Category:

• Diuretic

Description:

• Loop diuretic

Indications:

• Pulmonary edema

• edema in CHF, liver disease, renal disease including nephrotic syndrome,ascites

Contraindications:

Hypovolemia

• Anuria

• Electrolyte depletion

• Infants

Precautions:

• Pregnancy category B; contraindicated per manufacturer

• Dehydration

• Cirrhosis (may precipitate hepatic encephalopathy)

• Concurrent administration of other ototoxic drugs

• Sulfa allergy

Adverse Reactions (Side Effects):

• CNS: encephalopathy in hepatic disease, fatigue, headache, vertigo, weakness

• CV: chest pain, circulatory collapse, ECG changes, hypotension

• EENT: blurred vision, ear pain, hearing loss, tinnitus

• GI: abdominal distension/pain, acute pancreatitis, anorexia, jaundice, GI bleeding, dry mouth, cramps, severe diarrhea, nausea, vomiting

• GU: glycosuria, polyuria, renal failure, sexual dysfunction

• HEME: agranulocytosis, leukopenia, neutropenia, thrombocytopenia

• METAB: decreased glucose tolerance, hyperglycemia, hyperuricemia, hypocalcemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hyponatremia

• MS: arthritis, cramps, stiffness

• SKIN: photosensitivity, pruritis, purpura, rash, Stevens-Johnson syndrome, sweating  

Dosage:

Administered orally or intravenously

• Adult: 

  • PO 50-200mg daily; may give up to 200mg twice daily, adjust dose in 25-50mg increments

  • IV 50mg or 0.5-1.0 mg/kg given over several minutes

• Child: 

  • PO 25mg increased by 25mg per day until desired effect occurs; not established for infants or parenterally

Special Consideration:

• Reserve for patients not responding or intolerant to furosemide or bumetanide