In this medical article you can read: medicine Lasix. The instructions for use will explain at what pressure these injections or tablets can be taken, what the medicine helps with, what are the indications for use, contraindications and side effects. The annotation presents the forms of release of the drug and its composition.

In the article, doctors and consumers can only leave real reviews about Lasix, from which you can find out whether the medicine helped in the treatment of edema syndrome and hypertensive crisis in adults and children, for which it is also prescribed. The instructions list analogues of Lasix, prices of the drug in pharmacies, as well as its use during pregnancy.

Lasix is ​​a fast-acting diuretic drug. Instructions for use indicate that 40 mg tablets, injections in ampoules for intramuscular and intravenous injections dilate blood vessels and reduce blood pressure.

Release form and composition

Lasix is ​​available in tablet form and as a solution.

The tablets are round in shape, white in color and have a special “DLI” engraving above the line on both sides. The tablets are packaged in aluminum strips of 10 or 15 pieces. A cardboard pack contains 5 (10 pieces each) or 3 (15 pieces each) strips.

Lasix in ampoules of 2 ml is a clear solution. There are 10 ampoules in a cardboard pack.

The tablet contains 40 mg and additional components: colloidal form of silicon dioxide, talc, lactose, Mg stearate, pregelatinized starch.

1 ml of solution contains 10 mg of furosemide (20 mg in an ampoule) and additional components: Na hydroxide, Na chloride and water.

pharmachologic effect

Lasix has a pronounced diuretic (diuretic) and moderate hypotensive (lowering blood pressure) effect. The diuretic effect of the drug is achieved by blocking the reabsorption of sodium and chlorine. Furosemide penetrates into the renal tubule, in particular to its loop-shaped part (Hegel's loop) and there blocks the reabsorption of Na+ and Cl ions.

An increase in the release of sodium ions entails an increased release of fluid, potassium, calcium and magnesium. When administering an injection solution intravenously diuretic effect observed within 5 minutes and lasts for two hours. When taking Lasix tablets, diuresis occurs within an hour and lasts about seven hours.

The hypotensive effect of the drug occurs as a result of increasing the secretion of sodium chloride (salt) and preventing vasoconstriction due to a decrease in circulating blood volume. The hypotensive effect is more effective when administered intravenously. Quite quickly reduces blood pressure, as well as pressure in the left ventricle and pulmonary artery, dilates large veins and thus reduces the preload of the heart.

With intravenous administration, the pressure decreases within 5-10 minutes; if the medicine is used in tablets, the pressure returns to normal within an hour and remains within normal limits for 2-3 hours.

Indications for use

What does Lasix help with? Tablets and injections are used mainly for edema syndrome. Main indications for the use of Lasix:

• cerebral edema;
• hypertensive crisis;
• edema syndrome in chronic heart failure;
• edema syndrome in heart failure (acute form);
• edema syndrome in chronic pathology of the renal system;
• acute renal failure during burns (maintaining fluid excretion), during pregnancy;
• edema syndrome due to pathology of the hepatic system (in combination with aldosterone antagonists);
• edema syndrome in nephrotic syndrome (together with therapy of the underlying disease);
• support for forced diuresis during intoxication chemical compound, which is excreted unchanged through the renal system.

Instructions for use

When prescribing Lasix, it is recommended to use the smallest doses sufficient to achieve the required therapeutic effect. Tablets should be taken on an empty stomach without chewing and drinking enough liquid.

The ampoule form of the drug is administered intravenously and exceptional cases intramuscularly (when intravenous or oral administration of the drug is not possible). Intravenous administration of the drug Lasix is ​​carried out only when taking the drug orally is not possible or there is a malabsorption of the drug in the small intestine or if necessary to obtain the fastest possible effect.

Using intravenous administration Lasix is ​​always recommended to transfer the patient to oral Lasix as early as possible.

When administered intravenously, Lasix should be administered slowly. The rate of intravenous administration should not exceed 4 mg per minute. In patients with severe renal impairment (serum creatinine >5 mg/dL), it is recommended that the rate of intravenous administration of Lasix do not exceed 2.5 mg per minute.

To achieve optimal effectiveness and suppression of counter-regulation (activation of renin-angiotensin and antinatriuretic neurohumoral regulation), prolonged intravenous infusion of Lasix should be preferable to repeated intravenous administration of the drug.

If after one or more bolus intravenous injections with acute conditions there is no possibility of ongoing intravenous infusion, then it is more preferable to administer low doses with no large intervals between administrations (approximately 4 hours apart) than intravenous bolus administration of higher doses with longer intervals between administrations.

The solution for parenteral administration has a pH of about 9 and does not have buffering properties. At a pH below 7, the active substance may precipitate, therefore, when diluting Lasix, it is necessary to ensure that the pH of the resulting solution ranges from neutral to slightly alkaline. For dilution, you can use saline solution.

The diluted solution of Lasix should be used as soon as possible. The recommended maximum daily intravenous dose for adults is 1500 mg. In children, the recommended dose for parenteral administration is 1 mg/kg body weight (but not more than 20 mg per day). The duration of treatment is determined by the doctor individually depending on the indications.

