, urticaria, vasculitis, purpura, fever, chills, necrotizing angitis and anaphylactic shock.

Overdose

If the recommended dose is exceeded or prolonged uncontrolled use of Furosemide, patients develop signs of overdose, which are clinically manifested by increased side effects described above, paralysis, respiratory depression, cardiovascular depression, development of coma, acute renal failure and shock.

Treatment of overdose consists of correcting the water-electrolyte balance through diffuse infusions of isotonic sodium chloride solution, gastric lavage, replenishment of circulating blood volume, and symptomatic treatment.

special instructions

Before you start using the drug, read the special instructions:

1. The use of furosemide slows down the excretion of uric acid, which can provoke an exacerbation of gout.
2. Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to furosemide.
3. If azotemia and oliguria appear or worsen in patients with severe progressive kidney disease, it is recommended to suspend treatment.
4. In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of the level of glucose concentration in the blood and urine is required.
5. In unconscious patients with benign prostatic hyperplasia, narrowing of the ureters or hydronephrosis, monitoring of urinary output is necessary due to the possibility of acute urinary retention.
6. This medicine contains lactose monohydrate, therefore patients with rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
7. The drug contains wheat starch in an amount that is safe for use in patients with celiac disease (gluten enteropathy).
8. Patients with a wheat allergy (other than celiac disease) should not use this drug.

Before starting therapy with Furosemide Sopharma, the presence of severe disturbances in the outflow of urine should be excluded; patients with partial disturbances in the outflow of urine require careful monitoring. During 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 status, residual nitrogen, creatinine, uric acid, liver function and, if necessary, carry out appropriate treatment adjustment.

In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit the consumption of table salt. To prevent hypokalemia, it is recommended to simultaneously administer potassium supplements and potassium-sparing diuretics, as well as adhere to a diet rich in potassium. The selection of a dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in a hospital setting (violations of water and electrolyte balance can lead to the development of hepatic coma). This category of patients requires regular monitoring of plasma electrolyte levels.

Compatibility with other drugs

When using the drug, it is necessary to take into account interactions with other medications:

1. Furosemide may increase the risk of nephropathy after administration of radiocontrast agents.
2. The combination of the drug with cardiac glycosides increases the risk of developing digitalis intoxication.
3. The effect of Furosemide is reduced when used simultaneously with phenobarbital and phenytoin.
4. 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 aminoglycoside antibiotics slows down when they are combined with Furosemide, which also increases the likelihood of intoxication.
5. Elderly patients often have to take Furosemide and drugs from the group of non-steroidal anti-inflammatory drugs. You should be careful with this combination, as it leads to a decrease in the effectiveness of Furosemide. If salicylates are chosen as NSAIDs, Furosemide may enhance their toxic effect.
6. A 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.

each tablet contains: active substance: furosemide - 40 mg; Excipients: lactose monohydrate, magnesium stearate, potato starch.

Description

pharmachologic effect

"Loop" diuretic. In normal therapeutic doses, it disrupts the reabsorption of sodium and chlorine ions in the thick segment of the ascending part of the loop of Henle. Due to an increase in the release of sodium ions, a secondary (mediated by osmotically bound water) increased excretion of water and an increase in the secretion of potassium ions occurs in the distal part of the renal tubule. Furosemide has secondary effects due to the release of intrarenal mediators and redistribution of intrarenal blood flow. These effects increase renal medullary perfusion. Furosemide has a hypotensive effect due to an increase in the excretion of sodium chloride and a decrease in the response of vascular smooth muscles to vasoconstrictor effects and as a result of a decrease in blood volume. In heart failure, it quickly leads to a decrease in preload on the heart by dilating large veins. The diuretic effect depends on the dose. During the course of treatment, the effect does not weaken. Furosemide does not change the glomerular filtration rate and remains effective at low glomerular filtration rates.

The onset of diuresis is observed within the first hour after oral administration of furosemide. The peak of the diuretic effect occurs in the first two hours after administration, and the duration of the diuretic effect is 6-8 hours.

Pharmacokinetics

Suction:

Oral absorption is rapid but incomplete. Maximum plasma concentration is reached after approximately 60 minutes. Digestive resorption is slowed but not reduced in the presence of food. The bioavailability of furosemide is about 65%.

Distribution:

Plasma protein binding is 96-98%. Plasma protein binding is reduced in liver failure. The apparent volume of distribution is approximately 0.150 l/kg.

Metabolism:

The drug is inactivated in the liver with the formation of glucuronides.

Removal:

The half-life is approximately 50 minutes. Plasma clearance ranges from 2 to 3 ml/min/kg. It is carried out through urination and through the digestive tract (partially with bile). The predominant urinary excretion is rapid and mainly concerns the active form of furosemide.

