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Furosemide is a loop diuretic that inhibits the Na+-K+-2Cl- cotransporter 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 and systemic vasculature.

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 medical attention immediately:

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 change in the amount of urine produced
+ 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
+ Change in how much urine is passed
+ Blood in the urine
+ Significant weight gain
Signs of a pancreas problem (pancreatitis), such as:
+ Severe stomach pain
+ Severe back pain
+ Severe upset stomach or vomiting
Severe dizziness or passing out
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 body organs and may be life-threatening. Seek medical help immediately if you experience:

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

Other Side Effects

Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild side effects. If you are concerned about any of the following side effects or if they persist, contact your doctor:

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

Reporting Side Effects

This is not an exhaustive list of potential 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 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 have 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

This list is not exhaustive, and it is crucial to disclose all your medications, including:
Prescription and over-the-counter (OTC) drugs
Natural products
Vitamins

Your doctor and pharmacist need to be aware of all your medications and health conditions to assess potential interactions and ensure it is safe for you to take this medication. Never start, stop, or change the dose of any medication without consulting your doctor first.

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 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 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.

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 scheduled 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, discuss this with your doctor. You may also require additional potassium supplements; consult your doctor about this.

Interactions with Other Substances
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or OTC medications that may cause drowsiness, discuss this with 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 possibility of gout attacks. If you have lupus, this medication may reactivate or worsen your condition; promptly report any new or worsening symptoms to your doctor.

Hearing and Blood Cell Problems
Hearing problems, such as decreased hearing or hearing loss, may occur 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 may occur, which can lead to bleeding problems, infections, or anemia. Seek medical attention if you have signs of infection (fever, chills, sore throat), unexplained bruising or bleeding, or feel extremely tired or weak.

Special Considerations
If you are 65 years 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 for you and your baby.

• Ethacrynic acid (increased risk of ototoxicity)

• Aminoglycosides (increased risk of ototoxicity and nephrotoxicity)
• Cisplatin (increased risk of ototoxicity)
• Lithium (decreased renal clearance of lithium, leading to toxicity)
• NSAIDs (may reduce diuretic and antihypertensive effects of furosemide, increased risk of renal toxicity)
• Digoxin (increased risk of digoxin toxicity due to hypokalemia)
• Phenytoin (may reduce diuretic effect of furosemide)
• Sucralfate (may reduce absorption of furosemide)
• Chloral hydrate (flushing, sweating, blood pressure changes)

• Antihypertensives (additive hypotensive effects)
• Corticosteroids (increased risk of hypokalemia)
• Laxatives (increased risk of hypokalemia)
• Amphotericin B (increased risk of hypokalemia)
• Metformin (increased risk of lactic acidosis in patients with renal impairment)
• Probenecid (may decrease renal clearance of furosemide)
• Cephalosporins (increased risk of nephrotoxicity with high doses)

• Alcohol (additive hypotensive effects)
• Licorice (may increase potassium loss)

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

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Furosemide can cause fetal or neonatal jaundice, thrombocytopenia, and other adverse reactions seen in adults. In pregnant women with hypertension, furosemide may reduce placental perfusion.

L3 (Moderately Safe). Furosemide is excreted into breast milk. While generally considered compatible with breastfeeding, monitor the infant for dehydration, electrolyte imbalance, and weight loss. High doses may suppress lactation.

Dosing is weight-based. Neonates and infants may be more susceptible to adverse effects, particularly electrolyte disturbances and ototoxicity. Close monitoring of fluid and electrolyte balance is crucial. Not recommended for routine use in neonates due to potential for nephrocalcinosis.

Elderly patients may be more sensitive to the effects of furosemide, particularly hypotension and electrolyte disturbances. They may also have age-related decreases in renal function, requiring lower doses and closer monitoring. Increased risk of falls due to orthostatic hypotension.

• Administer furosemide in the morning or early afternoon to prevent nocturia.
• Monitor for signs of dehydration (e.g., dry mucous membranes, decreased skin turgor, excessive thirst) and electrolyte imbalances, especially hypokalemia, hyponatremia, and hypomagnesemia.
• Potassium supplementation is often necessary, especially with chronic use or high doses.
• Rapid IV administration can increase the risk of ototoxicity, especially in patients with renal impairment or those receiving other ototoxic drugs.
• Furosemide is less effective in patients with severe renal impairment (CrCl < 30 mL/min) compared to other loop diuretics like torsemide or bumetanide, which may be preferred in these cases.
• Patients should be advised to report any ringing in the ears or hearing changes immediately.
• Orthostatic hypotension is a common side effect; advise patients to change positions slowly.

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