Furosemide

General characteristics. Structure:

Active agent: Furosemide of 40,0 mg

Excipients: lactoses monohydrate (sugar milk) - 67,40 mg, cellulose microcrystallic - 20,0 mg, starch corn - 15,0 mg, povidone (polyvinylpirrolidone) - 5,40 mg, silicon dioxide colloid - 0,70 mg, magnesium stearate - 1,50 mg

Pharmacological properties:

Pharmacodynamics. "Loopback" diuretic; causes quickly coming, severe and short-term diuresis. Breaks a reabsorption of ions of sodium and chlorine both in proximal, and in distal sites of gyrose tubules and in a thick segment of the ascending part of a Henle's loop. Furosemide renders the expressed diuretic, natriuretic, hloruretichesky effect. Besides, increases removal of potassium ions, calcium, magnesium.

Pharmacokinetics. Absorption high, maximum concentration is noted in a blood plasma at intake in 1 hour.
Bioavailability - 60-70%. The relative volume of distribution - 0,2 l/kg. Communication with proteins of a blood plasma - 98%. Gets through a placental barrier, it is allocated with breast milk. It is metabolized in a liver. Cosecretes in a gleam of renal tubules through the system of transport of anions existing in proximal department of nephron. 60-70% are allocated with kidneys, other part - intestines. An elimination half-life - 1-1.5 h.

Indications to use:

Edematous syndrome at heart failure of IB - the III Art., cirrhosis, a disease of kidneys (including a nephrotic syndrome); an acute left ventricular failure (fluid lungs), hypostases at burns, arterial hypertension.

Route of administration and doses:

The mode of dosing is set individually, depending on indications, a clinical situation, age of the patient. In the course of treatment the mode of dosing is adjusted depending on the size of the diuretic answer and dynamics of a condition of the patient.
Drug is appointed inside in the morning, to food and the initial dose for adults makes 2040 mg (1/2 - 1 tab.). At insufficient influence the dose is gradually increased to 80 - 160 mg a day (2-3 receptions with intervals of 6 hours). After reduction of hypostases drug is appointed in smaller doses with a break by 1-2 days. At arterial hypertension appoint 20-40 mg, in the absence of sufficient decrease in the ABP it is necessary to attach other hypotensive drugs to treatment. At addition of furosemide to already appointed hypotensive drugs, their dose has to be reduced twice. The initial single dose at children makes 1-2 mg/kg, maximum - 6 mg/kg.

Features of use:

Against the background of course treatment it is necessary to control periodically the ABP, the content of electrolytes of a blood plasma (including sodium, calcium, potassium, magnesium), an acid-base condition, residual nitrogen, creatinine, uric acid, function of a liver and to carry out, if necessary, the corresponding correction of treatment.
Patients with hypersensitivity to streptocides and derivatives of sulphonylurea can have cross sensitivity to furosemide. To the patient receiving high doses of furosemide in order to avoid development of a hyponatremia and a metabolic alkalosis it is inexpedient to limit consumption of table salt.
For prevention of a hypopotassemia co-administration of drugs of potassium and kaliysberegayushchy diuretics is recommended (first of all Spironolactonum), and also to adhere to the diet rich with potassium. Selection of the mode of dosing by the patient with ascites against the background of cirrhosis needs to be carried out in stationary conditions (disturbances of water and electrolytic balance can entail development of a hepatic coma). Regular control of the content of electrolytes of plasma is shown to this category of patients. At emergence or strengthening of an azotemia and oliguria in patients with the serious progressing illness of kidneys it is recommended to suspend treatment. It is allocated with milk at women in the period of a lactation in this connection the termination of breastfeeding for treatment is reasonable.
Periodic control of glucose level in blood and urine is required from patients with a diabetes mellitus or with reduced tolerance to glucose.
At patients in unconsciousness, with prostate adenoma, narrowing of ureters or a hydronephrosis, control of a mocheotdeleniye, in connection with a possibility of an acute ischuria is necessary. During treatment it is necessary to avoid occupations potentially dangerous types of activity requiring special attention and speed of psychomotor reactions.