Furosemide crosses the placental barrier. Furosemide passes into breast milk.

Features of pharmacokinetics in elderly people:

The binding of furosemide to albumin may be reduced in older adults. The initial diuretic effect in elderly patients is less than in young people. Urinary excretion of furosemide decreases in proportion to gradually progressive age-related changes in tubular function.

Features of pharmacokinetics in patients with renal failure:

Bioavailability after oral administration decreases. In case of renal failure, renal excretion is compensated by its excretion in bile and in people with absent (non-functioning) kidneys it can reach 86-98% of the excreted amount. Furosemide is poorly dialyzable.

Features of pharmacokinetics in newborns:

Bioavailability when taken orally is reduced. In neonates, the half-life is prolonged (up to 7 hours) because the apparent volume of distribution is increased and plasma clearance is reduced. In premature infants, the half-life is increased to 20 hours due to decreased urinary excretion.

Indications for use

Edema of cardiac or renal origin. Edema of hepatic origin, usually in combination with potassium-sparing diuretics. Arterial hypertension in patients with chronic renal failure for whom the use of thiazide diuretics is contraindicated (especially when creatinine clearance is below 30 ml/min).

Contraindications

Hypersensitivity to the active substance or to any of the excipients of the drug; hypersensitivity to sulfonamides due to possible cross-allergy to furosemide;

Acute renal failure;

Hepatic encephalopathy;

Obstruction of the urinary tract;

Hypovolemia or dehydration;

Decompensated hypokalemia;

Decompensated hyponatremia;

Breast-feeding;

Galactosemia, glucose-galactose malabsorption syndrome, lactase deficiency;

Hepatitis and hepatocellular failure in patients on hemodialysis with severe renal failure (creatinine clearance<30 мл/мин), в связи с риском накопления фуросемида, экскреция которого осуществляется преимущественно с желчью.

Pregnancy and lactation

Directions for use and doses

The drug is taken orally before meals. The dose depends on the course and severity of the disease.

Adults. For edema of cardiac, renal or hepatic origin:

Moderate condition: 1/2 -1 tablet per day;

Severe condition: 2-3 tablets per day in 1 or 2 divided doses, or 3-4 tablets per day in 2 divided doses.

For high blood pressure in patients with chronic renal failure: in combination with other antihypertensive agents (antagonists of the renin-angiotensin system) the usual recommended dose is 20-120 mg per day in 1 or 2 divided doses. Changes in blood pressure should be carefully monitored when furosemide is used in conjunction with other antihypertensive drugs, especially during initial therapy. To prevent an excessive drop in blood pressure, the dose of other antihypertensive drugs should be reduced by at least 50% when furosemide is added to the main treatment.

Children. For the treatment of edema, the daily dose is 1-2 mg/kg body weight in 1-2 doses.

Use in elderly patients. Dose selection and adjustment in elderly patients should be done with caution, usually starting at the lower end of the therapeutic dose range.

Side effect

From the cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased circulating blood volume.

From the nervous system: dizziness, headache, muscle weakness, calf muscle cramps (tetany), apathy, adynamia, weakness, lethargy, drowsiness, confusion.

From the senses: visual and hearing impairment (hearing loss and tinnitus, usually short-term, appear in rare cases, especially in patients with renal failure, hypoproteinemia (for example, nephrotic syndrome)).

From the digestive system: hepatic encephalopathy in patients with hepatic cell failure, increased transaminases, anorexia, dry mouth, thirst, nausea, vomiting, diarrhea, constipation, cholestatic jaundice, pancreatitis (exacerbation).

From the genitourinary system: oliguria, acute urinary retention (in patients with prostate adenoma), muscle spasm, bladder spasm, interstitial nephritis, hematuria, decreased potency.

Allergic reactions: urticaria, eosinophilia, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing angitis, pruritus, chills, fever, photosensitivity, anaphylactic and/or anaphylactoid reactions, purpura, paresthesia (burning, pain), bullous reactions (bullous pemphigoid, erythema), syndrome Stevens-Johnson, toxic epidermal necrolysis.

From the hematopoietic organs: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.

From the side of water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis.

Effect on laboratory parameters: hyperglycemia, increased levels of cholesterol, low-density lipoproteins (when taking large doses of the drug), hyperuricemia, glucosuria, hypercalciuria, increased creatinine levels in the blood.

If adverse reactions occur, the dose should be reduced or the drug discontinued.

Overdose

Symptoms: marked decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemoconcentration, arrhythmias (including atrioventricular block, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy, hypokalemia and hypochloremic alkalosis.

Treatment: correction of water-salt balance and acid-base status, replenishment of circulating blood volume, symptomatic treatment, maintenance of vital functions. There is no specific antidote.