Arterial hypertension

Lasix can be used alone or in combination with other antihypertensive agents. The usual maintenance dose is 20-40 mg per day. At arterial hypertension in combination with chronic renal failure, higher doses of Lasix may be required.

Hypertensive crisis, cerebral edema

Maintaining forced diuresis during poisoning

Furosemide is prescribed after intravenous infusion of electrolyte solutions. The recommended starting dose for intravenous administration is 20-40 mg. The dose depends on the response to furosemide. Before and during treatment with Lasix, fluid and electrolyte losses should be monitored and replaced.

Edema in nephrotic syndrome

Acute renal failure (to maintain fluid excretion)

Before starting treatment with Lasix, hypovolemia, arterial hypotension and significant disturbances in electrolyte and acid-base status must be eliminated. It is recommended that the patient be switched from intravenous administration of the drug to taking Lasix tablets as soon as possible (the dose of tablets depends on the selected intravenous dose).

The recommended initial intravenous dose is 40 mg. If after its administration the required diuretic effect is not achieved, then Lasix can be administered as a continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.

Edema syndrome in chronic heart failure

Edema syndrome in chronic renal failure

The natriuretic response to furosemide depends on several factors, including the severity renal failure and blood sodium levels, so the dose effect cannot be accurately predicted.

In patients with chronic renal failure, careful selection of the dose is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 kg of body weight per day is possible).

In patients on hemodialysis, the usual maintenance dose is 250-1500 mg per day.

When administered intravenously, the dose of furosemide can be determined as follows: treatment begins with an intravenous drip at a rate of 0.1 mg per minute, and then gradually increases the rate of administration every 30 minutes depending on the therapeutic effect.

Edema syndrome in acute heart failure

Edema syndrome in liver diseases

Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are insufficiently effective.

To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in electrolyte or acid-base status, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of body weight per day is possible).

If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.

Contraindications

• Severe disturbance of urine outflow of any origin;
• Hypersensitivity to the components of Lasix;
• Severe disturbance of acid-base and water-salt balance: hypokalemia, hyponatremia, hypovolemia (without arterial hypotension or with it), dehydration;
• Pregnancy and breastfeeding period;
• Hepatic precoma and coma;
• Renal failure with anuria (in the absence of response to furosemide).

The drug is contraindicated in patients with allergies to sulfonylureas or sulfonamides. antimicrobials(possible development of cross-allergy to furosemide).

In addition, the use of Lasix tablets is contraindicated:

• An increase in central venous pressure by more than 10 mmHg;
• Age up to 3 years;
• Acute glomerulonephritis;
• Decompensated mitral and aortic stenosis, hypertrophic obstructive cardiomyopathy;
• Digitalis intoxication;
• Hyperuricemia.

Lasix solution should be used with caution in patients with hearing loss and premature infants (due to possible nephrolithiasis and nephrocalcinosis, renal function should be regularly monitored, including ultrasound).

Side effects

When using the drug Lasix with an inadequate dosage regimen, the patient quickly develops negative side reactions:

• The risk of developing thrombosis due to changes in water electrolyte balance;
• From the cardiovascular system - a rapid decline in indicators blood pressure, dizziness, weakness, lethargy, drowsiness, vascular insufficiency, collapse;
• Acute urinary retention, development of hydronephrosis, hematuria, glomerulonephritis;
• People prone to allergic reactions may develop rashes, hives and itching of the skin;
• Reversible hearing impairment;
• Feeling of “pins and needles” crawling throughout the body;
• From the side of water-salt balance - a decrease in the blood level of potassium, sodium, chlorine, magnesium, calcium, against the background of which metabolic alkalosis and disorder of the function of the kidneys and other vital organs rapidly develop;
• An increase in blood serum levels of cholesterol, triglycerides, fats;
• Decreased glucose tolerance;
• From the digestive canal – nausea, vomiting, diarrhea, intrahepatic cholestasis, increased activity of hepatic transminases.

Children, pregnancy and breastfeeding

The active component penetrates the placental barrier, so the drug should not be prescribed during pregnancy. If, for health reasons, Lasix is ​​prescribed to pregnant women, then careful monitoring of the condition of the fetus is necessary. Lasix is ​​contraindicated during breastfeeding. Furosemide suppresses lactation.

Use in children

Contraindicated in children under 3 years of age (solid dosage form).

special instructions

Use with caution for hyperplasia prostate gland, hypoproteinemia, with stenotic atherosclerosis of the cerebral arteries. Do not mix furosemide solution in the same syringe with other drugs.

Drug interactions

Medicines that lower blood pressure, diuretics and antihypertensive drugs in combination with Lasix can provoke sharp drop blood pressure.

ACE inhibitors may worsen functional state renal system, provoke hypotension. IN severe cases acute renal failure develops.

Carbenoxolone, glucocorticosteroids, drugs with licorice root, laxatives in combination with Lasix increase the risk of developing hypokalemia.

It has been noted that furosemide is able to enhance the nephrotoxic and ototoxic effects of aminoglycosides due to delayed excretion through the renal system. The nephrotoxic effects of medications are enhanced by parallel treatment with furosemide. Kidney damage is also recorded with the use of high doses of cephalosporins, the predominant route of elimination of which is through the renal system.

