Furosemide 8mg/ml Solution

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 ions, 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, irregular or rapid heartbeat, severe dizziness or fainting, increased thirst, seizures, extreme fatigue or weakness, decreased appetite, difficulty urinating 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, pale-colored stools, vomiting, or yellowing of the skin or eyes.
Signs of kidney problems: difficulty urinating, 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 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 be life-threatening and may also affect other organs. 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 may not experience any side effects or may only have mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical help:

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

Reporting Side Effects

This list is not exhaustive, and you may experience other 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.

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. Be sure to describe the symptoms you experienced.
If you have difficulty urinating.
If you are dehydrated or have electrolyte imbalances.
If you have a history of 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 ensure that it is safe to take this medication in conjunction with your other treatments and health conditions.

Remember, do not start, stop, or adjust the dosage of any medication without first consulting your doctor.

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 (high blood sugar), closely monitor your blood sugar levels. Be aware of signs of high blood sugar, such as confusion, drowsiness, unusual 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-salt 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 high cholesterol and triglyceride levels. If you already have high cholesterol or triglycerides, consult your doctor. You may also require additional potassium; discuss this with your doctor.

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 easy sunburning while taking this medication.

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

Hearing and Blood Cell Problems
Hearing problems, such as decreased hearing or hearing loss, may occur with this medication. Sometimes these issues may resolve, but in other 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, low blood cell counts may occur, which can lead to bleeding problems, 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. You and your doctor will need to discuss the benefits and risks of this medication to you and your baby.

• Aminoglycosides (e.g., gentamicin, tobramycin): Increased risk of ototoxicity.
• Ethacrynic acid: Increased risk of ototoxicity.
• Lithium: Decreased renal clearance of lithium, leading to increased lithium levels and toxicity.
• Chloral hydrate: Transient flushing, sweating, restlessness, tachycardia, and blood pressure elevation.
• NSAIDs (e.g., ibuprofen, naproxen): May reduce diuretic and antihypertensive effects of furosemide; increased risk of renal impairment.

• ACE inhibitors/ARBs: Increased risk of hypotension and renal dysfunction, especially with initial doses.
• Digoxin: Hypokalemia induced by furosemide can potentiate digoxin toxicity.
• Corticosteroids: Increased risk of hypokalemia.
• Amphotericin B: Increased risk of hypokalemia.
• Cisplatin: Increased risk of ototoxicity and nephrotoxicity.
• Phenytoin: May reduce the diuretic effect of furosemide.
• Sucralfate: May reduce the absorption of furosemide; administer 2 hours apart.

• Antidiabetic agents: Furosemide may cause hyperglycemia, requiring adjustment of antidiabetic medication.
• Muscle relaxants (nondepolarizing): May enhance the effect of muscle relaxants.

• Dizziness
• Lightheadedness
• Muscle cramps or weakness
• Nausea
• Vomiting
• Excessive thirst
• Dry mouth
• Unusual tiredness or weakness
• Irregular heartbeat
• Hearing changes (tinnitus, hearing loss)
• Signs of dehydration (decreased urination, dry skin)
• Confusion
• Lethargy

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. In animal studies, it has shown some adverse effects at high doses.

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.

Dosing is weight-based. Neonates and infants may be more susceptible to adverse effects, particularly electrolyte imbalances and ototoxicity. Close monitoring of fluid and electrolyte status is crucial.

Elderly patients may be more susceptible to the hypotensive and electrolyte-depleting effects of furosemide. Initial doses should be lower, and titration should be gradual. Close monitoring of renal function, electrolytes, and hydration status is essential.

• Furosemide oral solution (8mg/ml) is particularly useful for patients who have difficulty swallowing tablets or require precise dose adjustments, especially in pediatric or geriatric populations.
• Administer furosemide in the morning to avoid nocturia (nighttime urination). If a second dose is needed, give it in the early afternoon.
• Always monitor electrolytes (especially potassium) closely, as hypokalemia is a common and potentially serious side effect. Potassium supplementation or potassium-sparing diuretics may be needed.
• Educate patients on the signs of dehydration and electrolyte imbalance, and advise them to report these symptoms immediately.
• Caution patients about orthostatic hypotension (dizziness upon standing) and advise them to rise slowly.
• Furosemide can cause ototoxicity, especially with rapid IV administration, high doses, or in patients with renal impairment or concurrent use of other ototoxic drugs (e.g., aminoglycosides).
• NSAIDs can reduce the diuretic and antihypertensive effects of furosemide and increase the risk of renal dysfunction; concurrent use should be monitored carefully.
• In patients with severe heart failure, continuous infusion of furosemide may be more effective and safer than intermittent bolus dosing.

• Other loop diuretics (e.g., torsemide, bumetanide, ethacrynic acid)
• Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) for hypertension or mild edema
• Potassium-sparing diuretics (e.g., spironolactone, eplerenone, amiloride, triamterene) often used in combination to counteract potassium loss or for specific indications like heart failure.
• Vasodilators (e.g., nitrates, hydralazine) for heart failure or hypertension.
• ACE inhibitors/ARBs (for heart failure, hypertension, renal protection).

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