Interaction with other drugs

Hypokalemia

With the simultaneous use of glucocorticosteroids, amphotericin B, laxatives, the risk of developing hypokalemia increases, and with cardiac glycosides the risk of developing digitalis intoxication due to hypokalemia increases.

Hyponatremia

Taking diuretics, desmopressin, antidepressants that inhibit serotonin reuptake, carbamazepine and oxcarbazepine increases the risk of developing hyponatremia.

Ototoxicity

The ototoxicity of aminoglycosides, glycopeptides such as vancomycin and teicoplanin, and other ototoxic drugs may be increased by concomitant use of furosemide. Since this can lead to irreversible hearing damage, these drugs are used concomitantly with furosemide only in exceptional cases.

The simultaneous use of furosemide and lithium preparations is not recommended. The level of lithium in the blood serum increases with signs of overdose, the renal clearance of lithium preparations decreases and the toxicity of lithium preparations increases. If concomitant use of drugs cannot be avoided, careful monitoring of serum lithium levels and lithium dosage adjustment is necessary.

Combinations requiring special caution:

Furosemide should be used with caution in combination with risperidone, as there may be an increase in mortality in elderly patients. The need for combined use should be justified taking into account the risks and benefits of the combination. The risk of mortality increases with the presence of dehydration.

Anti-inflammatory non-steroidal drugs, including aspirin, anti-inflammatory doses of acetylsalicylic acid ≥1 g per dose and/or ≥3 g per day) or analgesics in antipyretic doses (≥500 mg per dose and/or<3 г в день): риск развития острой почечной недостаточности, особенно у пациентов группы риска (пожилые пациенты, пациенты с дегидратацией), снижение антигипертензивного эффекта. Необходим контроль функции почек в начале исследования, гидратация пациента.

Medicines that increase the risk of hypokalemia: monitoring of serum potassium levels is necessary.

Digitalis preparations: hypokalemia increases the cardiac toxicity of digitalis preparations.

Potassium-sparing diuretics, alone or in combination (amiloride, potassium canrenoate, eplerenone, spironolactone, triamterene): the possibility of hypokalemia cannot be excluded. Monitoring serum potassium levels and ECG is recommended.

Aminoglycosides: potentiation of nephrotoxic and ototoxic effects of drugs.

Phenytoin: reduction of the diuretic effect by up to 50%. It is possible to use higher doses of furosemide.

Carbamazepine: risk of symptomatic hyponatremia.

Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonistsII: risk of sudden arterial hypotension and/or acute renal failure. It is recommended to temporarily discontinue the use of furosemide or reduce its dose 3 days before starting treatment with ACE inhibitors/angiotensin II receptor antagonists. For congestive heart failure, it is recommended to begin treatment with low doses of ACE inhibitors. It is recommended to monitor renal function (creatinine determination) in the first weeks of treatment with ACE inhibitors/angiotensin II receptor antagonists.

Medicines, the use of which increases the risk of ventricular arrhythmia;

Antiarrhythmic drugs class Ia (quinidine, hydroquinidine, disopyramide), class III (amiodarone, sotalol, ibutilide, dofetilide);

Some neuroleptics: phenothiazines (aminazine, cyamemazine, fluphenazine, levomepromazine, pipothiazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol, pipamrenon), other neuroleptics (pimozide, sertindole, flupenthixol, zuclopenthixol);

Other drugs: bepridil, cisapride, difemanil, dolasetron IV, dronedarone, spiramycin, erythromycin IV, mizolastine, levofloxacin, halofantrine, lumefantrine, pentamidine, vincamine IV, moxifloxacin, mequitazine, methadone, toremifene, citalopram, escitalopram and others.

Concomitant use of furosemide with these drugs may increase the risk of developing ventricular arrhythmia, including potentially dangerous torsades de pointes (hypokalemia is a predisposing factor). Before taking the drug, monitoring of electrolyte and electrocardiographic parameters is recommended.

Metformin: possible development of lactic acidosis. Metformin should not be used if creatinine levels exceed 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women.

Baclofen: increased risk of arterial hypotension, including orthostatic hypotension. It is recommended to monitor blood pressure and, if necessary, adjust the dose of antihypertensive drugs.

Significant interactions of furosemide with other drugs:

Cyclosporine: risk of increasing blood creatinine levels, risk of hyperuricemia and gout;

Neuroleptics, tricyclic antidepressants, amifostine, nitrates: increased risk of arterial hypotension, including orthostatic hypotension;

Alpha blockers used in urology (alfuzosin, doxazosin, prazosin, terazosin, tamsulosin), antihypertensive alpha blockers: increased hypotensive effect, increased risk of orthostatic hypotension;

Platinum drugs: risk of ototoxicity and/or nephrotoxicity.

