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General

Excessive diuresis may cause dehydration and blood volume reduction with circulatory
collapse and perhaps vascular thrombosis and embolism, specifically
in elderly
patients. As with any effective diuretic, electrolyte depletion may occur during
Lasix (furosemide) therapy, especially in patients receiving
higher doses and also a restricted
salt intake. Hypokalemia may develop with Lasix (furosemide) , especially with brisk diuresis,
inadequate
oral electrolyte intake, when cirrhosis occurs, or during concomitant
usage of corticosteroids, ACTH, licorice in copious amounts, or prolonged use
of
laxatives. Digitalis therapy may exaggerate metabolic link between hypokalemia,
especially myocardial effects.

All patients receiving Lasix (furosemide) therapy
must be observed of those signs or
the signs of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis,
hypokalemia, hypomagnesemia or
hypocalcemia): dryness of mouth, thirst, weakness,
lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue,
hypotension, oliguria, tachycardia, arrhythmia, or
gastrointestinal disturbances
for example nausea and vomiting. Increases in glucose levels and alterations in glucose
tolerance tests (with abnormalities on
the fasting and 2-hour postprandial sugar)
are already observed, and rarely, precipitation of diabetes has become
reported.

In patients
with severe signs of urinary retention (as a consequence of bladder emptying
disorders, prostatic hyperplasia, urethral narrowing), the administration of/>furosemide might cause acute urinary retention relevant to increased production
and retention of urine. Thus, these patients require careful monitoring,
especially
over the early stages of treatment.

In patients at risky for radiocontrast nephropathy Lasix (furosemide) can cause a/>higher incidence of deterioration in renal function after receiving radiocontrast
compared to high-risk patients who received only intravenous hydration prior/>to receiving radiocontrast.

In patients with hypoproteinemia (e. g. , regarding nephrotic syndrome)
the effects of Lasix (furosemide) may
be weakened and its ototoxicity potentiated.

Asymptomatic hyperuricemia can happen and gout may rarely be precipitated.

Patients allergic
to sulfonamides may also be allergic to Lasix (furosemide) . The chance
exists of exacerbation or activation of systemic lupus
erythematosus.

As with numerous other drugs, patients really should be observed regularly for your possible
occurrence of blood dyscrasias,
liver or kidney damage, or any other idiosyncratic
reactions.

Laboratory Tests

Serum electrolytes (particularly potassium), CO2, creatinine and BUN
should
be determined frequently over the first couple of months of Lasix (furosemide) therapy and periodically
thereafter. Serum and urine
electrolyte determinations are particularly significant
if the patient is vomiting profusely or receiving parenteral fluids. Abnormalities
must be corrected or
even the drug temporarily withdrawn. Other medications may
also influence serum electrolytes.

Reversible elevations of BUN may occur and
so are regarding dehydration,
which will be ignored, particularly patients with renal insufficiency.

Urine and blood sugar should be
checked periodically in diabetics receiving
Lasix (furosemide) , even during those suspected of latent diabetes.

Lasix (furosemide) may lower
serum numbers of calcium (rarely cases of tetany have already been reported)
and magnesium. Accordingly, serum amounts of these electrolytes
ought to be determined
periodically.

In premature infants Lasix (furosemide) may precipitate nephrocalcinosis/nephrolithiasis,
therefore renal function have to be
monitored and renal ultrasonography performed
(See PRECAUTIONS: Pediatric Use).

Carcinogenesis, Mutagenesis, Impairment of Fertility

Furosemide was tested for carcinogenicity
by oral administration in a single strain
of mice and another strain of rats. A smaller but significantly increased incidence/>of mammary gland carcinomas happened in female mice at the dose 17. More the
maximum human dose of 600 mg.
There were marginal increases in uncommon tumors
in male rats for a dose of 15 mg/kg (slightly in excess of
the utmost human
dose) but not at 30 mg/kg.

