11.04.2019

Diuretic Lasix. Treatment of edema syndrome arising against the background of chronic heart failure. Side effects of Lasix

Registration number: P N014865/02-240114
Trade name of the drug: Lasix®
International Nonproprietary Name (INN)- furosemide
Dosage form: solution for intravenous and intramuscular injection

Compound
1 ml of solution contains:
active substance: furosemide - 10.00 mg.
Excipients: sodium chloride 7.50 mg, sodium hydroxide - 1.28 mg (sodium hydroxide, which is required to convert furosemide to sodium furosemide), sodium hydroxide - 0.44 mg (approximately) (sodium hydroxide, which is required to establish the pH value to 9 ,0-9.3), water for injection 1.00 ml.

Description: transparent colorless solution.

Pharmacotherapeutic group: diuretic.

ATX code - C03CA01

Pharmacological properties

Pharmacodynamics
Lasix® is a fast-acting diuretic that is a sulfonamide derivative. Lasix® blocks the transport system of Na+, K+, Cl- ions in the thick segment of the ascending limb of the loop of Henle, and therefore its saluretic effect depends on the entry of the drug into 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 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 Lasix® is re-administered, 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 (due to varicose vein dilation), 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 muscles to vasoconstrictor effects (due to the natriuretic effect, furosemide reduces the vascular response to catecholamines, the concentration of which is increased in patients with arterial hypertension).
Dose-dependent diuresis and natriuresis are observed when taking Lasix® in doses from 10 mg to 100 mg (healthy volunteers). After intravenous administration 20 mg of Lasix®, the diuretic effect develops after 15 minutes and lasts about 3 hours.
The relationship between intratubular concentrations of unbound (free) furosemide and its natriuretic effect takes the form of a sigmoidal curve with a minimum effective speed Furosemide excretion is approximately 10 mcg/min. Therefore, continuous infusion of furosemide is more effective than repeated bolus administration. In addition, there is no significant increase in effect above a certain bolus dose. 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.

Pharmacokinetics
The volume of distribution of furosemide is 0.1-0.2 l/kg body weight and varies significantly depending on the underlying disease. 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. After intravenous administration of furosemide, 60-70% of the administered dose is eliminated by this route. 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 after intravenous administration 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 individual breast 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.
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.
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 in elderly people excretion of furosemide slows down due to decreased renal function.
Furosemide excretion in premature and full-term infants may slow down, which depends on the degree of maturity of the kidneys; the metabolism of the drug in infants may also be slowed down, since their glucurinating ability of the liver is defective. In children whose age after conception exceeds 33 weeks, the terminal half-life does not exceed 12 hours. In infants two months of age and older, the excretion of furosemide does not differ from that in adults.

Indications for use

Edema syndrome in chronic heart failure.
- Edema syndrome in acute 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 (with 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).
- Brain swelling.
- Hypertensive crisis.
- Maintaining forced diuresis in case of poisoning with chemical compounds excreted unchanged by the kidneys.

Contraindications

Hypersensitivity to the active substance or to any of the components of the drug; in patients with allergies to sulfonamides (sulfonamide antimicrobial agents or sulfonylureas) a cross-allergy to furosemide may develop.
- Renal failure with anuria not responding to furosemide.
- Hepatic precoma and coma.
- Severe hypokalemia.
- Severe hyponatremia.
- Hypovolemia (with or without arterial hypotension) or dehydration.
- Severe disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract).
- Pregnancy (see “Pregnancy and lactation”).
- Breastfeeding period.

Carefully
- For arterial hypotension;
- In conditions in which excessive reduction 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 manifest diabetes mellitus;
- For gout;
- With hepatorenal syndrome (that is, with renal functional failure associated with liver disease);
- In case of hypoproteinemia (for example, in nephrotic syndrome, when a decrease in the diuretic effect and an increase in the risk of developing the ototoxic effect of furosemide is possible, dose selection in such patients should be carried out with extreme caution);
- With partial obstruction of the urinary tract (hyperplasia prostate gland, narrowing urethra);
- At increased risk development of water-electrolyte balance and acid-base state disorders or in case of significant additional fluid losses (vomiting, diarrhea, profuse sweating) (monitoring of water-electrolyte balance and acid-base state is required and, if necessary, correction of their disorders before use furosemide).
- For pancreatitis;
- With a history of ventricular heart rhythm disturbances;
- With systemic lupus erythematosus;
- In premature infants (the possibility of the formation of calcium-containing kidney stones (nephrolithiasis) and the deposition of calcium salts in the kidney parenchyma (nephrocalcinosis); therefore, in such children, regular monitoring of kidney function is required and an ultrasound examination of the kidneys is required;
- 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
When prescribing Lasix®, it is recommended to use the smallest doses sufficient to achieve the required therapeutic effect.
Lasix® is administered intravenously and, in exceptional cases, intramuscularly (when intravenous administration or oral administration is not possible). Intravenous administration of the drug Lasix® is carried out only when oral administration of the drug is impossible or there is a malabsorption of the drug in the small intestine or if necessary to obtain the fastest possible effect. When administering Lasix® intravenously, it is always recommended that as much early appointment Lasix® for oral administration.
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 failure(serum creatinine greater than 5 mg/dL), it is recommended that the rate of intravenous administration of Lasix® should not exceed 2.5 mg per minute. To achieve optimal effectiveness and suppress counterregulation (activation of renin-angiotensin and antinatriuretic neurohumoral regulation), continuous intravenous infusion of Lasix® is preferable to repeated intravenous bolus administration of the drug. If, after one or more intravenous bolus administrations in acute conditions, a continuous intravenous infusion is not possible, then administration of low doses with no large intervals time between administrations (approximately 4 hours) 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®, you must strive to ensure that the pH of the resulting solution is from neutral to slightly alkaline. For dilution, you can use 0.9% sodium chloride solution. A diluted solution of Lasix® should be used as soon as possible after preparation.
The recommended maximum daily intravenous dose for adults is 1500 mg. In children, the recommended daily 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.

