Furosemide 40mg 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, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine production
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or vomiting
Signs of liver problems, such as:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Signs of kidney problems, including:
+ Unable to pass urine
+ Changes in urine production
+ Blood in the urine
+ Sudden weight gain
Signs of pancreatitis (pancreas problems), such as:
+ Severe stomach pain
+ Severe back pain
+ Severe upset stomach or vomiting
Other severe symptoms, including:
+ Very bad dizziness or passing out
+ Burning, numbness, or tingling sensations
+ Blurred vision
+ Restlessness
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious reactions, which may also affect internal organs
+ Symptoms may include:
- 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 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 concern you, contact your doctor:

Dizziness or headache
Constipation
Diarrhea
Upset stomach
Vomiting
Decreased appetite
Stomach cramps

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult 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:

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.
Certain health conditions, including liver problems or low blood pressure.
* If you are taking any of the following medications: chloral hydrate, ethacrynic acid, or lithium.

This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing medications and health conditions.

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

Important Warnings and Precautions

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 engaging in activities that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and exercise caution when climbing stairs.

Managing Diabetes
If you have diabetes (high blood sugar), 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 promptly.

Dietary Considerations
If you are on a low-salt or salt-free diet, consult your doctor. Additionally, if you have high blood pressure and are taking this medication, discuss the use of 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 to monitor your condition.

Potential Side Effects
High cholesterol and triglyceride levels have been associated with this medication. If you have high cholesterol or triglycerides, discuss this with your doctor. You may require additional potassium supplements; consult your doctor about this.

Interactions with Other Substances
Before using alcohol, marijuana or other forms of cannabis, or 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 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, such as decreased hearing or loss of hearing, have been reported with this medication. In some cases, these problems may be temporary, while in others, 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, low blood cell counts have been associated with this medication, which can increase the risk of bleeding, infections, or anemia. Seek medical attention if you experience signs of infection, such as fever, chills, or sore throat, or if you notice 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 potential benefits and risks of this medication to you and your baby.

• Ethacrynic acid (increased risk of ototoxicity)

• Aminoglycosides (e.g., gentamicin, amikacin): Increased risk of ototoxicity and nephrotoxicity.
• Cisplatin: Increased risk of ototoxicity and nephrotoxicity.
• Lithium: Decreased renal clearance of lithium, leading to increased serum lithium levels and toxicity.
• NSAIDs (e.g., ibuprofen, naproxen): May reduce diuretic and antihypertensive effects of furosemide; increased risk of renal dysfunction.
• ACE inhibitors/ARBs: Increased risk of severe hypotension and acute renal failure, especially with initial doses.
• Digoxin: Increased risk of digoxin toxicity due to hypokalemia.
• Phenytoin: May reduce the diuretic effect of furosemide.
• Sucralfate: May reduce the absorption of furosemide; administer at least 2 hours apart.

• Corticosteroids: Increased risk of hypokalemia.
• Amphotericin B: Increased risk of hypokalemia.
• Muscle relaxants (non-depolarizing): May potentiate neuromuscular blockade.
• Antidiabetic agents: May decrease the hypoglycemic effect.
• Cyclosporine: Increased risk of gouty arthritis due to hyperuricemia and renal dysfunction.

• Probenecid: May decrease renal clearance of furosemide.
• Salicylates (high dose): May compete for renal excretion, increasing risk of salicylate toxicity.

• Dizziness
• Lightheadedness
• Muscle cramps or weakness
• Excessive thirst
• Dry mouth
• Nausea
• Vomiting
• Unusual tiredness or weakness
• Irregular heartbeat
• Confusion
• Decreased urination
• Hearing changes (tinnitus, hearing loss)

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 adverse effects, including electrolyte disturbances.

Furosemide is excreted in breast milk and may suppress lactation. Use with caution. The American Academy of Pediatrics considers it compatible with breastfeeding, but monitor infant for dehydration and electrolyte imbalance.

Dosing is weight-based and requires careful titration. Infants and young children are more susceptible to fluid and electrolyte imbalances. Close monitoring of fluid status, electrolytes, and renal function is crucial. Ototoxicity risk may be higher in neonates, especially with concomitant aminoglycosides.

Elderly patients may be more susceptible to the hypotensive and electrolyte-depleting effects of furosemide, particularly hypokalemia and dehydration. Start with lower doses and titrate slowly. Monitor renal function and electrolytes closely. Increased risk of falls due to orthostatic hypotension.

• Furosemide is a potent diuretic; initiate with caution and monitor fluid and electrolytes closely, especially potassium.
• Advise patients to take furosemide in the morning to avoid nocturia.
• Educate patients on symptoms of dehydration and electrolyte imbalance (e.g., muscle cramps, dizziness, excessive thirst).
• Concomitant use with NSAIDs can reduce furosemide's efficacy and increase the risk of renal dysfunction.
• Avoid concurrent use with aminoglycosides due to increased risk of ototoxicity.
• In patients with severe renal impairment, higher doses may be required, but monitor for ototoxicity.
• Patients on digoxin should have potassium levels closely monitored due to increased risk of digoxin toxicity with hypokalemia.
• Daily weight monitoring is a key indicator of fluid status and treatment effectiveness.

• Other loop diuretics (e.g., torsemide, bumetanide)
• Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) for hypertension or mild edema
• Potassium-sparing diuretics (e.g., spironolactone, amiloride) often used in combination with loop diuretics to counteract potassium loss
• Aldosterone antagonists (e.g., spironolactone, eplerenone) for heart failure or resistant hypertension
• Vasodilators (e.g., nitrates, hydralazine) for acute heart failure
• ACE inhibitors/ARBs for heart failure and hypertension
• Beta-blockers for hypertension and heart failure

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.