Furosemide 40mg/4ml Inj 4ml
WARNING: This drug is a strong fluid-lowering drug (diuretic). Sometimes too much water and electrolytes (like potassium) in the blood may be lost. This can lead to severe health problems. Your doctor will follow you closely to change the dose to match your body's needs. @ COMMON USES: It is used to get rid of extra fluid.
Drug Class
Diuretic
Pharmacologic Class
Loop Diuretic
Pregnancy Category
Category C
FDA Approved
Jun 1966
DEA Schedule
Not Controlled
Overview
What is this medicine?
Furosemide is a 'water pill' (diuretic) that helps your body get rid of extra salt and water. It's used to treat swelling (edema) caused by heart failure, kidney disease, or liver disease, and also high blood pressure. It works by making your kidneys remove more fluid from your blood.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Take this medication exactly as directed, and adhere to all guidelines provided. This medication is administered via injection into a muscle or vein.
For storage and disposal, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to keep this medication at home.
If you miss a dose, contact your doctor promptly to receive guidance on the appropriate course of action.
For storage and disposal, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to keep this medication at home.
If you miss a dose, contact your doctor promptly to receive guidance on the appropriate course of action.
Lifestyle & Tips
- Follow your doctor's instructions regarding fluid intake and diet, especially potassium intake.
- Weigh yourself daily at the same time, wearing similar clothing, and report significant changes to your doctor.
- Avoid sudden changes in position (e.g., standing up quickly) to prevent dizziness.
- Limit alcohol consumption, as it can increase dizziness and dehydration.
- Avoid excessive heat exposure and strenuous exercise, which can lead to dehydration.
Available Forms & Alternatives
Available Strengths:
- Furosemide 10mg/ml Oral Soln 60ml
- Furosemide 10mg/ml Oral Soln 120ml
- Furosemide 8mg/ml Solution
- Furosemide 10mg/ml Inj, 10ml
- Furosemide 10mg/ml Inj 4ml
- Furosemide 40mg Tablets
- Furosemide 80mg Tablets
- Furosemide 20mg Tablets
- Furosemide 80mg Tablets
- Furosemide 20mg Tablets
- Furosemide 40mg Tablets
- Furosemide 40mg/4ml Inj 4ml
- Furosemide 10mg/ml Inj 2ml
- Furosemide 40mg/4ml Inj 4ml
- Furosemide 10mg/ml Inj, 10ml
- Furosemide 10mg/ml Inj, 4ml
Dosing & Administration
Adult Dosing
Standard Dose:
Edema: 20-40 mg IV/IM once, may repeat in 1-2 hours. Acute Pulmonary Edema: 40 mg IV over 1-2 min, then 80 mg IV if needed 1 hour later.
Dose Range:
20 - 200 mg
Condition-Specific Dosing:
severeEdema:
Up to 200 mg IV/IM per dose, administered slowly.
hypertensiveCrisis:
40-80 mg IV, often in combination with other agents.
Pediatric Dosing
Neonatal:
0.5-1 mg/kg IV/IM every 12-24 hours. Max 2 mg/kg/dose.
Infant:
1 mg/kg IV/IM once, then 1 mg/kg every 6-12 hours. Max 6 mg/kg/dose.
Child:
1 mg/kg IV/IM once, then 1 mg/kg every 6-12 hours. Max 6 mg/kg/dose.
Adolescent:
1 mg/kg IV/IM once, then 1 mg/kg every 6-12 hours. Max 6 mg/kg/dose (or adult dose if appropriate).
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment, monitor closely.
Moderate:
No specific adjustment, monitor closely; higher doses may be required.
Severe:
Higher doses may be required (e.g., 80-200 mg IV). Monitor closely for ototoxicity.
Dialysis:
Administer after dialysis. Furosemide is not significantly removed by dialysis. Monitor fluid status and electrolytes.
Hepatic Impairment:
Mild:
No specific adjustment.
Moderate:
Use with caution; reduced doses may be necessary due to increased risk of electrolyte imbalance and hepatic encephalopathy.