Special dosage recommendations for adults
Edema syndrome in chronic heart failure
The recommended starting dose is 20-80 mg per day.
The dose is selected depending on the diuretic response. It is recommended that the daily dose be administered two to three times.
Edema syndrome in acute heart failure
The recommended starting dose of Lasix® is 20-40 mg as an intravenous bolus. If necessary, the dose of Lasix® may be adjusted depending on the therapeutic effect.
Edema syndrome in chronic renal failure
The natriuretic response to furosemide depends on several factors, including the severity of renal impairment and blood sodium levels, so the dose response 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 approximately 2 liters per day is possible, which can amount to up to 280 mmol Na + per day).
In patients on hemodialysis, the usual maintenance dose is 250-1500 mg/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.
Acute renal failure (to maintain fluid excretion)
Before starting treatment with Lasix®, hypovolemia, arterial hypotension and significant violations water-electrolyte balance and/or acid-base status. It is recommended that the patient be switched from IV Lasix® to Lasix® Tablets as soon as possible (the dose of Lasix® Tablets depends on the IV dose selected).
The recommended starting dose for intravenous administration 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 in nephrotic syndrome
The recommended starting dose is 20-40 mg per day.
The dose is selected depending on the diuretic effect.
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 body weight is possible day).
If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.
Hypertensive crisis, cerebral edema
The recommended starting dose is 20-40 mg by intravenous bolus. The dose may be adjusted depending on the effect.
Maintaining forced diuresis during poisoning
Lasix® 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.

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 according to the CIOMS (Council of International Organizations of Medical Sciences) classification are used:
very frequent ≥ 10 %;
frequent≥ 1% and< 10%;
infrequent≥ 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
- Water-electrolyte balance disorders, including those occurring with clinical symptoms. Symptoms indicating the development of water-electrolyte imbalance may include headache, convulsions, tetany, muscle weakness, violations heart rate 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 alter water-electrolyte balance; Not proper 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 uric acid in the blood and gout attacks.
Infrequent
- Decreased glucose tolerance. Possible manifestation of latent diabetes mellitus(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.
Rare
- Vasculitis.
Unknown frequency
- Thrombosis.
Renal and urinary tract disorders
Frequent
- Increased urine volume.
Rare
- Tubulo interstitial nephritis.
Unknown frequency
- Increased sodium and chloride content in urine.
- Urinary retention (in patients with partial obstruction of the urinary tract, see section “Special instructions”).
- Nephrocalcinosis/nephrolithiasis of premature infants (see section “Special instructions”).
- 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 (eg, nephrotic syndrome) and/or with too rapid intravenous administration of furosemide.
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
- Itchy skin, 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 non-union ductus arteriosus, when furosemide is administered to premature infants during the first week of life.
General and administration site disorders
Rare
- Fever
Unknown frequency
- After intramuscular injection possible local reaction in the form of pain.
Since some adverse reactions (such as changes in blood count, severe anaphylactic or anaphylactoid reactions, severe allergic skin reactions) under certain conditions can be life-threatening for patients, if any side effects occur, you should immediately report them to your doctor.

Overdose

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.
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 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 within a 24-hour period after administration of chloral hydrate may lead to hyperemia skin, profuse sweating, anxiety, nausea, increased blood pressure and tachycardia.
- 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. Since this can lead to irreversible damage to the hearing organ, such drugs should only be used concomitantly with furosemide for strict medical reasons.
- Cisplatin - when used simultaneously with furosemide, there is a risk of ototoxicity. In addition, there may be an increase in the nephrotoxic effect of cisplatin if furosemide is not used in low doses (for example, 40 mg in patients with normal renal function) and in combination with appropriate hydration of the patient when it is used for forced diuresis during treatment with cisplatin.
- 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, 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 and electrolyte imbalance (hypokalemia or hypomagnesemia) develops during the administration of furosemide toxic effect cardiac glycosides, drugs that cause prolongation of the QT interval (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 furosemide 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 (not intended for this dosage form) 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 a high risk of developing nephropathy, the administration of radiocontrast agents receiving furosemide was associated with 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.
- Lasix® administered intravenously is slightly alkaline and should not be mixed with medications with a pH less than 5.5.

