FUROSEMIDE

amp. 1% 2 ml of N10

Structure : 2 ml of solution contain furosemide 0.02 g;
excipients: sodium chloride, solution of sodium of hydroxide of 1 M, water for injections.

PHARMACOLOGICAL PROPERTIES.

Pharmacodynamics . Furosemide is effective and high-speed diuretic (saluretichesky) remedy. The diuretic effect is connected with oppression of a reabsorption of ions of sodium and chlorine in a Henle's loop. Increases removal of potassium ions, magnesium, calcium.

At intravenous administration is caused by expansion of peripheral veins, reduces preloading, reduces pressure of filling of a left ventricle and pulmonary pressure.

Diuretic effect at intravenous administration is observed by

in 3 - 4 min. and proceeds 1 - 2 h. It does possible use of medicament at medical emergencies - a fluid lungs, a brain.

Pharmacokinetics. Concentration of furosemide increases in blood plasma with increase in a dose, but time of achievement of a maximum does not depend on a dose and varies over a wide range depending on a condition of the patient. In blood plasma active agent is in the basic in connection with albumine: in the range of concentration from 1 to 400 ng/ml the communication with protein at healthy faces makes 91 - 99%. Free fraction - 2.5 - 4.1% of therapeutic concentration. In the course of biotransformation, furosemide in an organism turns generally into a glucuronide.

INDICATIONS . Wet brain, an acute left ventricular failure (fluid lungs), hypertensive crisis, an artificial diuresis, hypostases at developments of stagnation in small and big circles of blood circulation, an eclampsia.

ROUTE OF ADMINISTRATION AND DOSES . Furosemide is appointed intravenously and intramusculary. For adults a daily dose for parenteral administration - 40 - 60 - 120 mg (1 - 2 time a day). The maximum daily dose for adults - 240 mg. For children an initial daily dose - 1 mg on body weight kg, the maximum daily dose - 6 mg on body weight kg.

SIDE EFFECT . Nausea, diarrhea, hyperaemia and an itching of skin, hypotension, temporary deterioration in hearing, interstitial nephrite are possible. Because of a profound diuresis there can be dizziness, a depression, muscle weakness, thirst, a hyperuricemia, an uricosuria, a hyperglycemia, disturbance of electrolytic balance (a hypopotassemia, especially at patients with cirrhosis, a hyponatremia, a gipokhloremichesky alkalosis), increase in concentration of uric acid in blood with development of an attack of gout in patients with predisposition.
At premature children the nephrocalcinosis is possible.

CONTRAINDICATION . Hypersensitivity to components of medicament and sulfonamides; a hypopotassemia, a hepatic coma, an acute renal failure with an anury, mechanical impassability of urinary tract, urine outflow disturbance; pregnancy (especially the first half) and lactation.

OVERDOSE . Symptoms: dehydration, decrease in the volume of the circulating blood (VCB), arterial hypotension, an electrolytic imbalance, a hypopotassemia and a gipokhloremichesky alkalosis caused by diuretic effect.
Treatment : correction of water-salt balance, completion of volume of the circulating blood, therapy symptomatic. Specific antidote does not exist.

FEATURE of USE . During medicament use the diet has to be rich with potassium. With care apply to elderly people with the atherosclerosis phenomena, at heavy

a circulatory unefficiency, prolonged use of medicaments of a foxglove. The accruing azotemia and an oliguria are the indication for medicament withdrawal.

Pregnancy and lactation .

during pregnancy the use of medicament is only possible

in case the expected advantage for mother exceeds potential risk for a fruit.
Furosemide is emitted with milk at women in the period of a lactation, in communication than it is reasonable to stop feeding by a breast.

during treatment by Furosemide should avoid occupations potentially dangerous types of activity requiring special attention and speed of psychomotor reactions.

INTERACTION WITH OTHER MEDICINES . Furosemide cannot be mixed in one volume with solutions of other medicaments for parenteral administration.
Increases concentration and risk of development nefro- and ototoksichesky effect of cephalosporins, aminoglycosides, chloramphenicol, Acidum etacrynicum, Cisplatinum, Amphotericinum B (owing to competitive renal removal).

is Raised by efficiency of diazoxide and theophylline, reduces - hypoglycemic medicines, Allopyrinolum.
renal clearance of medicaments of lithium Reduces and raises a likelihood of developing intoxication.
Strengthens hypotensive effect of hypotensive drugs, the neuromuscular blockade caused by the depolarizing muscle relaxants (succinylcholine) and (tubocurarine) weakens action of not depolarizing muscle relaxants.
Pressor amines and Furosemide mutually reduce efficiency.

