Pharmacological action of Furosemide 40 mg:
Furosemide “Loop” diuretics, is fast approaching, and a strong short-term diuresis. It has a natriuretic and hlorureticheskim effects, increases the excretion of K +, Ca2 +, Mg2 +. Getting into the lumen of renal tubules in the thick ascending segment of the tribe of Henle’s loop, blocks the reabsorption of Na + and Cl-. Due to increasing Na + release is a secondary (indirect osmotically bound water) increased excretion of water and an increase in K + secretion in the distal renal tubule. Simultaneously, the excretion of Ca2 + and Mg2 +. Has the secondary effects caused by the release of neurotransmitters and intrarenal redistribution of intrarenal blood flow. Against the background of a course of treatment is no weakening effect. In heart failure quickly leads to a reduction of preload on the heart through the expansion of large veins. It has a hypotensive effect due to increased excretion of NaCl and reduce vascular smooth muscle response to the vasoconstrictor effects and by reducing the BCC. Effect of furosemide after / in the introduction occurs in 5-10 min after oral administration – after 30-60 minutes, maximum of – after 1-2 hours, duration of effect – 2-3 hours (reduced kidney function – up to 8 hours) . During the period of excretion of Na + is greatly increased, but following his termination of the elimination rate is reduced below the initial level (the syndrome of “bounce” or “cancel”). The phenomenon is due to a sharp activation of the renin-angiotensin and other antinatriuretic neurohumoral regulation of the units in response to a massive diuresis, stimulates arginine vazopressivnuyu and sympathetic systems. Reduces the incidence of atrial natriuretic factor in the plasma, causing vasoconstriction. Due to the phenomenon of “rebound” when taking a once a day may not have a significant impact on the daily excretion of Na + and blood pressure.
Indications Furosemide 40 mg:
Edematous syndrome in CHF II-III century., Liver cirrhosis, kidney disease (including nephrotic syndrome on the background), acute heart failure (pulmonary edema), cerebral edema, hypertensive crisis (either alone or in combination with other antihypertensive drugs ), hypertension (Severe), hypercalcemia, conducting forced diuresis in cases of poisoning by chemicals that are excreted renally as unchanged; eclampsia.
Contraindications Furosemide 40 mg:
Hypersensitivity, acute renal failure with anuria (the value of glomerular filtration rate less than 3.5 ml / min), severe hepatic failure, hepatic coma and precoma, urethral stenosis, acute glomerulonephritis, obstruction of the urinary tract stone prekomatoznogo state, hyperglycemic coma, hyperuricemia, gout , decompensated mitral or aortic stenosis, GOKMP, increased central venous pressure (above 10 mm Hg), hypotension, acute myocardial infarction, pancreatitis, impaired water and electrolyte metabolism (hypovolemia, hyponatremia, hypokalemia, chloropenia, hypocalcemia, hypomagnesemia) , digitalis intoksikatsiya.C caution. Prostatic hyperplasia, SLE, hypoproteinemia (risk of ototoxicity), diabetes (impaired glucose tolerance), constrictive atherosclerosis of cerebral arteries, pregnancy (especially the first half, can be applied to health), lactation.
Side effects of Furosemide 40 mg:
From the CCC: lowering blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decreased BCC. Nervous system disorders: dizziness, headache, myasthenia gravis, leg cramps (tetany), paresthesia, lethargy, weakness, fatigue, lethargy, drowsiness, confusion. From the senses: visual and hearing impairment. From the digestive system: loss of appetite, dry mouth, thirst, nausea, vomiting, constipation or diarrhea, cholestatic jaundice, pancreatitis (acute). Genitourinary: oliguria, urinary retention (in patients with prostatic hypertrophy), interstitial nephritis, hematuria, reduced potency. Allergic Reactions: purpura, urticaria, exfoliative dermatitis, erythema multiforme, vasculitis, necrotizing vasculitis, pruritus, chills, fever, photosensitivity, anaphylactic shock. On the part of hematopoiesis: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia. From the water-electrolyte metabolism: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponatremia, chloropenia, hypocalcemia, hypomagnesemia, metabolic alkalosis. Laboratory findings: hyperglycemia, hypercholesterolemia, hyperuricaemia, glycosuria, hypercalciuria. With / in the introduction (optional) – thrombophlebitis, renal calcinosis in preterm detey.Peredozirovka. Symptoms: decreased blood pressure, collapse, shock, hypovolemia, dehydration, haemoconcentration, arrhythmias (including AV block, ventricular fibrillation), acute renal failure with anuria, thrombosis, thromboembolism, drowsiness, confusion, flaccid paralysis, apathy. Treatment: correction of water-salt balance and CBS, filling the BCC, symptomatic treatment. No specific antidote.