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.
In premature infants, regular monitoring of renal function and ultrasound examination of the kidneys are required (possibility of nephrolithiasis and nephrocalcinosis).
There was a higher incidence of death in elderly patients receiving risperidone and furosemide concomitantly compared with patients receiving either furosemide 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).
Compatibility Notes
Lasix® should not be mixed in the same syringe with other medications.
Emergency measures for the development of anaphylactic shock
As a rule, the following activities are recommended:
At the first sign ( severe weakness cold sweat, nausea, cyanosis) stop the injection, leaving the needle in the vein. Along with other usual urgent measures It is necessary to ensure a low position of the head and torso and maintain patency of the airway.
Emergency medication measures (dosage recommendations are based on an adult patient with normal body weight; when treating children, the dosage should be reduced in proportion to body weight).
Immediate intravenous administration of epinephrine (adrenaline): after diluting 1 ml of a standard solution of adrenaline 1:1000 to 10 ml, first slowly inject 1 ml of the resulting solution (= 0.1 mg of adrenaline) under monitoring of heart rate, blood pressure and heart rate. If necessary, the administration of epinephrine can be continued by intravenous infusion. Simultaneously with the administration of epinephrine, intravenous administration of glucocorticosteroids (250-1000 mg of methylprednisolone or prednisolone) is administered, which can be repeated if necessary. In addition to these measures, intravenous infusion of plasma substitutes and/or electrolyte solutions is performed to replenish the volume of circulating blood.
If necessary: artificial respiration, oxygen inhalation, antihistamines.

Effect on 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 hazardous activities. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use antihypertensive drugs or alcohol.
In such cases, it is not recommended to drive vehicles or engage in potentially hazardous activities.

Information is current as of 2011 and is provided for informational purposes only. Please consult your doctor to choose a treatment regimen and be sure to first read the instructions for the drug.

Latin name: LASIX

Marketing authorization holder: AVENTIS PHARMA Ltd.

Instructions for use of the drug LASIX

LASIX - release form, composition and packaging

Pills white or almost white, round, with "DLI" engraving above and below the marks on one side.

Sodium chloride, sodium hydroxide, water d/i.

2 ml - dark glass ampoules with a breaking point (10) - contour plastic cell packaging (1) - cardboard packs.

pharmachologic effect

Lasix is a strong and fast-acting diuretic that is a sulfonamide derivative. Lasix blocks the transport system of Na + , K + , 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 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 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 in patients arterial hypertension increased).

After oral administration of 40 mg of Lasix, 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 into the gastrointestinal tract. Its Tmax (time to reach Cmax 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. V d 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 final 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 final T1/2 may increase to 24 hours.

In 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.

During hemodialysis and peritoneal dialysis and continuous outpatient peritoneal dialysis, furosemide is excreted insignificantly.

For liver failure T 1/2 of furosemide increases by 30-90% mainly due to an increase in V d. Pharmacokinetic parameters in this category of patients can vary greatly.

In heart failure, severe arterial hypertension and in the elderly, the excretion of furosemide slows down due to decreased renal function.

Dosage of the drug LASIX

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. Recommended maximum daily dose for adults is 1500 mg. U children The recommended dose for oral administration is 2 mg/kg body weight (but not more than 40 mg/day). The duration of treatment is determined by the doctor individually depending on the indications.

Edema syndrome in chronic heart failure

Edema syndrome in chronic renal failure

The natriuretic response to furosemide depends on several factors, including the severity of renal impairment and blood sodium levels, so the dose response 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 / day is possible).

The recommended starting dose is 40-80 mg/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 disturbances in electrolyte and acid-base status must be eliminated. It is recommended to switch the patient from IV Lasix to Lasix tablets as quickly as possible (the dose of Lasix tablets depends on the IV dose selected).

Edema in nephrotic syndrome

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 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/day is possible). The recommended starting dose is 20-80 mg/day.

Arterial hypertension

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

Drug interactions

Cardiac glycosides, drugs that cause prolongation of the QT interval - if electrolyte disturbances (hypokalemia or hypomagnesemia) develop while taking furosemide, the toxic effect of cardiac glycosides and drugs that cause prolongation of the QT interval increases (the risk of developing rhythm disturbances increases).

Glucocorticosteroids, carbenoxolone, licorice in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of developing hypokalemia.

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 unless it is necessary for health reasons, in which case an adjustment (reduction) of maintenance doses of aminoglycosides is required.

Medicines with nephrotoxic effects - when combined with furosemide, the risk of developing nephrotoxic effects increases.

High doses of some cephalosporins (especially those with a predominantly renal route of elimination) - in combination with furosemide, increase the risk of nephrotoxicity.

Cisplatin - when used simultaneously with furosemide, there is a risk of ototoxicity. In addition, in the case of co-administration of cisplatin and furosemide in doses above 40 mg (with normal renal function), the risk of developing the nephrotoxic effect of cisplatin increases.

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 enhance the toxic effects of salicylates.

Phenytoin - reduces the diuretic effect of furosemide.

Antihypertensive drugs, diuretics or other drugs that can lower blood pressure - when combined with furosemide, a more pronounced hypotensive effect is expected.

Angiotensin-converting enzyme (ACE) inhibitors - prescribing an ACE inhibitor to patients previously treated with furosemide can 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 with inhibitors ACEs or increasing their dose, it is recommended to discontinue furosemide or reduce its dose.

Probenicide, methotrexate or other drugs that, like furosemide, are secreted in the renal tubules, can reduce the effects of furosemide (the same route of renal secretion), on the other hand, furosemide can lead to a decrease in the renal excretion of these drugs.

Hypoglycemic agents, pressor amines (epinephrine, norepinephrine) - weakening of effects when combined with furosemide.

Theophylline, diazoxide, curare-like muscle relaxants - enhanced effects when combined with furosemide.

Lithium salts - under the influence of furosemide, the excretion of lithium decreases, thereby increasing the serum concentration of lithium and increasing the risk of developing the toxic effects of lithium, including its damaging effects on the heart and nervous system. Therefore, monitoring of serum lithium concentrations is required when using this combination.

Sucralfate - reduces the absorption of furosemide 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 increases due to hyperuricemia caused by furosemide and impairment of urate excretion by the kidneys by cyclosporine.

Radiocontrast agents - Patients at high risk of developing contrast agent nephropathy who received furosemide had a higher incidence of renal dysfunction compared with patients at high risk of developing contrast agent nephropathy who received only intravenous hydration before administration of radiocontrast agent.

Use of LASIX during pregnancy

Furosemide crosses the placental barrier, so it 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.

During breastfeeding, furosemide is contraindicated. Furosemide suppresses lactation.

Use in childhood

Contraindication: children under 3 years of age (solid dosage form).

LASIX - side effects

From the water-electrolyte and acid-base state

Hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis, which can develop in the form of either a gradual increase in electrolyte deficiency or massive loss of electrolytes over a very short time, for example, in the case of high doses of furosemide in patients with normal renal function. Symptoms indicating the development of electrolyte and acid-base imbalances may include headache, confusion, convulsions, tetany, muscle weakness, cardiac arrhythmias and dyspeptic disorders. Factors contributing to the development of electrolyte disturbances include underlying diseases (eg, cirrhosis of the liver or heart failure), concomitant medications, and poor nutrition. In particular, vomiting and diarrhea may increase the risk of hypokalemia. Hypovolemia (decrease in circulating blood volume) and dehydration (more often in elderly patients), which can lead to hemoconcentration with a tendency to develop thrombosis.

From the cardiovascular system

An excessive decrease in blood pressure, which, especially in elderly patients, may occur the following symptoms: impaired concentration and psychomotor reactions, headache, dizziness, drowsiness, weakness, visual disturbances, dry mouth, impaired orthostatic regulation of blood circulation; collapse.

Metabolism

Increased serum levels of cholesterol and triglycerides, transient increases in creatinine and urea levels in the blood, increased serum uric acid concentrations, which can cause or worsen the manifestations of gout. Decreased glucose tolerance (possible manifestation of latent diabetes mellitus).

From the urinary system

The appearance or intensification of symptoms caused by an existing obstruction to the outflow of urine, up to acute urinary retention with subsequent complications (for example, prostatic hypertrophy, narrowing of the urethra, hydronephrosis); hematuria, decreased potency.

From the gastrointestinal tract

Rarely - nausea, vomiting, diarrhea, constipation; isolated cases of intrahepatic cholestasis, increased levels of liver transaminases, acute pancreatitis.

From the central nervous system, hearing organ

IN in rare cases- hearing impairment, usually reversible, and/or tinnitus, especially in patients with renal failure or hypoproteinemia (nephrotic syndrome), rarely - paresthesia.

From the skin, allergic reactions

Rarely - allergic reactions: skin itching, urticaria, other types of rash or bullous skin lesions, erythema multiforme, exfoliative dermatitis, purpura, fever, vasculitis, interstitial nephritis, eosinophilia, photosensitivity. Extremely rare - severe anaphylactic or anaphylactoid reactions up to shock, which until now have been described only after intravenous administration.

From peripheral blood

Rarely - thrombocytopenia. In rare cases, leukopenia. In some cases, agranulocytosis, aplastic anemia or hemolytic anemia. Since some adverse reactions (such as changes in blood patterns, severe anaphylactic or anaphylactoid reactions, severe allergic skin reactions) under certain conditions can be life-threatening for patients, if any side effects occur, you should immediately report them to your doctor.

Special instructions when taking LASIX

Before starting treatment with Lasix, the presence of pronounced disturbances in the outflow of urine, including unilateral ones, should be excluded.

Patients with partial obstruction of urine outflow require careful monitoring, especially at the beginning of treatment with Lasix.

During treatment with Lasix, regular monitoring of serum sodium, potassium, and creatinine concentrations is usually required, and particularly close monitoring should be carried out in patients at high risk of developing fluid and electrolyte imbalance in cases of additional loss of fluid and electrolytes (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 and/or acid-base status, which may require short-term cessation of treatment with Lasix.

Registration numbers:

In this article you can read the instructions for use of the drug Lasix. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of the diuretic Lasix in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Lasix in the presence of existing structural analogues. Use for the treatment of edema syndrome and hypertensive crisis in adults, children, as well as during pregnancy and lactation.

Lasix- a strong and fast-acting diuretic, which is a sulfonamide derivative. Lasix blocks the transport system of Na+, K+, 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 mechanism of anion transport). 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.

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.

Compound

Furosemide + excipients.

Pharmacokinetics

Furosemide is rapidly absorbed into the gastrointestinal tract. 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. 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. 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.

In renal failure, the elimination of furosemide slows down and the half-life increases.

During hemodialysis and peritoneal dialysis and continuous outpatient peritoneal dialysis, furosemide is excreted insignificantly.

In heart failure, severe arterial hypertension and in the elderly, the excretion of furosemide slows down due to decreased renal function.

Indications

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);
cerebral edema;
hypertensive crisis;
arterial hypertension;
maintaining forced diuresis in case of poisoning with chemical compounds excreted unchanged by the kidneys.

Release forms

Tablets 40 mg.

Solution for intravenous and intramuscular administration (injections in injection ampoules).

Instructions for use and dosage

When prescribing Lasix, it is recommended to use the smallest doses sufficient to achieve the required therapeutic effect. The tablets should be taken on an empty stomach, without chewing and with sufficient liquid. The ampoule form of the drug is administered intravenously and, in 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 it is necessary to obtain the fastest possible effect. When using intravenous Lasix, it is always recommended that the patient be switched 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 a continuous intravenous infusion is not possible after one or more intravenous boluses in an acute setting, administering low doses with short intervals between administrations (approximately 4 hours) is preferable to administering higher-dose intravenous boluses with long intervals between administrations. introductions.

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.

Edema syndrome in chronic heart failure

Edema syndrome in acute heart failure

Edema syndrome in chronic renal failure

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.

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 Lasix to 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 in nephrotic syndrome

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.

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.

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, higher doses of Lasix may be required.

Side effect

hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis;
headache;
confusion;
convulsions;
muscle weakness;
heart rhythm disturbances;
dyspeptic disorders;
excessive decrease in blood pressure;
impaired concentration and psychomotor reactions;
headache;
dizziness;
drowsiness;
weakness;
dry mouth;
collapse;
increased serum levels of cholesterol and triglycerides;
decreased glucose tolerance (possible manifestation of latent diabetes mellitus);
hematuria;
decreased potency;
nausea, vomiting;
diarrhea;
constipation;
hearing impairment, usually reversible;
tinnitus, especially in patients with renal failure or hypoproteinemia (nephrotic syndrome);
allergic reactions: skin itching, urticaria, other types of rash or bullous skin lesions, erythema multiforme, exfoliative dermatitis, purpura, fever, vasculitis, interstitial nephritis, eosinophilia, photosensitivity;
thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia or hemolytic anemia.

Contraindications

renal failure with anuria (in the absence of response to furosemide);
hepatic coma and precoma;
severe hypokalemia;
severe hyponatremia;
hypovolemia (with or without arterial hypotension) or dehydration;
pronounced disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract);
digitalis intoxication;
acute glomerulonephritis;
decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy;
increased central venous pressure (over 10 mm Hg);
hyperuricemia;
children under 3 years of age (solid dosage form);
pregnancy;
breastfeeding period.
hypersensitivity to the active substance or to any of the components of the drug; Patients allergic to sulfonamides (sulfonamide antimicrobials or sulfonylureas) may have cross allergy to furosemide.

Use during pregnancy and breastfeeding

Lasix crosses the placental barrier, so it 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

Before starting treatment with Lasix, the presence of pronounced disturbances in the outflow of urine, including unilateral ones, should be excluded.

Patients with partial obstruction of urine outflow require careful monitoring, especially at the beginning of treatment with Lasix.

When treating with Lasix, it is always advisable to eat foods 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.

In everyday life, there are incorrect statements about the use of Lasix as a means of losing weight. This approach cannot be scientific and correct, since the effect of using this drug to reduce excess weight will be short-term (while the medication is being taken), after which the lost weight will be regained.

Some side effects (for example, a significant decrease in blood pressure and accompanying symptoms) may impair the ability to concentrate and reduce psychomotor reactions, which can be dangerous when driving or operating machinery. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use of antihypertensive drugs or ethanol (alcohol).

Drug interactions

Cardiac glycosides, drugs that cause prolongation of the QT interval in the case of development of electrolyte disturbances (hypokalemia or hypomagnesemia) while taking furosemide, the toxic effect of cardiac glycosides and drugs that cause prolongation of the QT interval increases (the risk of developing rhythm disturbances increases).

Glucocorticosteroids, carbenoxolone, licorice 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 Lasix, the risk of developing nephrotoxic effects increases.

High doses of some cephalosporins (especially those with a predominantly renal route of elimination) - in combination with furosemide, increase the risk of nephrotoxicity.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid, may reduce the diuretic effect of Lasix. In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may enhance the toxic effects of salicylates.

Phenytoin - reduces the diuretic effect of Lasix.

Antihypertensive drugs, diuretics or other drugs that can lower blood pressure - when combined with furosemide, a more pronounced hypotensive effect is expected.

Hypoglycemic agents, pressor amines (epinephrine, norepinephrine) - weakening of effects when combined with Lasix.

Theophylline, diazoxide, curare-like muscle relaxants - enhanced effects when combined with furosemide.

Sucralfate - reduces the absorption of furosemide and weakens its effect (furosemide and sucralfate should be taken at least two hours apart).

Cyclosporine A - when combined with Lasix, the risk of developing gouty arthritis increases due to hyperuricemia caused by furosemide and impairment of urate excretion by the kidneys by cyclosporine.

Analogues of the drug Lasix

Structural analogues according to active substance:

Furon;
Furosemide;
Fursemid.

Analogues pharmacological group(diuretics):

Aquaphor;
Acripamide;
Acripamide retard;
Akuter Sanovel;
Aldactone;
Arindap;
Arifon;
Brinaldix;
Brusniver;
Bufenox;
Verospilactone;
Veroshpiron;
Hygroton;
Hydrochlorothiazide;
Hypothiazide;
Diacarb;
Diuver;
Isobar;
Indap;
Indapamide;
Indapres;
Ionic;
Canephron H;
Klopamide;
Kristepin;
Lespenefril;
Lespeflan;
Lespefril;
Lorvas;
Mannitol;
Mannitol;
Urea;
Nebilong N;
Normatens;
Oxodoline;
Spironol;
Spironolactone;
Torasemide;
Triamtel;
Urakton;
Urological (diuretic) collection;
Phytolysin;
Cimalon.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

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 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 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 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 an allergy 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 damage to the urinary tract.
- Intoxication with cardiac glycosides.
- Acute glomerulonephritis.
- Decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy.
- Increased central venous pressure (over 10 mm Hg).
- Childhood up to 3 years (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 manifest 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 of the 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

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 disturbances in water-electrolyte balance and/or acid-base status must be eliminated. 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 (AR/AEs) was obtained from literature data and clinical studies. 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 according to the CIOMS (Council of International Organizations of Medical Sciences) classification are used:
very common ≥ 10%;
frequent ≥1% and< 10%;
uncommon ≥ 0.1% and< 1 %;
rare ≥ 0.01% and< 0,1 %;
very rare< 0,01 %,
unknown frequency (it is not possible to determine the frequency of occurrence of an adverse reaction based on the available data).
Metabolic and nutritional disorders
Very frequent
- Disturbances of water and electrolyte balance, including those occurring with clinical symptoms. Symptoms indicating the development of water and electrolyte imbalances 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; improper 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 improper and/or long-term use of furosemide.
Vascular disorders
Very frequent
- Decreased 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 blood count, severe anaphylactic or anaphylactoid reactions, severe allergic skin reactions) under certain conditions can be life-threatening for patients, if any side effects occur, you should 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 therapeutic measures may be required.
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 activated charcoal orally.
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 within a 24-hour period after administration of chloral hydrate can lead to skin flushing, 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 simultaneously with Lasix® only for strict medical indications, since 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 of 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 may lead to a decrease in the renal excretion of these drugs. 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 increases due to hyperuricemia and impaired urate excretion by the kidneys.
- Radiocontrast agents - in patients with a high risk of developing nephropathy on the introduction of radiocontrast agents who received furosemide, a higher incidence of renal dysfunction was observed compared with patients with a high risk of developing nephropathy on the introduction of radiocontrast agents who received only intravenous fluid supplementation (hydration) before administering a radiocontrast agent.

special instructions

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 hazardous activities. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use of antihypertensive drugs or alcohol.
In such cases, it is not recommended to drive vehicles or engage in potentially hazardous activities.

Lasix is a diuretic created on the basis of the well-known furosemide, which is what cardiologists and nephrologists prescribe more often than other similar drugs. Why Lasix is more popular and how to use it will be discussed in detail in this article.

Lasix is a drug with quick action and powerful effect. It is used in various areas medicine, beneficial properties and low cost make it very popular.

Drug group

The active substance of Lasix is a sulfonamide derivative and belongs to the group of loop diuretics. The INN of the drug is Furosemide, similar to the active substance.

Lasix is used in cardiac practice to treat edema caused by decreased cardiac function, such as heart failure. Also in other areas of medicine, Lasix is used to remove excess fluid, but it is prescribed mainly in severe cases– cerebral edema, malignant hypertension, liver cirrhosis, kidney dysfunction. Some patients use the drug for other purposes – for rapid decline weight.

Release forms and prices

The most popular form of Lasix is tablets for oral administration, but the manufacturing company also offers ampoules of solution for intravenous and intramuscular administration. The estimated cost is presented in the table (Table 1).

Table 1 - Cost of Lasix

When buying a solution, you should remember that it should only be administered by a physician, since there are specifics of administration and there is increased risk development of side effects.

Composition and pharmacological properties

The active ingredient - furosemide - contains 40 mg in each tablet and 20 mg in each ampoule. Additionally, the tablets contain: magnesium stearate, talc, colloidal silicon dioxide, lactose and starch. The solution contains only three auxiliary substances - water, sodium chloride and sodium hydroxide.

The mechanism of action of Lasix is based on its ability to inhibit the reabsorption of sodium and chloride in the ascending limb of the loop of Henle. As a result, large amounts of sodium and fluid are excreted from the body and the excretion of potassium in the renal tubule increases. The amount of magnesium and calcium released from the body also increases.

The drug affects the release of renal mediators and acts on renal blood flow. Relieves increased stress on the heart and pulmonary vessels, thanks to the ability to expand large veins.

The hypotonic effect is achieved by reducing the total volume of circulating blood, removing sodium and reducing the vascular response to vasoconstrictor effects.

The effect of the medicine occurs very quickly - 15 minutes after the injection and 30-60 minutes after taking the tablets. The duration of the diuretic effect is from 3 to 5 hours, but if the functional activity of the kidneys decreases, the effect can last up to 8 hours. It is excreted mainly in the urine, with a half-life of about an hour, but can increase in case of liver and kidney diseases to 12-20 hours.

Indications and contraindications

The main purpose of Lasix is to eliminate swelling of various origins, so we can highlight the main indications for use:

Severe deficiency of sodium, potassium, magnesium, chlorine and calcium.
Anuria with renal failure.
Acute glomerulonephritis.
Stenosis and obstruction of the urinary tract.
Movement of stones through the urinary tract.
Precomatose and comatose states, including hepatic and diabetic coma.
Mitral stenosis and aortic valve, coronary and cerebral vessels.
Hypertrophic obstructive cardiomyopathy.
Hypotension.
Acute myocardial infarction.
Individual intolerance.

In such conditions, it is necessary to regularly visit a doctor and monitor the amount of electrolytes. It is not advisable to take the medication during pregnancy and lactation, therefore in these cases, Lasix is prescribed only for strict indications.

Instructions for use

Taking tablets and administering the solution must be carried out strictly according to the instructions, which indicate dosages and other features of use.

Tablets 40 mg

Depending on the disease and general condition of the patient, the dosage is selected individually. But doctors recommend starting treatment with minimal doses, and increasing them during the treatment process, and when the condition improves, lowering them to a therapeutically effective dosage.

Adult patients are recommended to start treatment with ½ tablet, that is, 20 mg per day. But in severe cases, the initial dosage may be 80 mg. By monitoring the dynamics, the doctor can increase the daily dose, up to 600 mg in extreme cases, up to 1500 mg. For children, the dosage is selected based on body weight - 1-2 mg/kg per day. The maximum dose cannot exceed 6 mg/kg.

Injections

Lasix in ampoules is prescribed when a quick effect is required or the patient is unable to take pills. The recommended method of administration is intravenous, but if such administration is not possible, intramuscular injections are given.

Administration should be carried out slowly - 4 mg/min., and in case of kidney pathology no faster than 2.5 mg/min. If it is impossible to carry out constant infusions, then the drug is administered in small doses, but at short intervals.

The recommended therapeutic dose is 20-80 mg. If it is necessary to increase the dosage, the daily amount of medication is divided into 2-3 administrations. The maximum daily dose for adults is 1500 mg per day. Children are administered 1 mg/kg body weight, but not more than 20 mg per day.

To relieve swelling in acute heart failure, nephrotic syndrome, cerebral edema, hypertensive crisis and liver diseases, the initial daily dose is 20-40 mg per day. The dosage is adjusted depending on the severity of the therapeutic effect.

Also, 20-40 mg of solution is administered after droppers with electrolyte solutions to patients with intoxication. Electrolyte levels must be regularly monitored.

In case of chronic renal failure and being on hemodialysis, 250-1500 mg can be administered per day. First, start with the introduction of 0.1 mg/min., Then the speed is increased, monitoring the patient’s condition.

Intramuscular administration is very rarely used, so the dosage is selected very carefully - 4-5 mg/kg body weight. This method of administration can only be used in a hospital setting.

Duration of treatment

The duration of treatment with Lasix is determined individually, depending on the patient’s condition. Usually the course of treatment is at least a week and lasts until a lasting result occurs. After using cupping solution acute conditions, I prescribe pills, often as part of a complex treatment.

Be sure to regularly monitor daily diuresis and water-electrolyte balance.

Some features of therapy

You need to know the specifics of using Lasix, especially if it is used to treat conditions not listed in the instructions.

During pregnancy

Lasix is completely contraindicated in pregnant women; doctors usually select safer diuretics. Lasix penetrates the fetoplacental barrier and can cause Negative consequences for the fetus. But, at the same time, experts say that the use of the drug in small doses does not cause harm, but, on the contrary, improves the mother’s condition and reduces the risk of complications (for example, with arterial hypertension or severe swelling).

But in life-threatening cases, its use becomes a necessity. In this case, the drug is prescribed in minimal dosages and very short period time. When prescribing Lasix, a pregnant woman must be constantly under the supervision of a doctor, that is, she must be hospitalized for the entire period of treatment.

The use of Lasix in solution form is recommended - observed quick effect and the drug is eliminated from the body faster. In any case, it can only be prescribed by the attending physician, who has weighed the benefits of treatment and all the possible risks.

During eye surgery

In some cases after surgical interventions swelling forms in the eyes. In most cases, this is considered normal, and the swelling subsides after a week. But sometimes there is no improvement, and in this case it is necessary to find out what caused the swelling - the development of complications, increased intraocular pressure or exacerbation of concomitant diseases.

The use of Lasix is possible only if there are strict indications, since the removal of fluid can provoke increased blood viscosity and deterioration of the condition during the rehabilitation period. The use of diuretics before surgery is not recommended, as the electrolyte composition of the blood may be disrupted.

With high blood pressure

Removal excess liquid from the body has a beneficial effect on the entire body as a whole, but in addition, Lasix has an antihypertensive effect by reducing the volume of circulating blood. The pressure on blood vessels is reduced, blood circulation is improved and the general condition is normalized. In addition, Lasix reduces the response of blood vessels to vasoconstrictive processes.

Lasix is used for chronic arterial hypertension and relief hypertensive crises. Taking the drug can be a course or one-time, depending on the severity of the condition and the body’s response to the drug.

The dosage is determined by the attending physician - for some patients it is enough to take 1 tablet, while others need a maximum dose of 1500 mg. That is why self-medication is unacceptable - exceeding the dosage can provoke a sharp decrease in pressure, up to a hypotensive crisis.

Application for weight loss

The opinion is becoming increasingly popular that diuretics, including Lasix, help to lose weight. excess weight. You need to understand how it affects the body and why weight loss occurs.

Dosages and effects

Many patients note that taking Lasix causes by-effect in the form of weight loss. This is why the idea arises, especially among women, that the drug can be used for weight loss.

But you should understand an important thing - Lasix reduces weight only by removing excess fluid from the body, but it does not affect fat deposits.

The drug helps eliminate swelling and lose weight, which is especially useful for patients with heart and vascular diseases. But it gives only temporary results - after stopping the course and if the diet is not followed, the weight will very quickly return to its original levels.

It is recommended to use Lasix to prepare the body for weight loss, but at the same time switch to proper nutrition and start exercising physical exercise. It is enough to take the drug in small dosages - 20-80 mg per day, divided into 2 doses.

But the use of the drug is possible only as prescribed by a doctor - if there are contraindications, then even short-term use can lead to negative consequences.

Water-electrolyte imbalance is the most common and dangerous complication from taking diuretics. Such a malfunction in the body can lead to undesirable complications - cardiac dysfunction, hypotension, muscle pain, paresis, lethargy, intestinal obstruction and others. Critical decline amount of circulating blood can lead to malnutrition internal organs and as a consequence collapse, loss of consciousness and even coma.

Reviews from patients who took the product

Many patients are happy sharp decline weight while taking Lasix, but most experts have an extremely negative attitude towards this method and advise traditional methods weight loss - diet and exercise.

Patient reviews:

Irina: “After giving birth I couldn’t lose weight, and a friend advised me to take Lasix. I should have listened in vain - for the first 10 days I was happy with the kilograms I had lost, but then I fainted and only woke up in the hospital with severe dehydration. I still have problems with my pancreas. I don’t recommend it to anyone.”

Alexander: “I go in for sports, but before the competition I needed to lose 2 kg, I started taking Lasix and after a few days I was back to normal. But you need to take it together with potassium supplements to avoid complications.”

Maria: “I took Lasix for blood pressure and noticed that they help me lose weight. This makes me happy, but I wouldn’t take it just for weight loss – there’s a huge list of side effects.”

Possible side effects

The instructions for Lasix state that the drug can cause side effects from various organs and systems of the body.

General Negative Reactions

Lasix can cause negative reactions in the form of skin and allergic reactions. The most common of them are urticaria, skin rash, purpura, dermatitis and eczema. Complications such as vasculitis, photosensitivity, bullous lesions and anaphylactic shock occur less frequently.

The drug can disrupt the functioning of the heart and blood vessels. So, the following may occur:

Critical decrease in pressure.
Orthostatic hypotension.
Collapse.
Tachycardia.
Arrhythmia.
Decreased amount of circulating blood.

The nervous system also suffers, in particular, the following develop:

Headaches and dizziness.
Myasthenia.
Muscle cramps.
Paresthesia.
Weakness, drowsiness.
Confusion.

From the urinary organs, hematuria, impaired potency, acute urinary retention, interstitial nephritis, and oliguria are observed.

The drug can cause a deficiency of potassium, magnesium, sodium, chlorine, leading to metabolic acidosis, hyperglycemia and hyperuricemia.

Other consequences:

Dry mouth, thirst.
Visual and hearing impairments.
Decreased appetite.
Stool disorders.
Cholestatic jaundice.
Pancreatitis.
Kidney calcification (in children).

Symptoms of overdose depend on the degree of water-electrolyte imbalance. An overdose may result in cardiac rhythm and conduction disturbances, delusional states, paralysis, acute renal failure and confusion. In such conditions, therapy aimed at restoring water and electrolyte balance is necessary.

Alcohol compatibility

Lasix is not compatible with alcoholic beverages, as this combination leads to an enhanced effect of the drug and an increased risk of side effects. If you take the pill and drink alcohol, you may develop irreversible consequences for the kidneys, heart or liver.

Upon admission large quantity drug and alcohol, life-threatening overdose symptoms are observed.

In case of withdrawal syndrome, when alcohol has already been eliminated from the body, Lasix can be used to improve the condition. But such a reception should be accompanied by drinking large amounts of fluid and constant supervision by specialists.

Analogs

Lasix is very popular among loop diuretics, but in some situations it can be replaced with safer drugs.

Structural

A structural analogue of Lasix is. This is completely similar drug, no different from the original. The only thing that distinguishes these two products is the manufacturer and the price. The cost of the tablets is about 20 rubles, which is slightly lower than the cost of Lasix, but the price of the solution, depending on the manufacturer, is from 35 to 80 rubles.

Other structural analogues and average price:

There are other structural analogues, but Furosemide is the most popular, cheapest and can be found in any pharmacy.

Drugs with similar effects

Other diuretics are included in different subgroups of diuretics and have different indications and costs. The main analogs for action are presented in the table (Table 2).

Among these drugs, it is worth highlighting drugs created on the basis of torasemide - this is a highly effective diuretic substance, but has a milder effect compared to Lasix. Also, drugs with prolonged action have been created based on torasemide, allowing you to take just one tablet per day. but such drugs should not be taken in childhood.

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Pharmacological properties

Indications for use

Contraindications

Pregnancy and breastfeeding period

Directions for use and doses

Side effect

Overdose

Interaction with other drugs

special instructions

LASIX - release form, composition and packaging

pharmachologic effect

Pharmacokinetics

Dosage of the drug LASIX

Drug interactions

Use of LASIX during pregnancy

Use in childhood

LASIX - side effects

Special instructions when taking LASIX

Pharmacological properties

Indications for use

Contraindications

Carefully

Pregnancy and breastfeeding period

Directions for use and doses

Side effect

Overdose

Interaction with other drugs

special instructions

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

Drug group

Release forms and prices

Composition and pharmacological properties

Indications and contraindications

Instructions for use

Tablets 40 mg

Injections

Duration of treatment

Some features of therapy

During pregnancy

During eye surgery

With high blood pressure

Application for weight loss

Dosages and effects

Reviews from patients who took the product

Possible side effects

General Negative Reactions

Alcohol compatibility

Analogs

Structural

Drugs with similar effects

Random articles

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