Frusemide

Frusemide

[250mg IV $8.99, 20mg IV 59 cents, 40mg tablets 1 cent]

ADMINISTRATION ROUTES:

  • PO, IV

ALTERNATIVE NAMES:

  • Diurin, Lasix, Frusemide

ICU INDICATIONS:

  1. diuretic

PRESENTATION AND ADMINISTRATION:

  • PO:
    Tablets:
    Diurin 40mg tablets (off white), Diurin 500mg tablets (off white)
    Oral Solution:

    Lasix oral solution 10mg/ml
  • IV:
    IV formulations available are:
    1. Frusemide injection 20mg/2ml solution
    2. Lasix high dose infusion 250mg in 25ml with 1000mg of mannitol as a stabilising agent
    Administer doses of up to 80mg by slow IV injection over 2-5 minutes
    For infusion doses of up to 5mg/hr use low dose infusion mixture of 40mg in 40ml of compatible IV fluid; for infusion doses of greater than 5mg/hr use high dose infusion mixture with undiluted Lasix high dose infusion (ie 250mg in 25ml or 500mg in 50ml)
    Rate of infusion should not exceed 4mg/min
    Compatible with the following IV fluids:
    Normal saline, Hartmanns
    Note: glucose solutions are unsuitable
    Store at room temperature; protect from light
    Dilutions in compatible IV fluid are stable for 24 hours at room temperature – discard if not used within 24 hours. Do not use if solutions have a yellow colour or contain crystal deposits

DOSAGE:

  • PO:
    Usual dosage from 10mg daily to 80mg three times a day
  • IV:
    Dosage is highly individualised. 5mg may be sufficient to cause significant diuresis in the frusemide naïve patient. Doses of 100mg/hr by infusion may be required in those with significant renal impairment.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: dose as in normal renal function; increased doses may be required
    10-20: dose as in normal renal function; increased doses may be required
    >20-50: dose as in normal renal function
  • Dose in renal replacement therapy
    CAPD: not indicated
    HD: not indicated
    CVVHDF: rarely indicated; increased doses may be required

DOSAGE IN PAEDIATRICS:

  • IV/ PO:
    Usually, 0.5-1mg/kg 6 hourly to four times a day.
    IV infusion: 50mg/kg in 50ml of normal saline at 0.1-1 mg/kg/hr (i.e 0.1-1ml/hr)

CLINICAL PHARMACOLOGY:

  • Frusemide is a potent diuretic that inhibits the absorption of sodium and chloride in the proximal and distal tubules and the loop of Henle.

CONTRAINDICATIONS:

  1. known hypersensitivity to frusemide

WARNINGS

  • Allergy to Sulfur drugs:
    Patients allergic to sulfonamides may also be allergic to frusemide.
  • Ototoxicity:
    Cases of tinnitus and reversible or irreversible hearing impairment have been reported. Usually, reports indicate that frusemide ototoxicity is associated with rapid injection, severe renal impairment, doses exceeding several times the usual recommended dose, or concomitant therapy with aminoglycoside antibiotics or other ototoxic drugs.

PRECAUTIONS

  • General:
    Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse
    As with any effective diuretic, electrolyte depletion may occur during frusemide therapy, especially in patients receiving higher doses and a restricted salt intake. Hypokalemia may develop with frusemide, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids or ACTH. Digitalis therapy may exaggerate metabolic effects of hypokalemia, especially myocardial effects.
    Asymptomatic hyperuricemia can occur and gout may rarely be precipitated.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions:
    None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Frusemide may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination.
  • Lithium generally should not be given with diuretics because they reduce lithium’s renal clearance and add a high risk of lithium toxicity.

ADVERSE REACTIONS

  • Gastrointestinal System Reactions:
    Pancreatitis, jaundice (intrahepatic cholestatic juandice), anorexia, oral and gastric irritation, cramping, diarrhea, constipation, nausea, and vomiting.
  • Systemic Hypersensitivity Reactions:
    Systemic vasculitis, interstitial nephritis, and necrotizing angiitis.
  • Central Nervous System Reactions:
    Tinnitus and hearing loss, paresthesias, vertigo, dizziness, headache, blurred vision, and xanthopsia.
  • Hematologic Reactions:
    Aplastic anemia (rare), thrombocytopenia, agranulocytosis (rare), hemolytic anemia, leukopenia, and anemia.
  • Dermatologic-Hypersensitivity Reactions:
    Exfoliative dermatitis, erythema multiforme, purpura, photosensitivity, urticaria, rash, and pruritus.
  • Cardiovascular Reaction:
    Orthostatic hypotension may occur and be aggravated by alcohol, barbiturates or narcotics.
  • Other Reactions:
    Hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weaknesses, restlessness, urinary bladder spasm, thrombophlebitis, and fever.

Critical Care Drug Manual

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