The severity of the diuretic effect of Lasix is ​​reduced when taking NSAIDs. With severe dehydration and hypovolemia, NSAIDs can provoke the development of acute renal failure. Lasix enhances the toxic effects of salicylates. During treatment with Phenytoin, the severity of the diuretic effect of furosemide decreases.

Cisplatin with furosemide has a pronounced ototoxic effect. The administration of high doses (more than 40 mg) enhances the nephrotoxic effect of Cisplatin.

Analogues of the drug Lasix

Analogues are determined by structure:

1. Fursemid.
2. Furosemide.
3. Furon.

The group of diuretics includes analogues:

1. Nebilong N.
2. Isobar.
3. Lespeflan.
4. Oxodolin.
5. Urea.
6. Kristepin.
7. Arindap.
8. Hygroton.
9. Arifon.
10. Hypothiazide.
11. Urological (diuretic) collection.
12. Indapres.
13. Urakton.
14. Akuter Sanovel.
15. Ionic.
16. Normatens.
17. Clopamid.
18. Spironol.
19. Spironolactone.
20. Diuver.
21. Lespenefril.
22. Aldactone.
23. Canephron H.
24. Lespefril.
25. Acripamide retard.
26. Hydrochlorothiazide.
27. Lorvas.
28. Indap.
29. Aquaphor.
30. Triamtel.
31. Brinaldix.
32. Bufenox.
33. Verospilactone.
34. Mannitol.
35. Acripamide.
36. Torsemide.
37. Phytolysin.
38. Brusniver.
39. Diacarb.
40. Mannitol.
41. Cimalon.

Vacation conditions and price

The average cost of Lasix (40 mg tablets No. 45) in Moscow is 55 rubles. The price of injections is 90 rubles for 10 ampoules of 2 ml. Dispensed by prescription.

Store out of reach of children at a temperature not exceeding +25° C. Shelf life of tablets is 4 years, solution for injection is 5 years.

Registration number: P N014865/01-280114
Trade name of the drug: Lasix®
International Nonproprietary Name (INN)- furosemide
Dosage form: pills

Compound
One tablet contains:
Active substance: furosemide (frusemide) - 40 mg
Excipients: lactose - 53.00 mg, starch - 56.88 mg, pregelatinized starch - 7.00 mg, talc - 2.40 mg, colloidal silicon dioxide - 0.40 mg, magnesium stearate - 0.32 mg.

Description
White or almost white round tablets with "DLI" engraving above and below the marks on one side.

Pharmacotherapeutic group: diuretic.
ATX code- C03CA01.

Pharmacological properties

Pharmacodynamics
Lasix® is a strong and fast-acting diuretic that is a sulfonamide derivative. The drug Lasix® blocks the transport system of sodium (Na+), potassium (K+) chloride (Cl-) ions in the thick segment of the ascending limb of the loop of Henle, and therefore its diuretic effect depends on the entry of the drug into the lumen of the renal tubules (due to the anionic mechanism transport). The diuretic effect of Lasix® is associated with inhibition of sodium chloride reabsorption in this part of the loop of Henle. Secondary effects to the increase in sodium excretion are: an increase in the amount of urine excreted (due to osmotically bound water) and an increase in the secretion of potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases.
When the tubular secretion of furosemide decreases or when furosemide binds to albumin located in the lumen of the tubules (for example, in nephrotic syndrome), the effect of furosemide is reduced.
During a course of taking the drug Lasix®, its diuretic activity does not decrease, since furosemide interrupts the tubular-glomerular feedback in the Macula densa (a tubular structure closely associated with the juxtaglomerular complex). Lasix® causes dose-dependent stimulation of the renin-angiotensin-aldosterone system.
In heart failure, Lasix® rapidly reduces preload (by dilating the veins), reduces pulmonary artery pressure and left ventricular filling pressure. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which the realization of this effect also requires sufficient preservation of renal function.
The drug Lasix® has a hypotensive effect, which is caused by an increase in sodium excretion, a decrease in circulating blood volume and a decrease in the response of vascular smooth muscles to vasoconstrictor stimuli (due to the natriuretic effect, furosemide reduces the vascular response to catecholamines, the concentration of which is increased in patients with arterial hypertension).
After taking 40 mg of Lasix® orally, the diuretic effect develops within 60 minutes and lasts about 3-6 hours.
In healthy volunteers receiving 10 to 100 mg of Lasix®, dose-dependent diuresis and natriuresis were observed.
Pharmacokinetics
Furosemide is rapidly absorbed from the gastrointestinal tract.
Its tmax. (time to reach maximum concentration in the blood) ranges from 1 to 1.5 hours. The bioavailability of furosemide in healthy volunteers is approximately 50-70%. In patients, the bioavailability of Lasix® may be reduced by up to 30%, as it can be influenced by various factors, including the underlying disease. The volume of distribution of furosemide is 0.1-0.2 l/kg body weight. Furosemide binds to blood plasma proteins (more than 98%), mainly to albumin.
Furosemide is excreted predominantly unchanged and mainly by secretion in the proximal tubules. Glucuronidated metabolites of furosemide account for 10-20% of the drug excreted by the kidneys. The remaining dose is excreted through the intestines, apparently by biliary secretion.
The terminal half-life of furosemide is approximately 1-1.5 hours. Furosemide penetrates the placental barrier and is excreted into breast milk. Its concentrations in the fetus and newborn are the same as in the mother.
Features of pharmacokinetics in certain groups of patients
For renal failure excretion of furosemide slows down and the half-life increases; with severe renal failure, the terminal half-life may increase to 24 hours.
At neurotic syndrome a decrease in plasma protein concentrations leads to an increase in the concentrations of unbound furosemide (its free fraction), and therefore increases the risk of developing oto toxic effect. On the other hand, the diuretic effect of furosemide in these patients may be reduced due to the binding of furosemide to tubular albumin and decreased tubular secretion of furosemide.
For hemodialysis and peritoneal dialysis and continuous outpatient peritoneal dialysis Furosemide is excreted insignificantly.
At liver failure The half-life of furosemide increases by 30-90%, mainly due to an increase in the volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly.
For heart failure, severe arterial hypertension and elderly patients excretion of furosemide slows down due to decreased renal function.