Severe:
Contraindicated in hepatic coma or severe electrolyte depletion until condition is improved. Use with extreme caution, reduced doses.
Pharmacology
Mechanism of Action
Furosemide is a loop diuretic that inhibits the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle, leading to increased excretion of sodium, chloride, and water. It also causes vasodilation, which contributes to its antihypertensive effect.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
Immediate (IV)
FoodEffect:
Not applicable for IV administration
Distribution:
Vd:
0.1-0.2 L/kg
ProteinBinding:
91-99%
CnssPenetration:
Limited
Elimination:
HalfLife:
0.5-2 hours (IV)
Clearance:
Not available (primarily renal excretion)
ExcretionRoute:
Renal (primarily unchanged drug)
Unchanged:
60-90% (renal)
Pharmacodynamics
OnsetOfAction:
Within 5 minutes (IV)
PeakEffect:
20-60 minutes (IV)
DurationOfAction:
Approximately 2 hours (IV)
Safety & Warnings
BLACK BOX WARNING
Furosemide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and the dose must be adjusted to the individual patient's needs.
Side Effects
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, irregular or rapid 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 and vomiting.
Signs of liver problems: dark urine, fatigue, decreased appetite, nausea or stomach pain, pale-colored stools, vomiting, or yellowing of the skin and eyes.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or sudden weight gain.
Signs of pancreatitis (pancreas problems): severe stomach pain, severe back pain, or severe nausea and vomiting.
Severe dizziness or fainting.
Abnormal sensations such as burning, numbness, or tingling.
Blurred vision.
Restlessness.
Severe Skin Reactions
This medication may cause severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions. These reactions can be life-threatening and may also affect internal organs. Seek immediate medical help if you experience:
Red, swollen, blistered, or peeling skin
Red or irritated eyes
Sores in the 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 may 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 concern you, contact your doctor:
Dizziness or headache
Constipation, diarrhea, nausea, vomiting, or decreased appetite
Stomach cramps
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns 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.
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, irregular or rapid 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 and vomiting.
Signs of liver problems: dark urine, fatigue, decreased appetite, nausea or stomach pain, pale-colored stools, vomiting, or yellowing of the skin and eyes.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or sudden weight gain.
Signs of pancreatitis (pancreas problems): severe stomach pain, severe back pain, or severe nausea and vomiting.
Severe dizziness or fainting.
Abnormal sensations such as burning, numbness, or tingling.
Blurred vision.
Restlessness.
Severe Skin Reactions
This medication may cause severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions. These reactions can be life-threatening and may also affect internal organs. Seek immediate medical help if you experience:
Red, swollen, blistered, or peeling skin
Red or irritated eyes
Sores in the 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 may 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 concern you, contact your doctor:
Dizziness or headache
Constipation, diarrhea, nausea, vomiting, or decreased appetite
Stomach cramps
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns 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.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Extreme thirst or dry mouth
- Muscle cramps or weakness
- Unusual tiredness or confusion
- Irregular heartbeat
- Significant decrease in urine output
- Ringing in the ears or hearing loss
Before Using This Medicine
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 reaction you experienced, including the symptoms that occurred.
If you have difficulty urinating or are unable to pass urine.
If you are dehydrated or have electrolyte imbalances.
If you have a history of liver problems or low blood pressure.
* If you are currently taking any of the following medications: chloral hydrate, ethacrynic acid, or lithium.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to assess potential interactions and ensure it is safe for you to take this medication with your other treatments. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
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 reaction you experienced, including the symptoms that occurred.
If you have difficulty urinating or are unable to pass urine.
If you are dehydrated or have electrolyte imbalances.
If you have a history of liver problems or low blood pressure.
* If you are currently taking any of the following medications: chloral hydrate, ethacrynic acid, or lithium.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to assess potential interactions and ensure it is safe for you to take this medication with your other treatments. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
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
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. 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 and are taking this medication, discuss with your doctor before using 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 recommended by your doctor and discuss the results with them.
