Indicatios:

Furosemide is a potent diuretic and is recommended for use when prompt and effective diuresis is required.

Furosemide Injection 20mg/2ml is appropriate for use in emergencies or where oral therapy is not feasible. The indications include cardiac, pulmonary, hepatic and renal oedema.

Dosage and administration：

Posology

Furosemide Injection 20mg/2ml

Adults: Initially, doses of 20 - 50mg may be administered by the intramuscular route, or by slow intravenous injection at a rate not exceeding 4mg/minute.  The diuretic effect of furosemide is proportional to the dosage and, if larger doses are required, they should be given as a controlled infusion at a rate not exceeding 4mg/minute and titrated according to the response.

Elderly: Elimination of furosemide is generally slower in the elderly.  Dosage should be titrated until the required effect is achieved.

Paediatric population: Dosages for children range from 0.5 - 1.5mg/kg weight daily up to a maximum total daily dose of 20mg.

Method of administration

Furosemide Injection 20mg/2ml is for intramuscular or for intravenous administration and must always be given slowly.  

Contraindications:

Hypersensitivity to the active substance or to any of the excipients

Hypersensitivity to amiloride, sulphonamides or sulphonamide derivatives

Hypovolaemia and dehydration (with or without accompanying hypotension)

Severe hypokalaemia: severe hyponatraemia

Comatose or pre-comatose states associated with hepatic cirrhosis

Anuria or renal failure with anuria not responding to furosemide, renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents, renal failure associated with hepatic coma

Impaired renal function with a creatinine clearance below 30ml/min per 1.73 m2 body surface area

Addison's disease

Digitalis intoxication

Porphyria

Breast-feeding women

Precautions:

Conditions requiring correction before furosemide is started:

Hypotension.

Hypovolaemia.

Severe electrolyte disturbances – particularly hypokalaemia, hyponatraemia and acid-base disturbances.

Furosemide is not recommended in patients at high risk for radiocontrast nephropathy - it should not be used for diuresis as part of the preventative measures against radiocontrast-induced nephropathy.

Particular caution and/or dose reduction required:

Symptomatic hypotension leading to dizziness, fainting or loss of consciousness can occur in patients treated with furosemide, particularly in the elderly, patients on other medications which can cause hypotension and patients with other medical conditions that are risks for hypotension.

Elderly people (lower initial dose as particularly susceptible to side-effects)

difficulty with micturition including prostatic hypertrophy (increased risk of urinary retention: consider lower dose).  Closely monitor patients with partial occlusion of the urinary tract

diabetes mellitus (latent diabetes may become overt: insulin requirements in established diabetes may increase: stop furosemide before a glucose tolerance test)

pregnancy

gout (furosemide may raise uric acid levels/precipitate gout)

patients with hepatorenal syndrome

impaired hepatic function

impaired renal function

adrenal disease

hypoproteinaemia e.g. nephritic syndrome (effect of furosemide may be impaired and its ototoxicity potentiated - cautious dose titration required).

acute hypercalcaemia (dehydration results from vomiting and diuresis - correct before giving furosemide).  Treatment of hypercalcaemia with a high dose of furosemide results in fluid and electrolyte depletion - meticulous fluid replacement and correction of electrolyte required.

Patients who are at risk from a pronounced fall in blood pressure

premature infants (possible development nephrocalcinosis/nephrolithiasis;  renal function must be monitored and renal ultrasonography performed).

Avoidance with other medicines

concurrent NSAIDs should be avoided – if not possible diuretic effect of furosemide may be attenuated

ACE-inhibitors & Angiotensin II receptor antagonists – severe hypotension may occur – dose of furosemide should be reduced/stopped (3 days) before starting or increasing the dose of these

Storage:

Keep in outer carton

Do not store above 25°C

Do not refrigerate or freeze.