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Dosage
General recommendations:

Tablets should be taken on an empty stomach without chewing and drinking with a sufficient amount of liquid. When using Lasix it is recommended to use its lowest doses, sufficient to achieve the desired effect. The recommended maximum daily intake for adults is 1500 mg.
In children, the recommended dose for oral administration is 2 mg / kg body weight (but not more than 40 mg / day). The duration of treatment is determined by the doctor individually, depending on the indications.

Special recommendations on the dosing regimen in adults:

Edema Syndrome in Chronic Heart Failure
The recommended initial dose is 20-80 mg / day. The necessary dose is selected depending on the diuretic response. It is recommended that the daily dose be divided into 2-3 doses.

Edema Syndrome in Chronic Renal Failure

The natriuretic reaction to furosemide depends on several factors,
including the severity of renal failure and the sodium content in the blood, so the effect of the dose can not be exactly predictable. Patients with chronic renal failure require a careful dose selection, by gradually increasing it,
so that fluid loss occurs gradually (at the beginning of the treatment, a loss of fluid up to approximately 2 kg of body weight / day is possible).

The recommended initial dose is a dose of 40-80 mg / day. The necessary dose is selected depending on the diuretic response. The entire daily dose should be taken once or divided into two doses. In patients,
who are on hemodialysis, usually maintain a dose of 250-1500 mg / day.

Acute renal failure (to maintain the excretion of fluid)

Before starting treatment with furosemide, hypovolemia, arterial hypotension and significant disturbances of the electrolyte and acid-base state should be eliminated.
It is recommended to transfer the patient as soon as possible from the intravenous injection of Lasix to taking Lasix tablets (the dose of Lasix tablets depends on the amount of IV taken).

Edema with nephrotic syndrome

The recommended initial dose is 40-80 mg / day. The required dose is selected depending on the

diuretic response. The daily dose can be taken at one time or divided into several doses.

Edema syndrome with liver diseases

Lasix is a��a��prescribed in addition to treatment with aldosterone antagonists in case of their insufficient effectiveness. To prevent the development of complications,
such as disturbing the orthostatic regulation of the circulation or disturbing the electrolyte or acid-base state, careful selection of the dose is required so that the fluid loss occurs gradually (at the beginning of the treatment, a loss of fluid up to approximately 0.5 kg of body weight / day is possible). The recommended initial dose is 20-80 mg / day
.

Arterial hypertension

Lasix can be used in monotherapy or in combination with other antihypertensive drugs. The usual maintenance dose is a dose of 20-40 mg / day. With arterial hypertension in combination with chronic renal failure, higher doses of Lasix may be required.

Interaction
Cardiac glycosides, drugs that cause QT interval elongation -to case of development in patients receiving furosemide electrolyte abnormalities (hypokalemia or hypomagnesemia) increases the toxic effect of cardiac glycosides and drugs that cause QT interval prolongation (risk of arrhythmias increases).
Glucocorticosteroids, carbenox solon, licorice in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of hypokalemia.

Aminoglycosides –
slowing the excretion of aminoglycosides by the kidneys when they are used simultaneously with furosemide and an increased risk of development of ototoxic and nephrotoxic action of aminoglycosides. For this reason, use of this combination of drugs should be avoided, except when it is necessary for life indications,
and in this case correction (reduction) of maintenance doses of aminoglycosides is required.

Medicines with nephrotoxic action – when combined with furosemide, the risk of developing their nephrotoxic effect increases.

High doses of some cephalosporins (especially those with a predominantly renal excretory pathway) –
in combination with furosemide, the risk of nephrotoxic action increases.

Cisplatin – with simultaneous use with furosemide, there is a risk of developing an ototoxic effect. Besides,
In the case of co-administration of cisplatin and furosemide in doses above 40 mg (with normal renal function), the risk of developing nephrotoxic effects of cisplatin increases.

Non-steroidal anti-inflammatory drugs (NSAIDs) – NSAIDs, including acetylsalicylic acid, can reduce the diuretic effect of furosemide.
In patients with hypovolemia and dehydration (including those taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide can enhance the toxic effect of salicylates.

Phenytoin is a decrease in the diuretic effect of furosemide.

Hypotensive drugs, diuretics or other means that can reduce blood pressure –
when combined with furosemide, a more pronounced hypotensive effect is expected.

Angiotensin-converting enzyme (ACE) – assignment of an ACE inhibitor to patients pre-treated with furosemide treatment, can lead to excessive reduction in blood pressure with the deterioration of kidney function, and in some cases –
to the development of acute renal failure, therefore, three days before the start of treatment with ACE inhibitors or increasing their dose, it is recommended that furosemide be canceled or its dose reduced.