Side effects:

- From cardiovascular system: excessive decrease in the ABP, orthostatic hypotension, collapse, tachycardia, arrhythmias.
- From a nervous system: dizziness, headache, muscular weakness, spasms of gastrocnemius muscles (tetany), paresthesias, apathy, adynamia, weakness, slackness, drowsiness, confusion of consciousness. From sense bodys: vision disorder and hearing.
- From the alimentary system: anorexia, dryness in a mouth, thirst, nausea, vomiting, diarrhea, a lock, cholestatic jaundice, pancreatitis (aggravation).
- From urinogenital system: an oliguria, an acute ischuria (at patients with prostate adenoma), intersticial nephrite, a hamaturia, impotence.
- Allergic reactions: purpura, urticaria, exfoliative dermatitis, multiformny erythema, vasculitis, necrotizing angiitis, skin itch, fever, fever, photosensitization, acute anaphylaxis.
- From bodies of a hemopoiesis: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.
- From water and electrolytic exchange: hypovolemia, dehydration (risk of development of thrombosis and thromboembolism), hypopotassemia, hyponatremia, hypochloraemia, hypocalcemia, hypomagnesiemia, metabolic alkalosis.
- Laboratory indicators: hyperglycemia, hypercholesterolemia, hyperuricemia, glucosuria, hypercalcuria.

Interaction with other medicines:

Increases concentration and risk of development nefro-and ototoksichesky effect of cephalosporins, aminoglycosides, chloramphenicol, Acidum etacrynicum, Cisplatinum, Amphotericinum In (owing to competitive renal removal).
Increases efficiency of diazoxide and theophylline, reduces - hypoglycemic means, Allopyrinolum. The medicines blocking canalicular secretion increase concentration of furosemide in blood serum. At simultaneous use of glucocorticosteroids, Amphotericinum In the risk of development of a hypopotassemia increases, with cardiac glycosides - the risk of development of digitalis intoxication owing to a hypopotassemia increases.
Reduces renal clearance of drugs of lithium and increases probability of development of intoxication.
Non-steroidal anti-inflammatory drugs, сукральфат reduce diuretic effect.
Strengthens hypotensive effect of hypotensive drugs, nervnomyshechny blockade of the depolarizing muscle relaxants (сукцинилхолин) and (tubocurarine) weakens action of not depolarizing muscle relaxants.
The concomitant use of high doses of salicylates against the background of therapy by furosemide increases risk of manifestation of their toxicity.

Contraindications:

Hypersensitivity to furosemide, an acute renal failure with an anury (the size of glomerular filtering less than 3-5 ml/min.), a heavy liver failure, a hepatic coma, an urethra stenosis, an acute glomerulonephritis, obstruction of urinary tract a stone, prekomatozny states, a hyper glycemic coma, a hyperuricemia, gout, a dekompensirovanny mitral or aortal stenosis, increase in the central venous pressure (over 10 mm hg), an idiopathic hypertrophic subaortal stenosis, arterial hypotension. acute myocardial infarction, system lupus erythematosus, pancreatitis, disturbance of water and electrolytic exchange (hypovolemia, hyponatremia, hypopotassemia, hypochloraemia, hypocalcemia, hypomagnesiemia), digitalis intoxication.

With CARE - a benign hyperplasia of a prostate, a hypoproteinemia (risk of development of ototoxicity), the diabetes mellitus (decrease in tolerance to glucose) stenosing atherosclerosis of cerebral arteries, pregnancy (especially the first half, use according to vital indications is possible), the lactation period.

Overdose:

Symptoms: decrease in the ABP, a collapse, shock, a hypovolemia, dehydration, haemo concentration, arrhythmias, an acute renal failure with an anury, thrombosis, a thrombembolia, drowsiness, confusion of consciousness, sluggish paralysis, apathy.
Treatment: correction of water-salt balance and the acid-base state (ABS), completion of volume of the circulating blood, a symptomatic treatment. There is no specific antidote.

Storage conditions:

In the dry, protected from light place at a temperature not above 25 °C. To store in the place, unavailable to children.

Issue conditions:

According to the recipe

Packaging:

Tablets on 40 mg
On 10, 50 tablets in a blister strip packaging from a film of the polyvinyl chloride and printing aluminum foil varnished. On 10, 20, 30, 40, 50 or 100 tablets in banks polymeric for medicines. To one bank or 1, 2, 3, 4, 5 or 10 blister strip packagings together with the application instruction place in cardboard packaging (pack).