Furosemide 20mg Tablets

Furosemide is a loop diuretic that inhibits the Na+-K+-2Cl- cotransporter (NKCC2) in the thick ascending limb of the loop of Henle. This inhibition prevents the reabsorption of sodium, potassium, and chloride, leading to increased excretion of water, sodium, chloride, and potassium. It also has a direct vasodilatory effect on renal vasculature, increasing renal blood flow.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of fluid and electrolyte problems: mood changes, confusion, muscle pain or weakness, fast or abnormal heartbeat, severe dizziness or fainting, increased thirst, seizures, feeling extremely tired or weak, decreased appetite, inability to urinate or changes in urine output, dry mouth, dry eyes, or severe nausea or vomiting.
Signs of liver problems: dark urine, fatigue, decreased appetite, nausea or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or significant weight gain.
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe nausea or vomiting.
Severe dizziness or fainting.
Abnormal sensations such as burning, numbness, or tingling.
Blurred vision.
Restlessness.

Severe Skin Reactions

This medication can cause severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions. These reactions can affect other organs and be life-threatening. Seek immediate medical help if you experience:

Red, swollen, blistered, or peeling skin.
Red or irritated eyes.
Sores in your mouth, throat, nose, eyes, genitals, or skin.
Fever.
Chills.
Body aches.
Shortness of breath.
Swollen glands.

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:

Dizziness or headache.
Constipation, diarrhea, nausea, vomiting, or decreased appetite.
Stomach cramps.

Reporting Side Effects

This list is not exhaustive. If you have questions about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following conditions to ensure safe treatment:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reactions you experienced, including the symptoms.
If you have difficulty urinating.
If you are dehydrated or have electrolyte imbalances.
Certain health conditions, including liver problems or low blood pressure.

Additionally, tell your doctor if you are taking any of the following medications:
Chloral hydrate
Ethacrynic acid
* Lithium

Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. This will help determine if it is safe to take this medication with your existing treatments and health conditions.

Remember, do not start, stop, or change the dosage of any medication without first consulting your doctor to ensure your safety.

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and be cautious when climbing stairs.

Managing Diabetes
If you have diabetes, closely monitor your blood sugar levels. Be aware of signs of high blood sugar, such as confusion, drowsiness, increased thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath. Report these symptoms to your doctor.

Dietary Considerations
If you follow a low-sodium or salt-free diet, consult your doctor. Additionally, if you have high blood pressure, discuss with your doctor before taking over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.

Monitoring Your Condition
Regularly check your blood pressure as directed by your doctor. Also, have your blood work checked as scheduled by your doctor and discuss the results with them.

Potential Side Effects
This medication may cause increased cholesterol and triglyceride levels. If you have high cholesterol or triglycerides, consult your doctor. You may also require additional potassium supplements; discuss this with your doctor.

Interactions with Other Substances
Before using alcohol, marijuana, or other forms of cannabis, or taking prescription or OTC medications that may cause drowsiness, consult your doctor.

Sun Sensitivity
This medication may increase your risk of sunburn. Take precautions when exposed to the sun, and inform your doctor if you experience easy sunburning while taking this medication.

Other Potential Risks
Be aware of the potential for gout attacks. If you have lupus, this medication may exacerbate your condition; report any new or worsening symptoms to your doctor promptly.

Hearing and Blood Cell Problems
Hearing problems, such as decreased hearing or hearing loss, may occur with this medication. Sometimes these issues may resolve on their own, but in some cases, they may be permanent. If you experience ringing in the ears, changes in your hearing, or a feeling of fullness in your ears, contact your doctor immediately. Additionally, this medication may cause low blood cell counts, which can lead to bleeding problems, infections, or anemia. Seek medical attention if you have signs of infection, such as fever, chills, or sore throat; unexplained bruising or bleeding; or if you feel extremely tired or weak.

Special Considerations
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.

Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Your doctor will discuss the benefits and risks of this medication with you and help you make an informed decision.

• Aminoglycoside antibiotics (e.g., gentamicin, tobramycin): Increased risk of ototoxicity.
• Ethacrynic acid: Increased risk of ototoxicity.
• Chloral hydrate: Flushing, sweating, blood pressure changes (rare, but severe).
• Lithium: Decreased renal clearance of lithium, leading to increased lithium levels and toxicity.
• NSAIDs (e.g., ibuprofen, naproxen): May reduce diuretic and antihypertensive effects of furosemide; increased risk of renal dysfunction.
• Cisplatin: Increased risk of ototoxicity and nephrotoxicity.
• Digoxin: Increased risk of digoxin toxicity due to hypokalemia.

• ACE inhibitors/ARBs: Increased risk of hypotension and renal dysfunction, especially with initial doses.
• Corticosteroids: Increased risk of hypokalemia.
• Amphotericin B: Increased risk of hypokalemia.
• Sucralfate: May reduce furosemide absorption (separate administration by 2 hours).
• Phenytoin: May reduce diuretic effect of furosemide.
• Probenecid: May reduce diuretic effect of furosemide.
• Salicylates (high dose): Increased risk of salicylate toxicity due to competitive renal excretion.
• Antidiabetic agents: May decrease the hypoglycemic effect of antidiabetic drugs.

• Muscle relaxants (non-depolarizing): May enhance neuromuscular blockade.
• Theophylline: May alter furosemide excretion.

• Dizziness or lightheadedness (orthostatic hypotension)
• Muscle cramps or weakness (electrolyte imbalance, especially hypokalemia/hypomagnesemia)
• Excessive thirst or dry mouth (dehydration)
• Nausea, vomiting, or loss of appetite (electrolyte imbalance)
• Hearing changes or ringing in ears (ototoxicity, especially with high doses or rapid IV infusion)
• Gout symptoms (increased uric acid)
• Skin rash or photosensitivity

Furosemide is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It has been shown to cause fetal abnormalities in animal studies at high doses. It can also reduce plasma volume, which may compromise placental perfusion.

Furosemide is excreted into breast milk. It can suppress lactation. Use with caution in breastfeeding mothers. Monitor the infant for dehydration and electrolyte disturbances.

Use with caution. Dosing is weight-based. Neonates and infants may be more susceptible to adverse effects, including ototoxicity and electrolyte imbalances. Close monitoring of fluid and electrolytes is essential.

Elderly patients may be more susceptible to the hypotensive and electrolyte-depleting effects of furosemide. They may also have age-related decreases in renal function, requiring careful dose titration and close monitoring for dehydration, electrolyte imbalances, and renal impairment. Start with lower doses and titrate slowly.

• Furosemide is a potent diuretic; careful monitoring of fluid status, electrolytes (especially potassium), and renal function is crucial.
• Administer oral doses in the morning to avoid nocturia (nighttime urination). If a second dose is needed, give it in the late afternoon.
• Patients on furosemide often require potassium supplementation or a potassium-sparing diuretic to prevent hypokalemia.
• Rapid IV administration or very high doses can lead to transient or permanent ototoxicity, especially in patients with renal impairment or those receiving other ototoxic drugs.
• Furosemide can cause photosensitivity; advise patients to use sun protection.
• Monitor for signs of dehydration (e.g., excessive thirst, dry mouth, decreased urine output, dizziness).

• Other loop diuretics (e.g., torsemide, bumetanide)
• Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) - less potent, different site of action
• Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) - weaker diuretics, often used in combination
• Aldosterone antagonists (e.g., spironolactone, eplerenone) - for heart failure with reduced ejection fraction
• Vasodilators (e.g., nitrates, hydralazine) - for fluid overload in specific conditions
• SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) - for heart failure and CKD, with diuretic effects

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.