Potential Side Effects
Be aware that 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 prescription and OTC medications that may impair your actions, 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 increased sun sensitivity.
Other Potential Risks
Be aware of the potential for gout attacks. If you have lupus, this medication may exacerbate your condition or trigger a flare-up; report any new or worsening symptoms to your doctor promptly.
Hearing and Blood Cell Problems
Hearing problems, including decreased hearing and hearing loss, have been associated with this medication. These effects may be temporary or 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, low blood cell counts have been reported, which can increase the risk of bleeding, infections, or anemia. Seek medical attention if you experience signs of infection (fever, chills, sore throat), unexplained bruising or bleeding, or 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.
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
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. 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 and are taking this medication, discuss with your doctor before using 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 recommended by your doctor and discuss the results with them.
Potential Side Effects
Be aware that 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 prescription and OTC medications that may impair your actions, 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 increased sun sensitivity.
Other Potential Risks
Be aware of the potential for gout attacks. If you have lupus, this medication may exacerbate your condition or trigger a flare-up; report any new or worsening symptoms to your doctor promptly.
Hearing and Blood Cell Problems
Hearing problems, including decreased hearing and hearing loss, have been associated with this medication. These effects may be temporary or 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, low blood cell counts have been reported, which can increase the risk of bleeding, infections, or anemia. Seek medical attention if you experience signs of infection (fever, chills, sore throat), unexplained bruising or bleeding, or 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.
Overdose Information
Overdose Symptoms:
- Profound diuresis
- Severe dehydration
- Electrolyte depletion (hypokalemia, hyponatremia, hypochloremia)
- Hypotension
- Cardiovascular collapse
- Thrombosis and embolism (due to hemoconcentration)
- Acute renal failure
- Lethargy
- Confusion
- Coma
What to Do:
Call 1-800-222-1222 (Poison Control). Seek immediate medical attention. Treatment is supportive, focusing on fluid and electrolyte replacement.
Drug Interactions
Major Interactions
- Aminoglycosides (increased ototoxicity)
- Cisplatin (increased ototoxicity)
- Lithium (decreased renal clearance of lithium, leading to toxicity)
- NSAIDs (may reduce diuretic and antihypertensive effects, increased risk of renal impairment)
- Chloral hydrate (flushing, sweating, blood pressure fluctuations)
- Phenytoin (reduced diuretic effect of furosemide)
Moderate Interactions
- ACE inhibitors/ARBs (risk of severe hypotension and renal impairment, especially with initial doses)
- Digoxin (increased risk of digoxin toxicity due to hypokalemia)
- Corticosteroids (increased risk of hypokalemia)
- Other antihypertensives (additive hypotensive effects)
- Neuromuscular blockers (enhanced effect due to electrolyte imbalance)
- Sucralfate (reduced absorption of furosemide if given concurrently)
- Probenecid (reduced renal clearance of furosemide)
Minor Interactions
- Antidiabetic agents (may decrease hypoglycemic effect)
- Theophylline (may alter clearance)
Monitoring
Baseline Monitoring
Serum Electrolytes (Na, K, Cl, Mg, Ca)
Rationale: To establish baseline and identify pre-existing imbalances, as furosemide can cause significant electrolyte disturbances.
Timing: Prior to initiation of therapy.
Renal Function (BUN, Serum Creatinine)
Rationale: To assess baseline kidney function and guide dosing, as furosemide is primarily renally eliminated and can affect renal perfusion.
Timing: Prior to initiation of therapy.
Blood Pressure
Rationale: To establish baseline and monitor for hypotensive effects.
Timing: Prior to initiation of therapy.
Fluid Status (Weight, Edema, Urine Output)
Rationale: To assess baseline fluid overload and monitor response to therapy.
Timing: Prior to initiation of therapy.
Routine Monitoring
Serum Electrolytes (Na, K, Cl, Mg, Ca)
Frequency: Daily initially, then 1-3 times weekly, or as clinically indicated.