Dosage and administration Furosemide 40 mg:
V / a (rare / m), parenteral administration is advisable to carry out in those cases where there is no possibility of taking him inside – in urgent situations or when a pronounced edema. Edematous syndrome: initial dose – 40 mg. In / in a hold for 1-2 min in the absence of diuretic response is administered every 2 h in a 50% increase dose to achieve adequate diuresis. Average daily dose for the i / v administration in children – 0.5-1.5 mg / kg, maximum – 6 mg / kg. Patients with decreased glomerular filtration and diuretic response to low administered in large doses – 1-1.5, the maximum single dose – 2 grams Inside, in the morning, before meals, the average single initial dose – 20-80 mg in the absence of diuretic dose increased response to 20-40 mg every 6-8 hours to obtain adequate diuretic response. A single dose if necessary, may be increased to 600 mg or more (required for reducing the quantity of glomerular filtration and hypoproteinemia). When hypertension is prescribed 20-40 mg, in the absence of an adequate blood pressure lowering treatment is necessary to attach other antihypertensive drugs. If you are adding to the already designated furosemide antihypertensive drugs the dose should be reduced by a factor of 2. Initial single dose in children is 2 mg / kg, maximum – 6 mg / kg.
Cautions Furosemide 40 mg:
On the background of a course of treatment should be monitored periodically in blood pressure, concentration of electrolytes in the plasma (including Na +, Ca2 +, K +, Mg2 +), CBS, residual nitrogen, creatinine, uric acid, liver function and carry out, if necessary, appropriate correction of treatment (with multiplicity greater in patients with frequent vomiting and against parenterally administered fluids). Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to furosemide. Patients receiving high-dose furosemide, to avoid the development of hyponatremia and metabolic alkalosis inappropriate to limit consumption of salt. For prevention of hypokalemia is recommended to co-administration of drugs and K + potassium-sparing diuretics (especially spironolactone), and a diet rich in K +. The increased risk of disorders of fluid and electrolyte balance observed in patients with renal insufficiency. Selection of dosing regimen for patients with ascites on the background of cirrhosis of the liver should be carried out in stationary conditions (violations of water-electrolyte balance may lead to the development of hepatic coma). These patients shows regular monitoring of electrolytes in the plasma. When a gain or azotemia and oliguria in patients with severe progressive renal disease is recommended to stop treatment. Excreted in milk in lactating women, and therefore the appropriate cessation of feeding. In patients with diabetes or with impaired glucose tolerance requires periodic monitoring of glucose in blood and urine. Patients in an unconscious state, with hypertrophy of the prostate, narrowing of the ureter or hydronephrosis is necessary to monitor urine output due to the possibility of acute urinary retention. During treatment sessions should be avoided in potentially hazardous activities that require attention and psychomotor speed of reaction.
Interaction of Furosemide 40 mg:
Increasing the concentration and the risk of nephrotoxicity and Valium actions cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to renal elimination of competition). Improves the effectiveness of diazoxide and theophylline reduces – hypoglycemic drugs, allopurinol. Reduces the renal clearance of Li + and drugs increases the risk of intoxication. Enhances the hypotensive effect of antihypertensive drugs, neuromuscular blockade induced by depolarizing muscle relaxants (suxamethonium) and reduces the effect of nondepolarizing muscle relaxants (tubocurarine). Pressor amines and mutually reduce the effectiveness of furosemide. Drugs that block tubular secretion, increase the concentration of furosemide in serum. With simultaneous use of corticosteroids, amphotericin B increases the risk of hypokalemia, cardiac glycosides, increases the risk of digitalis toxicity due to hypokalemia (for high-and nizkopolyarnyh cardiac glycosides) and lengthening of T1 / 2 (for nizkopolyarnyh). NSAIDs, sucralfate reduces the diuretic effect by inhibiting the synthesis of Pg, changes in the concentration of plasma renin and aldosterone release. Receiving salicylates in high doses during therapy with furosemide increases the risk of developing toxicity (due to renal elimination of competition). B / B input furosemide is slightly alkaline, so it should not be confused with drugs with a pH less than 5.5.