Probenicides, methotrexate, or other drugs that, like furosemide, are secreted in the renal tubules,
can reduce the effects of furosemide (the same pathway of kidney secretion), on the other hand furosemide can lead to a decrease in the excretion of these drugs by the kidneys.

Hypoglycemic agents, pressor amines (epinephrine, norepinephrine) – weakening effects when combined with furosemide.

Theophylline, diazoxide, curare-like muscle relaxants –
enhanced effects when combined with furosemide.

Lithium salts – under the influence of furosemide, lithium excretion decreases, which increases the serum concentration of lithium and increases the risk of toxic effects of lithium, including its damaging effects on the heart and nervous system.
Therefore, when using this combination, control of serum lithium concentrations is required.

Sucralfate – reduce absorption of furosemide and weaken its effect (furosemide and sucralfate should be taken at intervals of not less than two hours).

Cyclosporin A –
when combined with furosemide, the risk of gouty arthritis is increased due to furosemide-induced hyperuricemia and cyclosporin-induced uracate excretion by the kidneys.

Radiopaque substances – in patients with a high risk of developing nephropathy for the administration of radiocontrast preparations receiving furosemide,
there was a higher incidence of renal dysfunction compared to patients at high risk of developing nephropathy for the introduction of radiopaque preparations that received only intravenous hydration prior to the administration of the radiopaque drug.

Side effects
From the side of water-electrolyte and acid-base state

Hyponatremia, hypochloraemia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis, which can develop as either a gradual increase in the electrolyte deficiency or a massive loss of electrolytes in a very short time, for example,
in the case of high doses of furosemide in patients with normal renal function. Symptoms that indicate the development of violations of the electrolyte and acid-base state can be headache, confusion, convulsions, tetany, muscle weakness, heart rhythm disturbances and dyspeptic disorders. The factors,
the main diseases (for example, cirrhosis of the liver or heart failure), concomitant therapy and malnutrition, are contributing to the development of electrolyte disorders. In particular, vomiting and diarrhea may increase the risk of hypokalemia.
Hypovolemia (decrease in the volume of circulating blood) and dehydration (more often in elderly patients), which can lead to hemoconcentration with a tendency to develop thrombosis.

From the side of the cardiovascular system

Excessive reduction in blood pressure, which, especially in elderly patients,
can be manifested by the following symptoms: violation of concentration and psychomotor reactions, headache, dizziness, drowsiness, weakness, visual disorders, dry mouth, violation of orthostatic regulation of blood circulation; collapse.

From the side of metabolism

Increased serum cholesterol and triglyceride levels
, a transient increase in the level of creatinine and urea in the blood, an increase in serum uric acid concentrations, which can cause or exacerbate gout. Decreased tolerance to glucose (possible manifestation of latent diabetes mellitus).

From the urinary system

The appearance or strengthening of symptoms,
due to the existing obstruction of urinary outflow up to acute urinary retention with subsequent complications (for example, with prostatic hypertrophy, narrowing of the urethra, hydronephrosis); hematuria, decreased potency.

From the gastrointestinal tract

Rarely – nausea, vomiting, diarrhea, constipation; individual cases of intrahepatic cholestasis,
increased levels of hepatic transaminases, acute pancreatitis.

From the side of the central nervous system, the organ of hearing

In rare cases, hearing impairment, usually reversible, and / or tinnitus, especially in patients with renal insufficiency or hypoproteinemia (nephrotic syndrome), rarely – paresthesia.

From the skin, allergic reactions

Rarely –
allergic reactions: pruritus, urticaria, other skin rashes or bullous skin lesions, polymorphic erythema, exfoliative dermatitis, purpura, fever, vasculitis, interstitial nephritis, eosinophilia, photosensitivity. It is extremely rare – severe anaphylactic or anaphylactoid reactions up to shock,
which until now have been described only after intravenous administration.

From the peripheral blood

Rarely – thrombocytopenia. In rare cases, leukopenia. In some cases, agranulocytosis, aplastic anemia or hemolytic anemia. Since some adverse reactions (such as a change in the pattern of blood,
severe anaphylactic or anaphylactoid reactions, severe skin allergic reactions) under certain conditions can threaten the life of patients, then if any side effects occur, you should immediately inform them about the doctor.

Indications
edematous syndrome with chronic heart failure;
edematous syndrome with chronic renal failure;
acute renal failure, including those with pregnancy and burns (to maintain fluid excretion);
edematous syndrome with nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease);
edematous syndrome with liver diseases (if necessary in
addition to treatment with aldosterone antagonists);
arterial hypertension.

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