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Furosemide

Antihypertensive, loop diuretic

CCP: Cardiogenic pulmonary edema

Systolic blood pressure < 100 mmHg
Hypersensitivity to furosemide or sulfonamide-derived drugs
Complete renal shutdown
Hepatic coma or precoma
Known or suspected electrolyte imbalance, hypovolemia, dehydration, or hypotension
Jaundice in newborn infants or infants with diseases capable of causing hyperbilirubinemia
Pregnancy or breast-feeding

For patients with intact renal function: 40-80 mg IV/IO, or double the patient's usual daily dose
For patients with known or suspected renal impairment (eGFR < 30 mL/minute/1.73 m²): higher doses may be required to achieve diuretic responses; single doses > 160-200 mg IV are unlikely to produce additional diuresis

CliniCall consultation required prior to administration as limited data available.

Furosemide inhibits the reabsorption of sodium and chloride in the ascending loop of Henle, as well as the proximal and distal tubules.

Intravenous:

Cardiovascular: Necrotizing angiitis, orthostatic hypotension, thrombophlebitis
Dermatologic: Acute generalized exanthematous pustulosis, bulla (hemorrhagic), bullous pemphigoid, erythema multiforme , exfoliative dermatitis, lichenoid eruption, pruritus, skin photosensitivity, skin rash, Stevens-Johnson syndrome , toxic epidermal necrolysis, urticaria
Endocrine & metabolic: Glycosuria, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hypovolemia, increased serum cholesterol, increased serum triglycerides
Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, oral irritation, pancreatitis, vomiting
Genitourinary: Bladder spasm
Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, hemolytic anemia, leukopenia, purpuric disease, thrombocytopenia
Hepatic: Hepatic encephalopathy, increased liver enzymes, intrahepatic cholestatic jaundice
Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, nonimmune anaphylaxis
Immunologic: Drug reaction with eosinophilia and systemic symptoms
Nervous system: Dizziness, headache, paresthesia, restlessness, vertigo
Neuromuscular & skeletal: Asthenia, muscle spasm
Ophthalmic: Blurred vision, xanthopsia
Otic: Deafness, tinnitus
Renal: Acute kidney injury, calcium nephrolithiasis (pediatric patients), interstitial nephritis (allergic), nephrolithiasis (pediatric patients)
Miscellaneous: Fever

Source: Furosemide. In: Lexicomp Online, UpToDate, Waltham, MA. (Accessed November 20, 2020.)

If given in excessive amounts, furosemide can lead to profound diuresis, causing fluid and electrolyte depletion. Supervise therapy closely.
Monitor fluid status and renal function to prevent oliguria, azotemia, and increases in BUN and creatinine.

May enhance the hypotensive effect of angiotensin-converting enzyme inhibitors.
Beta-2 adrenergic agonists may enhance the hypokalemic effect of loop diuretics, including furosemide.
Nonsteroidal anti-inflammatory agents may diminish the effectiveness of loop diuretics.
Opioid agonists may enhance the toxic effects of diuretics and diminish their therapeutic effectiveness.