Indications for use

Edema syndrome in chronic heart failure;
- edema syndrome in chronic renal failure;
- acute renal failure, including that during pregnancy and burns (to maintain fluid excretion);
- edema syndrome in nephrotic syndrome (in nephrotic syndrome, treatment of the underlying disease is in the foreground);
- edema syndrome in liver diseases (if necessary in addition to treatment with aldosterone antagonists);
- arterial hypertension.

Contraindications

Hypersensitivity to the active substance or to any of the components of the drug; in patients with allergies to sulfonamides (sulfonamide antimicrobials or sulfonylureas), as a “cross” allergy to furosemide may develop.
- Renal failure with anuria (in the absence of response to furosemide);
- Hepatic coma and precoma associated with hepatic encephalopathy.
- Severe hypokalemia.
- Severe hyponatremia.
- Hypovolemia (with or without a decrease in blood pressure) or dehydration.
- Severe disturbances in the outflow of urine of any etiology, including unilateral lesions urinary tract.
- Intoxication with cardiac glycosides.
- Acute glomerulonephritis.
- Decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy.
- Increased central venous pressure (over 10 mm Hg).
- Children up to 3 years of age (solid dosage form).
- Pregnancy (see “Pregnancy and breastfeeding”).
- Breastfeeding period (see “Pregnancy and breastfeeding period”).

Carefully

With arterial hypotension;
- In conditions where an excessive decrease in blood pressure is especially dangerous (stenotic lesions of the coronary and/or cerebral arteries);
- In case of acute myocardial infarction (increased risk of developing cardiogenic shock);
- With latent or manifested diabetes mellitus;
- For gout;
- With hepatorenal syndrome (that is, with functional renal failure associated with liver disease);
- With hypoproteinemia (for example, with nephrotic syndrome, when the diuretic effect may decrease and the risk of developing the ototoxic effect of furosemide may increase); dose selection in such patients should be carried out with extreme caution;
- With partial obstruction of the urinary tract (prostatic hyperplasia, narrowing urethra);
- With an increased risk of developing disorders of the water-electrolyte balance and acid-base state or in case of significant fluid losses (vomiting, diarrhea, profuse sweating - monitoring of the water-electrolyte balance and acid-base state is required and, if necessary, correction of their disorders to starting the use of furosemide);
- For pancreatitis;
- With a history of ventricular heart rhythm disturbances;
- With systemic lupus erythematosus;
- When risperidone is co-administered in elderly patients with dementia (risk of increased mortality).

Pregnancy and breastfeeding period

Furosemide crosses the placental barrier, so it should not be prescribed during pregnancy without strict medical indications. If, for health reasons, Lasix® is prescribed to pregnant women, then careful monitoring of the condition and development of the fetus is necessary.
During breastfeeding, taking Lasix® is contraindicated, because it suppresses lactation.
Women should not breastfeed while taking Lasix®.

Directions for use and doses

General recommendations:
The tablets should be taken on an empty stomach, without chewing and with sufficient liquid.
When prescribing Lasix®, it is recommended to use the smallest doses sufficient to achieve the desired effect.
The recommended maximum daily dose for adults is 1500 mg. In children, the recommended daily dose for oral administration is 2 mg/kg body weight (but not more than 40 mg per day).
The duration of treatment is determined by the doctor individually depending on the indications.
Special dosage recommendations for adults
Edema syndrome in chronic heart failure
The recommended starting dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended that the daily dose be divided into two or three doses.
Edema syndrome in chronic renal failure
The natriuretic response to furosemide depends on several factors, such as the severity of renal impairment and blood sodium levels, so the dose effect cannot be accurately predicted.
In patients with chronic renal failure, careful selection of the dose is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 liters per day is possible, approximately 280 mmol Na + per day).
The recommended starting dose is 40-80 mg per day. The required dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses.
In patients on hemodialysis, the maintenance dose is usually 250-1500 mg/day.
Acute renal failure (to maintain fluid excretion)
Before starting treatment with furosemide, hypovolemia, arterial hypotension and significant violations water-electrolyte balance and/or acid-base status. Dose selection begins with intravenous administration of Lasix®. The recommended starting dose is 40 mg intravenously. If the required diuretic effect is not achieved, then furosemide can be administered as a continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.
It is recommended to switch the patient from intravenous administration of Lasix® to taking Lasix® tablets as quickly as possible (the dose of tablets depends on the selected intravenous dose).
Edema in nephrotic syndrome
The recommended starting dose is 40 - 80 mg per day. The required dose is selected depending on the diuretic response. The daily dose can be taken at one time or divided into several doses.
Edema syndrome in liver diseases
Lasix® is prescribed in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation, or disturbances in water-electrolyte balance, or acid-base status, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of weight is possible bodies per day). The recommended starting dose is 20-80 mg per day. It can be adjusted depending on the patient's response. The daily dose can be used once a day or divided into 2 doses.
Arterial hypertension
Lasix® can be used alone or in combination with other antihypertensive agents.
The usual maintenance dose is 20-40 mg per day. In case of arterial hypertension in combination with chronic renal failure, the use of higher doses of Lasix® may be required.

