Tablets: a round form, almost white or white color, on one party below and above dividing risks the engraving of "DLI" is put (in strips from aluminum foil: on 10 pieces, in a cardboard pack of 5 strips; on 15 pieces, in a cardboard pack 3 strips);
Solution for intravenous (in/in) and intramuscular introduction (in oil): transparent colourless liquid (on 2 ml in glass ampoules of dark color with a break point, on 10 pieces in planimetric strip plastic packaging, in a cardboard pack 1 packaging).

Active ingredient of Lasixum – furosemide:

1 tablet – 40 mg;
1 ml of solution – 10 mg.

Auxiliary components:

Tablets: starch, lactose, starch prezhelatinizirovanny, magnesium stearate, silicon dioxide colloid, talc;
Solution: sodium hydroxide, sodium chloride, water for injections.

Indications to use

Use of Lasixum is shown for treatment of an edematous syndrome of various etiology:

Chronic heart failure;
Chronic renal failure;
Nephrotic syndrome;
Acute renal failure, including at burns and pregnancy;
Liver diseases (in need of simultaneous use with antagonists of Aldosteronum).

Besides:

Tablets: at arterial hypertension;
Solution: at an edematous syndrome at an acute heart failure, hypertensive crisis, brain hypostasis; for maintenance of an artificial diuresis at poisonings with chemical compounds, the removed kidneys in not changed look.

Contraindications

Renal failure with an anury (in the absence of the answer to furosemide);
Hepatic prekoma and coma;
The expressed disturbance of acid-base and water-salt balance: a hypopotassemia, a hyponatremia, a hypovolemia (without arterial hypotension or with it), dehydration;
Heavy disturbance of outflow of urine of any genesis;
Period of pregnancy and breastfeeding;
Hypersensitivity to drug components.

Drug is contraindicated to patients with an allergy to means of sulphonylurea or sulfanamide antimicrobic drugs (development of a cross allergy to furosemide is possible).

With extra care it is recommended to appoint Lasixum at arterial hypotension, states for which especially dangerously severe lowering of arterial pressure (ABP), including the stenosing defeats of brain and/or coronary arteries, at an acute myocardial infarction (the risk of development of cardiogenic shock increases), ventricular arrhythmia in the anamnesis, the latent or demonstrated diabetes mellitus, a gepatorenalny syndrome, gout, a hypoproteinemia (including, at selection of a dose for a nephrotic syndrome as against the background of possible reduction of diuretic action, the risk of development of ototoksichesky effect of furosemide increases), and also at pancreatitis, a system lupus erythematosus, the urine outflow disturbance caused by a prostatauxe, a hydronephrosis or an urethrostenosis, diarrhea.

Besides, use of tablets is contraindicated:

Digitalis intoxication;
Dekompensirovanny mitral and aortal stenosis, hypertrophic subaortic stenosis;
Acute glomerulonephritis;
Hyperuricemia;
Increase in the central venous pressure more than on 10 mm of a mercury column;
Age up to 3 years.

With care it is necessary to apply solution at patients with reduced hearing and premature children (in view of a possible nephrolithiasis and a nephrocalcinosis it is regularly necessary to control function of kidneys, including ultrasonography).

Route of administration and dosage

Tablets:
Accept inside, to food, without chewing, washing down with a small amount of liquid. The drug dosing is defined by the doctor on the basis of clinical indications, at the same time it is recommended to appoint the smallest doses providing achievement of necessary effect. For adults the maximum daily dose is recommended of 1500 mg, for children – at the rate of 2 mg for 1 kg of weight, but not higher than 40 mg. Individual clinically effective dose is selected taking into account the diuretic answer. At purpose of the mode of dosing at adults it is necessary to adhere to the following recommendations at an edematous syndrome against the background of: chronic heart failure – the initial daily dose makes 20-80 mg in 2-3 receptions; a chronic renal failure – an initial daily dose of 40-80 mg in 1-2 receptions (because of possible loss of liquid in an initiation of treatment to 2 kg of body weight a day selection of a dose is made with gradual increase not to allow sharp loss of liquid at the patient), a maintenance dose at a hemodialysis – 250-1500 mg a day; liver diseases – at inefficiency of monotherapy by antagonists of Aldosteronum Lasixum in an initial dose of 20-80 mg a day is in addition appointed, treatment needs to be accompanied with regular control of level of loss of liquid; a nephrotic syndrome – an initial dose of 40-80 mg a day in 1-2 receptions. At an acute renal failure use of drug is shown only after elimination of a hypovolemia, arterial hypotension and considerable disturbances of an acid-base and electrolytic state. At arterial hypertension drug is used in monotherapy and in a combination with hypotensive drugs in the form of a maintenance dose of 20-40 mg a day. Treatment of arterial hypertension against the background of a chronic renal failure provides purpose of higher doses.

Solution:
Apply for in/in introductions, in exceptional cases – in oil. In/in maintaining appoint in need of achievement of bystry effect, disturbance at the patient of absorption of drug in a small intestine or impossibility of reception of tablets inside. Appointment should be carried out in minimal effective doses and for the short period with further transfer into oral administration of drug. The recommended speed in/in introductions – to 4 mg, at a heavy renal failure – to 2,5 mg a minute, more preferable is long infusional introduction. Solution can be dissolved with normal saline solution to be in a proportion which allows an indicator рН (concentration of ions of hydrogen) the received solution at the level from neutral to alkalescent. The dose and the period of treatment are appointed by the doctor on the basis of clinical indications. The maximum daily dosing at in introduction for adults – 1500 mg, for children a dose is defined at the rate of 1 mg on 1 kg of weight of the child, but it is not higher than 20 mg in days. The recommended initial dosing for adults at an edematous syndrome: at chronic heart failure – 20-80 mg a day in 2-3 introductions; at an acute heart failure – 20-40 mg in a look in/in bolyusny introductions; at a chronic renal failure treatment should be begun with in/in drop introductions with a speed of 0,1 mg a minute with gradual increase in rate of administering every 30 minutes, the dose is selected individually taking into account degree of manifestation of a disease and level of sodium in a blood plasma, increase should be carried out gradually, controlling liquid loss. The supporting daily dose at a hemodialysis – 250-1500 mg. For removal of liquid at an acute renal failure 40 mg, initial in/in introduction, are recommended, in the absence of sufficient diuretic effect it is kapelno recommended to continue to administer the drug, since the speed of 50-100 mg an hour. It is necessary to aim at faster transfer of the patient into administration of drug inside. If necessary in/in introductions at hypostases against the background of a nephrotic syndrome and diseases of a liver to the patient appoint 20-40 mg of drug. At hypertensive crisis and hypostasis of a brain the initial dose of drug for in/in bolyusny introductions makes 20-40 mg. At poisonings the patient should appoint 20-40 mg of Lasixum for maintenance of an artificial diuresis (after preliminary in/in drop administrations of electrolytic solutions). Prior to treatment and during use of drug it is recommended to control, and if necessary and to recover loss of electrolytes and liquid.

Side effects

Cardiovascular system: strong decrease in the ABP, collapse;
Water and electrolytic and acid-base balance: hyponatremia, hypochloraemia, hypopotassemia, hypomagnesiemia, hypocalcemia, metabolic alkalosis. Symptoms of development of pathologies of balance: disturbances of a cordial rhythm, confusion of consciousness, a headache, spasms, muscular weakness, a tetany, dispepsichesky frustration, a hypovolemia and dehydration (is more often at patients of advanced age);
From a metabolism: increase in serumal level of triglycerides, cholesterol, creatinine and urea (passing), uric acid (risk of development of gout or strengthening of manifestation); decrease in tolerance to glucose (manifestation latentno of the proceeding diabetes mellitus is possible);
Alimentary system: seldom – diarrhea, nausea, vomiting, an intra hepatic cholestasia, increase in level of liver enzymes, acute pancreatitis;
Urinary system: partial obstruction of urinary ways;
Nervous system, acoustic organ: seldom – a hearing disorder (usually reversible) and/or a sonitus, paresthesias;
Peripheral blood: seldom – a leukopenia, thrombocytopenia; in some cases – aplastic or hemolitic anemia, an agranulocytosis;
Allergic and dermatological reactions: seldom – skin rash, an itch, a small tortoiseshell, violent damages of skin, fever, exfoliative dermatitis, a polymorphic erythema, a purpura, a photosensitization, a vasculitis.

Besides, against the background of reception of tablets disturbance of an urinary system is possible: decrease in a potentiality, hamaturia.

Use of solution of Lasixum can cause side effects also:

Cardiovascular system: arrhythmia, tachycardia, decrease in volume of the circulating blood;
Urinary system: seldom – intersticial nephrite, at premature children is a nephrocalcinosis or a nephrolithiasis;
Peripheral blood: eosinophilia;
Allergic reactions: very seldom – heavy anaphylactoid or anaphylactic reactions, shock;
Others: at premature children – against the background of use of furosemide in the first weeks of life high risk of preservation of Botallov Canal; morbidity in the place in oil of introduction.

Special instructions

Treatment should be begun after an exception of existence of heavy disturbances of outflow of urine, including unilateral.

At partial disturbance of outflow of urine patients have to be under careful observation, especially at the beginning of furosemide use.

Treatment demands carrying out regular researches on determination of level of serumal concentration of sodium, potassium and creatinine, especially from patients with intensive sweating, vomiting or diarrhea.

At emergence of clinically significant disturbances of an acid-base and/or electrolytic state, and also hypovolemia or dehydration, it is necessary to take measures for recovery of liquid balance in an organism, up to temporary drug withdrawal.

During treatment the diet rich with potassium including low-fat meat, a cauliflower, potatoes, tomatoes, spinach, bananas, dried fruits has to be recommended to the patient. Purpose of the accompanying therapy by kaliysberegayushchy drugs or potassium reception is possible.

At purpose of solution premature children need to control regularly function of kidneys not to allow development of a nephrolithiasis and nephrocalcinosis.

At ascites against the background of cirrhosis selection of a dose of solution needs to be carried out only in the conditions of a hospital.

It is impossible to mix Lasixum solution in one syringe with other drugs.

At the first signs of development of an acute anaphylaxis (sharp weakness and cold sweat, cyanosis, nausea) it is necessary to stop administration of drug (having left a needle in a vein) and, having provided low position of a trunk and head, to keep passability of respiratory system. The emergency medicamentous help assumes in/in maintaining Epinephrinum (adrenaline) and glucocorticosteroids under control of a cordial rhythm, heart rate and the ABP. For recovery of volume of the circulating blood infusional administration of electrolytic solutions is shown.

During use of Lasixum it is necessary to be careful at control of vehicles and mechanisms.

Medicinal interaction

Simultaneous use of Lasixum with other medicines needs to be begun only after consultation with the attending physician, it will allow to avoid development of undesirable side effects.