Medicines blocking kanaltsiyevy secretion increase concentration of furosemide in blood serum.

At simultaneous use of glucocorticosteroids, Amphotericinum B the risk of development of a hypopotassemia increases, with cardiac glycosides the risk of developing digitalis intoxication as a result of a hypopotassemia (for highly - and low-polar cardiac glycosides) and lengthenings of elimination half-life increases (for low-polar).
Non-steroidal anti-inflammatory drugs, sukralfat reduce diuretic effect.

Intake of salicylates in high doses against the background of therapy by Furosemide increases risk of manifestation of their toxicity.

CONDITION AND PERIOD OF STORAGE . To store in the inaccessible for children, protected from light place at a temperature of 15 - 25 Pages. An expiration date - 2 years.

CONDITION of RELEASE . According to the prescription

Description of goods is certified by the producer GNTsLS .

Editorial group Date of creation: 19.07.2022 Date of updating: 05.04.2023 Urusov Hannah Mikhayl_vna Author Oleksander V_ktorovich Sevryukov Reviewer

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Frequently asked questions

How much is Furosemide solution for infection. 10mg/ml amp. 2 ml No. 10?

Prices of Furosemide solution for infection. 10mg/ml amp. 2 ml No. 10 begin from 2:15 UAH - whether an ampoule / 1 piece

Can give this medicine to children?

It is possible. It is necessary to consult with your attending physician more in details.

What storage conditions at solution Furosemide (GNTsLS)?

It agrees with the instruction storage temperature Furosemide (GNTsLS) makes from 5 °C to 25 °C. To store out of children's reach.

What analogs at solution Furosemide No. 1?

Full analogs Furosemide solution for infection. 10mg/ml amp. 2 ml No. 10 are:

• Lasixum Neo solution for infection. 10mg/ml amp. 2 ml No. 10
• Furosemid-Darnitsa solution for infection. 10mg/ml amp. 2 ml No. 10

What country of origin at Furosemide (GNTsLS)?

Country the producer at Furosemide (GNTsLS) - Ukraine.

Structure

Active ingredient: furosemide;

10 mg contain

1 ml of solution to furosemide;

Other components: sodium chloride, solution of sodium of hydroxide of 1 M, water for injections.

Dosage form

Solution for injections.

Main physical and chemical properties: transparent, colourless or with slightly yellowish shade solution.

Pharmacotherapeutic group

Highly active diuretics. Drugs of sulphamides.

ATX C03C A01 Code.

Pharmacological properties

Pharmacodynamics

Furosemide is the loopback diuretic of fast action having rather strong and short-term diuretic effect. Furosemide blocks Na ⁺ K ⁺ 2Cl ^- kotransporter located in basal membranes of cells of a thick segment of the ascending part of a Henle's loop. The efficiency of saluretichesky effect of furosemide, thus, depends on whether medicine gets into tubules in places of gleams by the anion-transport mechanism. The diuretic effect results from sodium chloride reabsorption inhibition in this segment of a Henle's loop. As a result fractional excretion of sodium can reach 35% of glomerular filtration of sodium. Secondary effects of the increased excretion of sodium consist in the increased urine removal (thanks to osmotically connected water) and the increased distal canalicular secretion of potassium. Also excretion of calcium ions and magnesium increases. Furosemide causes dose-dependent stimulation of a system renin-angiotensin-Aldosteronum. In heart failure furosemide leads to acute reduction of warm preloading (by narrowing of capacitive venous vessels). This early vascular effect prostaglandinoposredstvenny also assumes adequate function of kidneys with activation of a system renin-angiotensin and safe synthesis of prostaglandins. Besides, thanks to natriuretic effect inherent to it, furosemide reduces reactivity of vessels concerning catecholamines which is increased at patients with arterial hypertension.

Antihypertensive efficiency of furosemide is explained by the increased sodium excretion, reduced volume of blood and the reduced response of unstriated muscles of vessels to stimulation vasoconstrictors or vasoconstrictors.