Side effect

The incidence of adverse reactions/adverse events (AEs/AEs) was obtained from literature data and clinical trials. If the frequency of occurrence for the same AEs/AEs in the literature and data from clinical studies differed, the highest frequency of AEs/AEs was selected.
The following gradations of the frequency of occurrence of ADRs/AEs are used according to the CIOMS classification (Council international organizations medical sciences):
very common ≥ 10%;
frequent ≥1% and< 10%;
uncommon ≥ 0.1% and< 1 %;
rare ≥ 0.01% and< 0,1 %;
very rare< 0,01 %,
unknown frequency (determine the frequency of occurrence adverse reaction According to the available data, it is not possible).
Metabolic and nutritional disorders
Very frequent
- Disturbances of water and electrolyte balance, including those occurring with clinical symptoms. Symptoms indicating the development of water-electrolyte imbalance may include headache, convulsions, tetany, muscle weakness, heart rhythm disturbances and dyspeptic disorders.
Such disorders can develop either gradually (over a long time) or quickly (over a very short time, for example, in the case of high doses of furosemide in patients with normal renal function).
Factors contributing to the development of fluid and electrolyte imbalances are underlying diseases (for example, cirrhosis of the liver or heart failure); concomitant therapy with drugs that change water and electrolyte balance; poor nutrition And drinking regime; vomiting, diarrhea, profuse sweating.
- Dehydration and hypovolemia (decrease in circulating blood volume), especially in elderly patients, which can lead to hemoconcentration with a tendency to develop thrombosis (see below).
- Increased creatinine concentration in the blood.
- Increased serum triglyceride concentrations.
Frequent
- Hyponatremia, hypochloremia, hypokalemia, increased cholesterol concentration in the blood.
- Increased concentration of uric acid in the blood and gout attacks.
Infrequent
- Decreased glucose tolerance. Manifestation of latent diabetes mellitus is possible (see section “Special instructions”).
Unknown frequency
- Hypocalcemia, hypomagnesemia, increased urea concentration in the blood, metabolic alkalosis, pseudo-Barter syndrome with incorrect and/or long-term use furosemide
Vascular disorders
Very frequent
- Reduced blood pressure, including orthostatic hypotension(this AE mainly relates to the parenteral use of furosemide).
Rare
- Vasculitis.
Unknown frequency
- Thrombosis.
Renal and urinary tract disorders
Frequent
- Increased urine volume.
Rare
- Tubulointerstitial nephritis.
Unknown frequency
- Increased sodium and chloride levels in the urine.
- Urinary retention (in patients with partial obstruction of the urinary tract, see section “Special instructions”).
- Nephrocalcinosis/nephrolithiasis in premature infants (see section “Special instructions”). This AE applies only to injection dosage form, since taking Lasix® tablets is contraindicated for children under 3 years of age).
- Renal failure (see section “Interaction with other drugs”).
Digestive system disorders
Infrequent
- Nausea.
Rare
- Vomiting, diarrhea.
Very rare
- Acute pancreatitis.
Disorders of the liver and biliary tract
Very rare
- Cholestasis, increased activity of “liver” transaminases.
Nervous system disorders
Rare
- Paresthesia.
Frequent
- Hepatic encephalopathy in patients with hepatocellular insufficiency (see section “Contraindications”).
Hearing and labyrinth disorders
Infrequent
- Hearing impairment, usually transient, especially in patients with renal failure, hypoproteinemia (for example, with nephrotic syndrome).
Cases of deafness, sometimes irreversible, have been reported after oral or intravenous administration of furosemide.
Very rare
- Noise in ears.
Skin and subcutaneous tissue disorders
Infrequent
- Skin itching, urticaria, rash, bullous dermatitis, erythema multiforme, pemphingoid, exfoliative dermatitis, purpura, photosensitivity reactions.
Unknown frequency
- Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, DRESS syndrome: drug rash with eosinophilia and systemic symptoms.
Immune system disorders
Rare
- Severe anaphylactic or anaphylactoid reactions up to the development of anaphylactic shock.
Blood and lymphatic system disorders
Frequent
- Hemoconcentration.
Infrequent
- Thrombocytopenia.
Rare
- Leukopenia, eosinophilia.
Very rare
- Agranulocytosis, aplastic anemia or hemolytic anemia.
Congenital, hereditary and genetic disorders
Unknown frequency
- Increased risk of patent ductus arteriosus when furosemide is administered to premature infants during the first week of life (applies to parenteral dosage form only).
General and administration site disorders
Rare
- Fever
Since some adverse reactions (such as changes in the blood picture, severe anaphylactic or anaphylactoid reactions, severe skin allergic reactions) under certain conditions can threaten the lives of patients, then if any side effects occur, you must immediately report them to your doctor.

Overdose

If you suspect an overdose, you should definitely consult a doctor, since in case of an overdose, certain measures may be required. therapeutic measures.
The clinical picture of acute or chronic drug overdose depends mainly on the degree and consequences of loss of fluid and electrolytes. Overdose may be manifested by hypovolemia, dehydration, hemoconcentration, cardiac rhythm and conduction disturbances (including atrioventricular block and ventricular fibrillation). Symptoms of these disorders are a pronounced decrease in blood pressure, progressing to the development of shock, acute renal failure, thrombosis, delirium, flaccid paralysis, apathy and confusion.
There is no specific antidote. If a little time has passed after oral administration, then to reduce the absorption of furosemide from gastrointestinal tract you should try to induce vomiting or perform gastric lavage, and then take it orally Activated carbon.
Treatment is aimed at correcting clinically significant disturbances in water-electrolyte balance and acid-base status under the control of the content of electrolytes in the blood serum, indicators of acid-base status, hematocrit, as well as at preventing or treating possible serious complications developing against the background of these disorders.

Interaction with other drugs

Not recommended combinations
- Chloral hydrate - intravenous infusion of furosemide in the 24-hour period after the use of chloral hydrate can lead to hyperemia of the skin, profuse sweating, anxiety, nausea, increased blood pressure and tachycardia. Therefore, the use of furosemide in combination with chloral hydrate is not recommended.
- Aminoglycosides - slowing down the excretion of aminoglycosides by the kidneys when used simultaneously with furosemide and increasing the risk of developing ototoxic and nephrotoxic effects of aminoglycosides. For this reason, the use of this combination of drugs should be avoided, except in cases where it is necessary for health reasons, in which case an adjustment (reduction) of maintenance doses of aminoglycosides is required.
Combinations that should be used with caution
- Ototoxic drugs - furosemide potentiates their ototoxicity. Such drugs can be used concomitantly with Lasix® only under strict conditions. medical indications, because joint use may cause permanent hearing damage.
- Cisplatin - when used simultaneously with Lasix®, there is a risk of ototoxicity. In addition, an increase in the nephrotoxic effect of cisplatin is possible if Lasix® is not used in low doses (for example, 40 mg in patients with normal renal function) and in combination with additional fluid administration (hydration of the patient) when Lasix® is used for forced diuresis during cisplatin treatment.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists - the administration of an ACE inhibitor or an angiotensin II receptor antagonist to patients previously treated with furosemide may lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases, to the development of acute renal failure, therefore, three days before starting treatment or increasing the dose of ACE inhibitors or angiotensin II receptor antagonists, it is recommended to discontinue furosemide or reduce its dose.
- Lithium salts - under the influence of furosemide, the excretion of lithium is reduced, thereby increasing the serum concentration of lithium, which increases the risk of developing toxic effects, including its damaging effects on the heart and nervous system. Therefore, when using this combination, monitoring of serum lithium levels is required.
- Risperidone - caution should be exercised, carefully weighing the risk-benefit ratio, when combining risperidone with furosemide or other strong diuretics (increased mortality was observed in elderly patients with dementia receiving concomitant risperidone and furosemide).
Interactions to Consider
- Cardiac glycosides, drugs that cause prolongation of the QT interval - if water-electrolyte imbalances (hypokalemia or hypomagnesemia) develop during the use of furosemide, the toxic effect of cardiac glycosides and drugs that cause prolongation of the QT interval increases (the risk of developing cardiac arrhythmias increases).
- Glucocorticosteroids, carbenoxolone, licorice preparations in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of developing hypokalemia.
- Medicines with nephrotoxic effects when combined with furosemide increases the risk of developing their nephrotoxic effects.
- High doses some cephalosporins (excreted primarily by the kidneys) - in combination with furosemide, increase the risk of nephrotoxicity of cephalosporins.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, including acetylsalicylic acid, may reduce the diuretic effect of furosemide.
In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure.
Furosemide may increase the toxicity of salicylates.
- Phenytoin - decreases the diuretic effect of furosemide.
- Antihypertensives, diuretics or other drugs that can lower blood pressure - when combined with furosemide, a more pronounced decrease in blood pressure is possible.
- Probenecid, methotrexate or other drugs that, like furosemide, are excreted in the renal tubules, can reduce the effects of furosemide (same route of renal excretion); on the other hand, furosemide can lead to a decrease in the renal excretion of these medicines. All this increases the risk of developing side effects of both Lasix® and the above drugs taken simultaneously with it.
- Hypoglycemic agents (both for oral administration and insulin), pressor amines (epinephrine, norepinephrine) - weakening of effects when combined with furosemide.
- Theophylline, diazoxide, curare-like muscle relaxants - enhanced effects when combined with furosemide.
- Sucralfate - decreases the absorption of furosemide when taken orally and weakens its effect (furosemide and sucralfate should be taken at least two hours apart).
- Cyclosporine A - when combined with furosemide, the risk of developing gouty arthritis due to hyperuricemia and impaired urate excretion by the kidneys.
- Radiocontrast agents - in patients with high risk the development of nephropathy following the administration of radiocontrast agents in those receiving furosemide was observed more high frequency renal dysfunction compared with patients at high risk of developing nephropathy on the administration of radiocontrast agents who received only intravenous additional fluid (hydration) before the administration of radiocontrast agents.

special instructions

Before starting treatment with Lasix®, the presence of pronounced disturbances in the outflow of urine, including unilateral ones, should be excluded. Patients with partial urinary obstruction require careful monitoring, especially when starting treatment with Lasix®.
During treatment with Lasix®, regular monitoring of sodium, potassium and creatinine levels in the blood serum is required; Particularly careful monitoring should be carried out in patients at high risk of developing fluid and electrolyte imbalance in cases of additional fluid and electrolyte losses (for example, due to vomiting, diarrhea or intense sweating).
Before and during treatment with Lasix®, it is necessary to monitor and, if occurring, correct hypovolemia or dehydration, as well as clinically significant disturbances in water-electrolyte balance and/or acid-base status, which may require short-term cessation of treatment with Lasix®.
When being treated with Lasix®, it is always advisable to eat food that rich in potassium(lean meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). In some cases, taking potassium supplements or prescribing potassium-sparing drugs may be indicated.
A high frequency was observed deaths in elderly patients receiving risperidone and furosemide concomitantly, compared with patients receiving either furosemide alone or risperidone alone. The mechanism of this effect is unclear. Concomitant use of risperidone with other diuretics (mainly low-dose thiazide diuretics) was not associated with increased mortality in elderly patients with dementia.
In elderly patients with dementia, furosemide and risperidone should be prescribed concomitantly with caution, carefully weighing the balance of benefit and risk. Since dehydration is common factor risk of increased mortality, dehydration of the patient should be avoided when deciding to use this combination in elderly patients with dementia.
The selection of a dosage regimen for patients with ascites against the background of cirrhosis of the liver should be carried out in a hospital (imbalances in water and electrolyte balance can lead to the development of hepatic coma).

Impact on the ability to drive vehicles and engage in other potentially hazardous activities.

Some side effects (for example, a significant decrease in blood pressure) may impair the ability to concentrate and reduce psychomotor reactions, which can be dangerous when driving or engaging in other potentially dangerous activities. dangerous species activities. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases simultaneous administration antihypertensive drugs or alcohol.
In such cases it is not recommended to operate vehicles or engage in potentially hazardous activities.

Lasix is ​​the trade name of a medicine whose active ingredient is furosemide. It is taken to reduce swelling caused by heart failure, kidney problems, and cirrhosis of the liver. Some people take Lasix for high blood pressure to help emergency care during hypertensive crises. Below you will find instructions for using this drug, written in clear language. Study its indications, contraindications and side effects. Find out how to take Lasix correctly: how many days in a row, in what dosages, how to combine Asparkam and Panangin with medications. Understand why torasemide is replacing Lasix (furosemide) in the treatment of heart failure and hypertension.

Drug card

Instructions for use

Along with the drug Lasix they are looking for:

How to take Lasix

Take Lasix as directed by your doctor. Do not take on your own for weight loss or swelling. Lasix can cause severe side effects and is therefore not suitable for self-medication. If you are concerned about swelling, consult a doctor. Get tested to find the cause and, if possible, eliminate it. Lasix and other diuretic medications do not affect the cause of edema, but only temporarily muffle the symptoms. Swelling may be a signal from the body that heart or kidney failure is on the horizon and needs to be treated aggressively to prevent serious illness.

In what dose and how many times a day to take Lasix - this will be indicated by the doctor. Do not attempt to change the dosage or regimen of this medication on your own. If the patient is bothered by the symptoms listed above in the “Side Effects” section, you should urgently contact your doctor. You will likely take Lasix tablets at home. This medicine in ampoules is usually used in a hospital or when calling an ambulance. Discuss with your doctor whether you should take Asparkam or Panangin potassium tablets along with a loop diuretic.

In the treatment of heart failure, the newer drug torasemide (Diuver) is replacing furosemide because it acts more smoothly and causes fewer side effects. Talk to your doctor about whether you need to switch from furosemide (Lasix) to Diuver or another torsemide drug. Do not change one medicine to another without permission. People who take Lasix need to have regular blood tests for potassium, creatinine, and other levels that may be of interest to the doctor. After looking at the test results, the doctor may increase or decrease the dosage of the diuretic medication.

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Catad_pgroup Diuretics

Lasix tablets - official* instructions for use

*registered by the Ministry of Health of the Russian Federation (according to grls.rosminzdrav.ru)

Registration number:

Trade name of the drug: Lasix®

International Nonproprietary Name (INN)- furosemide

Dosage form:

Compound
One tablet contains:
Active substance: furosemide (frusemide) - 40 mg
Excipients: lactose, starch, pregelatinized starch; talc; colloidal silicon dioxide; magnesium stearate.

Description
White or off-white round tablets with "DLI" engraved above and below the score on one side.

Pharmacotherapeutic group:

ATX Code- C03CA01.

Pharmacodynamics
Lasix is ​​a strong and fast-acting diuretic that is a sulfonamide derivative. Lasix blocks the Na + K + SG ion transport system in the thick segment of the ascending limb of the loop of Henle, and therefore its diuretic effect depends on the drug entering the lumen of the renal tubules (due to the anion transport mechanism). The diuretic effect of Lasix is ​​associated with inhibition of sodium chloride reabsorption in this section of the loop of Henle. Secondary effects to the increase in sodium excretion are: an increase in the amount of urine excreted (due to osmotically bound water) and an increase in the secretion of potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. When tubular secretion of furosemide decreases or when the drug binds to albumin located in the tubular lumen (for example, in nephrotic syndrome), the effect of furosemide is reduced. When taking Lasix for a course, its diuretic activity does not decrease, since the drug interrupts the tubular-glomerular feedback in the Macula densa (a tubular structure closely associated with the juxtaglomerular complex). Lasix causes dose-dependent stimulation of the renin-angiotensin-aldosterone system.
In heart failure, Lasix quickly reduces preload (by dilating the veins), reduces pulmonary artery pressure and left ventricular filling pressure. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which the realization of this effect also requires sufficient preservation of renal function.
The drug has a hypotensive effect, which is caused by an increase in sodium excretion, a decrease in circulating blood volume and a decrease in the response of vascular smooth muscle to vasoconstrictor stimuli (due to the natriuretic effect, furosemide reduces the vascular response to catecholamines, the concentration of which is increased in patients with arterial hypertension).
After taking 40 mg of Lasix orally, the diuretic effect begins within 60 minutes and lasts about 3-6 hours.
In healthy volunteers receiving 10 to 100 mg of Lasix, dose-dependent diuresis and natriuresis were observed.

Pharmacokinetics
Furosemide is rapidly absorbed from the gastrointestinal tract. Its tmax (time to reach maximum concentration in the blood) ranges from 1 to 1.5 hours. The bioavailability of furosemide in healthy volunteers is approximately 50-70%. In patients, the bioavailability of Lasix can be reduced by up to 30%, as it can be influenced by various factors, including the underlying disease. The volume of distribution of furosemide is 0.1-0.2 l/kg body weight. Furosemide binds very strongly to plasma proteins (more than 98%), mainly to albumin.
Furosemide is excreted predominantly unchanged and mainly by secretion in the proximal tubules. Glucuronidated metabolites of furosemide account for 10-20% of the drug excreted by the kidneys. The remaining dose is excreted through the intestines, apparently by biliary secretion.
The terminal half-life of furosemide is approximately 1-1.5 hours.
Furosemide penetrates the placental barrier and is excreted into breast milk. Its concentrations in the fetus and newborn are the same as in the mother.

Features of pharmacokinetics in certain groups of patients
In renal failure, the elimination of furosemide slows down and the half-life increases; with severe renal failure, the terminal half-life may increase to 24 hours.
For nephrotic syndrome a decrease in plasma protein concentrations leads to an increase in the concentrations of unbound furosemide (its free fraction), and therefore the risk of developing ototoxicity increases. On the other hand, the diuretic effect of furosemide in these patients may be reduced due to the binding of furosemide to tubular albumin and decreased tubular secretion of furosemide.
For hemodialysis and peritoneal dialysis and continuous outpatient peritoneal dialysis Furosemide is excreted insignificantly.
For liver failure The half-life of furosemide increases by 30-90%, mainly due to an increase in the volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly.
For heart failure, severe arterial hypertension and in elderly people excretion of furosemide slows down due to decreased renal function.

Indications for use

Lasix- diuretic, diuretic drug.
The diuretic effect of the drug is realized by blocking the reabsorption of sodium and chlorine. Furosemide penetrates into the renal tubule, in particular to its loop-shaped part, which is called Hegel's loop and there blocks the reabsorption of Na+ and Cl? ions. An increase in the release of sodium ions entails an increased release of fluid, potassium, calcium and magnesium.
Blocks the reabsorption of sodium and chlorine ions in the ascending limb of the loop of Henle. It also increases the excretion of potassium, calcium, and magnesium.
Pharmacokinetics
When taken orally, bioavailability is 64%. Cmax increases with increasing dose, but the time to reach the maximum is independent of the dose and varies widely depending on the patient's condition. T1/2 - about 2 hours. In plasma, 91-99% is bound to protein, 2.4-4.1% is in a free state. Biotransforms mainly into glucuronide. Excreted in urine (more after intravenous administration than after oral administration).
The onset of the diuretic effect when taken orally is observed within 1 hour, the maximum effect is after 1-2 hours, the duration is 6-8 hours. With intravenous administration, the onset of action is after 5 minutes, the maximum is after 30 minutes, the duration is about 2 hours. When administered intravenously, it causes varicose veins, quickly reduces preload, reduces pressure in the left ventricle and pulmonary artery system, and reduces systemic pressure.

Indications for use

Mode of application

Side effects

Contraindications

Pregnancy

Interaction with other drugs

Overdose

Storage conditions

Release form

Compound

1 mlsolution for injection Lasix contains: active substance: furosemide 10 mg.
Additional substances: Na hydroxide, Na chloride, prepared water for injection.

Additionally