Precautionary measures

In the presence of ascites without peripheral edema, it is recommended to use furosemide in doses that provide additional diuresis in a volume of no more than 700-900 ml per day in order to avoid the development of oliguria, azotemia and disturbances in electrolyte metabolism.

Long-term use can lead to weakness, fatigue, decreased blood pressure and cardiac output, and excessive diuresis during myocardial infarction with congestion in the pulmonary circulation can contribute to the development of cardiogenic shock.

In patients receiving high doses of furosemide, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit the consumption of table salt. To prevent hypokalemia, it is recommended to simultaneously administer potassium supplements and potassium-sparing diuretics, as well as adhere to a diet rich in potassium.

Increased diuresis causes dehydration and hypovolemia, which can lead to arterial thrombosis, especially in elderly patients. All patients receiving furosemide should be monitored for signs of electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia): dry mouth, thirst, weakness, drowsiness, muscle pain, muscle spasms, muscle weakness, hypotension, oliguria, tachycardia, arrhythmia, gastrointestinal disorders.

Accidental administration of the drug can lead to hypovolemia and dehydration.

In case of hepatocellular failure, treatment should be carried out with caution, under strict monitoring of electrolytes, taking into account the risk of hepatic encephalopathy. If necessary, treatment should be stopped immediately.

Taking furosemide in case of partial obstruction of the urinary tract can lead to urinary retention. Careful monitoring of urine output should be ensured, especially at the start of furosemide treatment.

Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitization to furosemide.

Cases of photosensitivity reactions have been reported with the use of thiazide diuretics. If photosensitivity reactions occur, it is recommended to discontinue furosemide. If necessary, it is recommended to protect exposed skin exposed to sunlight or artificial ultraviolet radiation.

Since the drug contains lactose, its use is not recommended for patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.

When treating with furosemide, careful monitoring and dose adjustment is required in the following cases:

In patients at risk of cerebral, coronary ischemia or other ischemia associated with circulatory failure;

In patients with hepatorenal syndrome (renal failure associated with severe liver disease);

In patients with hypoproteinemia in the case of nephrotic syndrome: possible reduction of the effect of furosemide and potentiation; side effects, especially ototoxicity.

Increased urine output may cause or worsen urinary retention in patients with urinary tract obstruction.

Treatment with furosemide may lead to a transient increase in creatinine, cholesterol, and triglyceride levels.

There have been several cases of kidney stones occurring in premature infants receiving high-dose furosemide injections due to the development of hypercalciuria. Electrolyte balance:

Natremia. It is necessary to monitor sodium levels before starting therapy and regularly monitor them thereafter. Treatment with diuretics may cause hyponatremia. A decrease in sodium levels in the blood is initially asymptomatic; regular monitoring should be more frequent in patients at risk: advanced age, cachexia (malnutrition) or cirrhosis.

Kalemia. When using loop diuretics, a decrease in sodium levels with hypokalemia may occur. Risk of sudden hypokalemia (<3,5 ммоль/л) должен мониторироваться у пациентов групп риска: пожилой возраст и/или недоедание, и/или политерапия, в случае цирроза и асцита, у больных с сердечной недостаточностью. Гипокалиемия увеличивает сердечную токсичность препаратов дигиталиса и риск расстройств ритма. У пациентов с удлиненным интервалом QT врожденного или медикаментозного происхождения, гипокалиемия способствует расстройству ритма (потенциально летальная пируэтная тахикардия или брадикардия). Во всех случаях необходим частый контроль калиемии. Первый контроль калия в плазме должен быть вьшолнен в течение недели после начала терапии.

Glycemia. The frequency of glycemia is low, however, in diabetes mellitus it is necessary to systematically monitor the level of glucose in the blood and urine.

Uricemia. The secretion of uric acid is reduced, so use is not recommended for hyperuricemia and especially gout.

Creatinine. Regular monitoring of serum creatinine is recommended during treatment with furosemide.

Careful monitoring of patients at high risk of developing electrolyte disorders (vomiting, diarrhea, sweating) is necessary. Dehydration, hypovolemia or acid-base imbalance require treatment adjustment and/or temporary cessation of treatment.

Athletes. The presence of furosemide gives positive tests during anti-doping control.

Newborns and premature babies. In newborns and premature infants, long-term use of high doses of furosemide increases the risk of developing nephrocalcinosis and/or nephrolithiasis. Ultrasound monitoring of the kidneys is recommended.

Impact on the ability to drive vehicles and other potentially dangerous mechanisms. When using furosemide, the possibility of a decrease in the ability to concentrate cannot be excluded, therefore driving and other activities that require increased attention and reaction speed are not recommended.

Release form

Storage conditions

Best before date

Conditions for dispensing from pharmacies

Self-medication can be harmful to your health.
You should consult your doctor and read the instructions before use.