Beginning of diuretic effect is observed by

within 15 minutes after introduction of a dose of furosemide.

Dose-dependent increase in a diuresis and a natriuresis was observed by

at the healthy volunteers receiving furosemide in doses of 10-100 mg. Action duration at healthy volunteers is about 3 hours after introduction of 20 mg of furosemide.

interrelation between concentration of untied (free) furosemide in tubular bodies (it is defined on the basis of the speed of excretion of furosemide in urine) and natriuretic effect is expressed by

At patients in the form of a sigmoidal curve with the minimum effective speed of excretion furosemida0 that makes approximately Thus, continuous infusion of furosemide is more effective, than repeated bolyusny injections. Moreover, except a certain bolyusny medicament dose the significant increase in effect is not observed. The effect of furosemide decreases if there is an underestimated tubular secretion or linking of medicament with albumine in tubules.

Pharmacokinetics

Volume of distribution of furosemide makes from 0.1 to 0.2 l on 1 kg of body weight. The volume of distribution can be higher depending on a disease.

Furosemide (more than 98%) forms strong connections with blood plasma proteins, especially with albumine.

Furosemide is removed mainly in not changed look by secretion in a proximal tubule. After introduction from 60% to 70% of the entered dose of furosemide it is removed thus. The furosemide metabolite – a glucuronide – makes 10-20% of the substances which are contained in urine. The residual dose is removed with excrements probably by biliary secretion.

Final elimination half-life of furosemide after intravenous appointment makes from 1 to 1.5 hours.

Furosemide gets into breast milk, through a placental barrier and slowly gets to a fruit. Furosemide is defined at a fruit or at the newborn in the same concentration, as at the child's mother.

Disease of kidneys. In a renal failure the removal of furosemide is slowed down, and elimination half-life is extended; final elimination half-life can last till 24 o'clock at patients with a heavy renal failure.

reduced concentration of proteins of blood plasma lead

At a nephrotic syndrome to increase in concentration of untied (free) furosemide. On the other hand, the efficiency of furosemide at these patients is reduced thanks to linking with intratubulyarny albumine and the underestimated canalicular secretion.

Furosemide badly is exposed to dialysis at patients to whom carry out a hemodialysis, peritoneal dialysis and chronic peritoneal dialysis in out-patient conditions.

Liver failure. In a liver failure the elimination half-life of furosemide increases by 30-90%, mainly thanks to the bigger volume of distribution. It should be noted that in this group of patients a big variety of all pharmacokinetic parameters is observed.

Stagnant heart failure, heavy arterial hypertension, patients of advanced age. Removal of furosemide is slowed down because of the reduced function of kidneys at patients with stagnant heart failure, heavy arterial hypertension and at patients of advanced age.

Premature and full-term babies. Depending on the level of formation of kidneys the removal of furosemide can be slowed down. Drug metabolism also decreases if at babies the ability to a glyukuronization is broken. Final elimination half-life lasts less than 12 hours at a fruit of 33 weeks after fertilization of an ovum. At babies of 2 months the final clearance is similar to clearance at adult patients.

Indication

Hypostases in chronic stagnant heart failure (if treatment with diuretics is necessary).

Hypostases in acute stagnant heart failure.

Hypostases at HPN.

Acute renal failure, including at pregnant women or during childbirth.

Hypostases in liver diseases (if necessary for addition of treatment using antagonists of Aldosteronum).

Hypertensive crisis (as the supporting means).

Support of an artificial diuresis.

Contraindication

Hypersensitivity to the furosemide or other components which are a part of drug.

cross sensitivity to furosemide can be found In patients with an allergy to sulfonamides (for example, sulphonamide antibiotics or sulphonylurea).

Hypovolemia or dehydration of an organism.

Renal failure in the form of an anury if the therapeutic answer to furosemide is not observed.

Renal failure as a result of poisoning with nephrotoxic or hepatotoxic drugs.

Heavy hypopotassemia.

Heavy hyponatremia.

Prekomatozny or coma states are associated with hepatic encephalopathy.

Interaction with other medicines and other types of interactions.

Unrecommended compositions.

In some cases intake of furosemide within 24 hours after Chlorali hydras can cause inflows, the increased sweating, the excited state, nausea, increase in the ABP and tachycardia. Therefore, simultaneous use of furosemide and Chlorali hydras is not recommended.