Target: Within normal limits (e.g., K: 3.5-5.0 mEq/L)
Action Threshold: Significant deviations (e.g., K < 3.0 mEq/L or > 5.5 mEq/L), symptomatic electrolyte imbalance.
Renal Function (BUN, Serum Creatinine)
Frequency: Daily initially, then 1-3 times weekly, or as clinically indicated.
Target: Stable or improving
Action Threshold: Significant increase in BUN/Creatinine, signs of acute kidney injury.
Blood Pressure
Frequency: Daily or more frequently if unstable, then regularly.
Target: Individualized, within target range for condition.
Action Threshold: Symptomatic hypotension (e.g., dizziness, syncope), significant drop from baseline.
Fluid Status (Weight, Urine Output, Edema)
Frequency: Daily (weight, urine output), or as clinically indicated.
Target: Gradual weight loss (e.g., 0.5-1 kg/day), increased urine output, reduction in edema.
Action Threshold: Excessive diuresis leading to dehydration, inadequate diuresis, signs of worsening fluid overload.
Hearing (for high doses or rapid IV infusion)
Frequency: Monitor for symptoms of ototoxicity.
Target: Not applicable
Action Threshold: Tinnitus, hearing loss.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Muscle cramps
- Weakness
- Fatigue
- Nausea
- Vomiting
- Dry mouth
- Excessive thirst
- Confusion
- Irregular heartbeat
- Tinnitus
- Hearing loss
Special Patient Groups
Pregnancy
Furosemide is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It can cause fetal or neonatal jaundice, thrombocytopenia, and other adverse reactions seen in adults.
Trimester-Specific Risks:
First Trimester:
Limited data, potential for adverse effects on fetal development.
Second Trimester:
Risk of electrolyte imbalance and volume depletion in mother, potentially affecting fetal perfusion.
Third Trimester:
Risk of electrolyte imbalance and volume depletion in mother, potential for neonatal jaundice, thrombocytopenia, and other adverse effects.
Lactation
Furosemide is excreted in breast milk and may inhibit lactation. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Monitor infant for dehydration and electrolyte imbalance.
Infant Risk:
Low to moderate risk. Potential for dehydration, electrolyte imbalance, and theoretical risk of ototoxicity in the infant. May decrease milk supply.
Pediatric Use
Use with caution. Neonates and infants may have prolonged half-life due to immature renal function. Higher risk of ototoxicity, especially in premature infants or those with impaired renal function. Close monitoring of fluid and electrolytes is crucial.
Geriatric Use
Elderly patients may be more sensitive to the effects of furosemide, particularly hypotension and electrolyte disturbances. Age-related decreases in renal function may necessitate lower doses and closer monitoring. Increased risk of falls due to orthostatic hypotension.
Clinical Information
Clinical Pearls
- Administer IV furosemide slowly (over 1-2 minutes for doses up to 40 mg, or 4 mg/min for higher doses) to minimize the risk of ototoxicity.
- Rapid IV administration or high doses are associated with an increased risk of transient or permanent hearing impairment.
- Patients on furosemide often require potassium supplementation or a potassium-sparing diuretic to prevent hypokalemia.
- Monitor for signs of dehydration (e.g., dry mucous membranes, decreased skin turgor, orthostatic hypotension).
- Furosemide can cause photosensitivity; advise patients to use sun protection.
- In patients with severe heart failure, continuous IV infusion may be more effective and cause fewer electrolyte shifts than intermittent boluses.
Alternative Therapies
- Bumetanide (another loop diuretic)
- Torsemide (another loop diuretic)
- Ethacrynic acid (another loop diuretic, used in sulfa allergy)
- Thiazide diuretics (e.g., hydrochlorothiazide, metolazone - often used in combination with loop diuretics for refractory edema)
- Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene - often used in combination to counteract potassium loss)
Cost & Coverage
Average Cost:
Not available Not available
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Additionally, some medications may come with a separate patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred.