Furosemide*

• Furosemide

• Lasix

Classification:

• Diuretic

Mechanism of Action:

• Loop diuretic, inhibits reabsorption of sodium (and other electrolytes) and water
• Initially causes vasodilatation, increasing venous capacitance (decreasing SVR) then diuresis

Indications:

•  Circulatory overload
  • Acute pulmonary edema
  • CHF
  • Hypertensive emergency

Contraindications:

• Sulfonamide allergy
• Electrolyte imbalances (Hypokalemia etc.)
• Hypotension/hypovolemia (SBP < 100 mmHg)
• Pregnancy
• Anuric renal failure

Precautions:

• Administration of furosemide to patients with pneumonia increases mortality; it can be difficult to distinguish heart failure from other conditions such as pneumonia therefore should not be given until patient has been diagnosed with fluid overload.
• Administer furosemide with caution in patients with a fever (temperature greater than 38°C), as fever often indicates an infectious process such as sepsis or pneumonia and these patients should not receive furosemide. 

Adverse Effects:

• Dysrhythmias
• Metabolite disturbances
• Tinnitus
• Nausea and vomiting

Dose:

• 40 mg slow IV push or as directed by sending facility (If using during transfer)

• IV

• Heart failure responds best to nitrates and positive pressure (e.g., CPAP/PEEP); furosemide is a 3rd line agent.
• Pregnancy category C [if the patient will benefit from a Category C drug, it is generally used]

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2nd Edition