Furosemide can exponentiate ototoxicity of aminoglycosides and other ototoksichesky medicines. As it can lead to the damage having irreversible character, these medicines should not be applied along with furosemide.

Combination, demanding taking measures of precaution.

At simultaneous use of Cisplatinum and furosemide the risk of emergence of ototoksichesky effects exists. Besides, nephrotoxicity of Cisplatinum if not to appoint furosemide in low doses (for example, 40 mg to patients with normal function of kidneys) and positive balance of liquid can amplify if to use medicament for achievement of effect of an artificial diuresis during therapy by Cisplatinum.

Furosemide reduces removal of salts of lithium and can lead to increase in levels of lithium in blood serum that results in the increased risk of toxicity of lithium, including bigger risk of emergence of cardiotoxic and neurotoxic effects of lithium. Thus, it is recommended to carry out careful monitoring of levels of lithium at the patients receiving such combination therapy.

Patients receiving diuretics can suffer from

from heavy arterial hypotension and deterioration in function of kidneys, including cases of a renal failure, especially at the first use of inhibitor of angiotensin-converting enzyme (APF inhibitor) or the antagonist of a receptor of angiotensin II. It is necessary to solve, it is necessary to stop temporarily use of furosemide or at least to lower a furosemide dose in 3 days prior to treatment or to increase a dose of APF inhibitor or the antagonist of a receptor of angiotensin II.

Risperidon: it is necessary to show care and to carefully weigh risk and advantage before making the decision on performing combination therapy or simultaneous use with furosemide or other powerful diuretics.

Combination, having the reservation.

Simultaneous use of non-steroidal anti-inflammatory drugs, including acetylsalicylic acid, can reduce effect of furosemide. At patients with dehydration of an organism or with a hypovolemia non-steroidal anti-inflammatory medicaments can lead to an acute heart failure. Under the influence of furosemide the toxicity of salicylate can increase.

Reduction of efficiency of furosemide can arise after combined use with Phenytoinum.

Use of corticosteroids, a karbenoksolona, a licorice root in high doses and prolonged use of depletive can increase risk of development of a hypopotassemia.

Some disturbances of electrolytic balance (such as hypopotassemia, hypomagnesiemia) can increase toxicity of some other medicines (for example the medicaments of a digitalis and medicines causing a syndrome of lengthening of an interval of QT).

If the antihypertensive drugs, diuretics or other medicines having property to reduce arterial blood pressure, to apply along with furosemide has to expect much more still decrease in the ABP.

Probenetsid, the methotrexate and other medicines, as well as furosemide, are subject to considerable canalicular secretion in kidneys, can reduce efficiency of furosemide. To the contrary, furosemide can reduce removal of these medicines kidneys. Performing treatment using high doses (both furosemides, and other medicines) can lead to increase in their levels in blood serum and to growth of risk of the side effects caused by intake of furosemide or the accompanying therapy.

efficiency of the anti-diabetic medicines and sympathomimetics having property to raise the ABP Can decrease (for example epinephrine, Norepinephrinum). Action of kurarepodobny muscular relaxants or theophylline can amplify.

strengthening of harmful effects of nephrotoxic medicines on kidneys Is possible

.

Renal failure can develop at the patients receiving the accompanying therapy by furosemide and high doses of separate cephalosporins.

Simultaneous use of cyclosporine A and furosemide is associated with the increased risk of developing of the gouty arthritis secondary concerning the hyperuricemia caused by furosemide and disturbance of the renal excretion of urates caused by cyclosporine.

by

At the patients treating group of high risk of development of a nephropathy owing to therapy by radiocontrast substances at treatment by furosemide observed the big frequency of deterioration in function of kidneys after receiving radiocontrast substances in comparison with that at patients of group of high risk by which carried out intravenous hydration to prescribing of radiocontrast substances.

during treatment should provide to

with

Feature of use

continuous outflow of urine. Patients with partial obstruction of outflow of urine need close attention, especially at the initial stages of treatment.