Furosemide was free of mutagenic activity in a number of
strains of Salmonella
typhimurium when tested from the presence or lack of an in vitro metabolic
activation system, and questionably
positive for gene mutation in mouse lymphoma
cells in the presence of rat liver S9 at the highest dose tested.
Furosemide
didn't induce sister chromatid exchange in human cells in vitro , but
other studies on chromosomal aberrations in human
cells in vitro gave
conflicting results. In Chinese hamster cells it induced chromosomal damage
but was questionably positive for sister
chromatid exchange. Studies about the
induction by furosemide of chromosomal aberrations in mice were inconclusive. The urine of rats helped
by this drug wouldn't induce gene conversion in Saccharomyces
cerevisiae.

Lasix (furosemide) produced no impairment of love and fertility
in woman or man rats,
at 100 mg/kg/day (the ideal effective diuretic dose from the rat and 8 times
the
maximal human dose of 600 mg/day).

Pregnancy
Pregnancy Category C

Furosemide can cause unexplained maternal deaths and abortions
in
rabbits at 2, 4 and 8 times the maximal recommended human dose. You will find
no adequate and well-controlled studies
in pregnant women. Lasix (furosemide) should be taken
in pregnancy provided that the potential benefit justifies the wide ranging risk/>on the fetus.

Treatment in pregnancy requires monitoring of fetal growth as a result of
possibility of higher birth
weights.

The effects of furosemide on embryonic and fetal development and on pregnant
dams were studied in mice, rats
and rabbits.

Furosemide caused unexplained maternal deaths and abortions in the rabbit at
the minimum dose of 25 mg/kg
(Twice the maximal recommended human dose of 600
mg/day). In another study, a dose of 50 mg/kg (Four times the
maximal recommended
human dose of 600 mg/day) also caused maternal deaths and abortions when administered
to rabbits between Days 12
and 17 of gestation. In a third study, no
pregnant rabbits survived a dose of 100 mg/kg. Data through the
above research indicates
fetal lethality that can precede maternal deaths.

The connection between a button study and one of
the three rabbit studies also showed
an elevated incidence and seriousness of hydronephrosis (distention from the renal
pelvis and, sometimes,
of the ureters) in fetuses derived from the treated
dams compared to the incidence in fetuses in the control group.

Nursing Mothers

Because it seems in breast milk, caution ought to be exercised when Lasix (furosemide) is
administered with
a nursing mother.

Lasix (furosemide) may inhibit lactation. buy lumigan online without a prescription

Pediatric Use

In
premature infants Lasix (furosemide) may precipitate nephrocalcinosis/nephrolithiasis. Nephrocalcinosis/nephrolithiasis has been affecting children under 4
years without having reputation of prematurity
have been treated chronically
with Lasix (furosemide) . Monitor renal function, and renal ultrasonography should be considered,
in pediatric patients
receiving Lasix (furosemide) .

If Lasix (furosemide) is administered to premature infants through the first weeks of life,
it
might raise the probability of persistence of patent ductus arteriosus

Geriatric Use

Controlled clinical studies of Lasix (furosemide) did not
include sufficient varieties of
subjects aged 65 and over to determine whether or not they respond differently from
younger subjects.
Other reported clinical experience hasn't identified differences
in responses between your elderly and younger patients. Generally, dose selection
to the
elderly patient must be cautious, usually starting on the low end
from the dosing range, reflecting the greater frequency of
decreased hepatic,
renal or cardiac function, and of concomitant disease and other drug therapy.

This drug is known to
be substantially excreted because of the kidney, and the risk
of toxic reactions to the present drug may be greater
in patients with impaired renal
function. Because elderly patients will have decreased renal function,
care really should be consumed in
dose selection plus it can be employed to monitor renal
function (See PRECAUTIONS: General and DOSAGE AND ADMINISTRATION).

Last
reviewed on RxList: 11/15/2010
This monograph continues to be modified to include the generic and brand in many cases.

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