Treatment using furosemide demands constant medical observation of the patient.

especially careful monitoring of a state Is necessary for

:

– patients with arterial hypotension;

- patients who get into group of extra risk owing to considerable decrease in the ABP, for example patients with the profound stenosis of coronary arteries or blood vessels which deliver blood in a brain;

– patients with the latent or expressed form of diabetes;

– patients with gout;

– patients with a gepatorenalny syndrome, that is with a functional renal failure that is associated with a serious illness of a liver;

– patients with a hypoproteinemia that, in particular, is associated with a nephrotic syndrome (the effect of furosemide can be weakened along with ototoxicity potentiation). Careful titration of a dose is necessary;

– premature babies (development of a nephrocalcinosis/nephrolithiasis is possible); it is necessary to carry out monitoring of function of kidneys and to carry out USI of kidneys.

Monitoring of sodium, potassium and creatinine of blood serum in general is recommended to

at therapy by furosemide. Patients of group of high risk of development of electrolytic imbalances or in case of considerable additional loss of liquid need especially careful monitoring (for example, as a result of vomiting, diarrhea or intensive discharge of sweat). The hypovolemia or dehydration of an organism and also any significant disturbances of electrolytic and acid-base balance should be modified. For this purpose the temporary termination of therapy by furosemide can be required.

development of disturbances of electrolytic balance is influenced by such factors as the existing diseases (for example, cirrhosis, heart failure), the accompanying use of medicines and food. For example, as a result of vomiting or diarrhea there can be a lack of potassium.

At use of medicament it is reasonable to p to recommend to the patient to eat food with the high content of potassium (baked potatoes, bananas, tomatoes, spinach, dried fruits). It is necessary to remember that at use of furosemide there can be a need of medicamentous compensation of deficiency of potassium.

higher level of lethality was observed by

Among patients of advanced age with dementia at the patients who were receiving furosemide along with risperidony in comparison with patients, receiving only risperidon or only furosemide.

Should show care and to carefully weigh risks and advantage before making the decision on use of such combination or simultaneous treatment using other powerful diuretics. It is necessary to avoid dehydration.

Should avoid simultaneous alcohol intake and furosemide.

It is medicine contains less than 1 mmol (23 mg) / a sodium dose, that is it is almost free from sodium.

Use during pregnancy and feeding by a breast

Pregnancy. Furosemide gets through a placental barrier. It is not necessary to appoint it during pregnancy, except for cases of performing treatment at vital indications. Drug treatment during pregnancy demands observation of growth and fetation.

feeding Period breast. Furosemide gets into breast milk and can inhibit a lactation. Women should stop feeding by a breast for treatment by furosemide.

Ability to influence speed of response at control of motor transport or other mechanisms

At medicament use some side effects (for example, unexpected considerable decrease in the ABP) the ability of the patient to concentration of attention and speed of its reaction can break

.

Therefore for treatment should abstain from control of motor transport or work with other mechanisms.

Route of administration and doses

Mode of a dosage is set by the doctor individually depending on severity of disorders of water and electrolytic balance, size of glomerular filtration, weight of a condition of the patient. In the course of use of medicament it is necessary to adjust indicators of water and electrolytic balance taking into account a diuresis and dynamics of a condition of the patient.

Furosemide to appoint

intravenously only when reception is orally inexpedient or neeffektivn (for example at disturbance of absorption in intestines) or in case of need fast effect. In case of use of intravenous therapy the fastest transition to therapy by furosemide for oral administration is recommended.

in general are preferable

continuous infusion of furosemide in comparison with repeated bolyusny injections To achievement of optimum efficiency and oppression of counter regulation.

to

When continuous infusion of furosemide is inexpedient for the subsequent treatment after introduction of one or several bolyusny doses, prefers the further scheme of treatment with purpose of low doses which enter through short intervals of time (about 4 hours), in comparison with high bolyusny doses that are entered through wide intervals of time.

to

For adults recommends the maximum daily dose of furosemide – 1500 mg.

Recommended furosemide dose for parenteral administration for children makes 1 mg/kg of body weight, but the maximum daily dose should not exceed 20 mg.

Special recommendations about a dosage

Dosage for adults is based on use of the recommendations below.

Hypostases in chronic stagnant heart failure. Recommended initial dose for oral administration makes from 20 mg to 50 mg a day. If necessary it is possible to regulate a dose according to the therapeutic answer of the patient.

Is recommended to accept the daily dose distributed on 2 or 3 receptions.

Hypostases in acute stagnant heart failure. Recommended initial dose makes from 20 mg to 40 mg, to appoint in a look bo