How Long Should You Take Lasix

What is Lasix and how is it used?

Lasix is a prescription medicine used to care for the symptoms of fluid retention (edema) in individuals with congestive middle failure, liver disease or kidney disorder. Lasix may be used alone or with other medications.

Lasix belongs to a class of drugs called Diuretics, Loop.

Information technology is not known if Lasix is safe and effective in children younger than 1 years of historic period when used for treatment of resistant hypertension.

What are the possible side effects of Lasix?

Lasix may cause serious side effects including:

lightheadedness,
ringing in your ears,
hearing loss,
muscle spasms or contractions,
pale skin,
easy bruising,
unusual bleeding,
increased thirst,
increased urination,
dry rima oris,
fruity breath odor,
little or no urination,
swelling in your feet or ankles,
feeling tired,
brusk of breath,
loss of ambition,
upper stomach hurting,
nausea,
airsickness,
dark urine,
yellowing of the skin or eyes (jaundice),
drowsiness,
feeling jittery,
feeling unsteady,
irregular heartbeats,
fluttering in your chest,
numbness or tingling,
muscle cramps, and
muscle weakness or limp feeling

Go medical help correct away, if you have whatever of the symptoms listed above.

The most mutual side furnishings of Lasix include:

diarrhea,
constipation,
loss of appetite,
numbness or tingling,
headache,
dizziness, and
blurred vision

Tell the doctor if you lot accept whatsoever side outcome that bothers you or that does not go away.

These are non all the possible side effects of Lasix. For more than information, inquire your physician or pharmacist.

Phone call your md for medical advice about side effects. Yous may report side effects to FDA at 1-800-FDA-1088.

Warning

LASIX® (furosemide) is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose and dose schedule must be adjusted to the individual patient's needs. (See DOSAGE AND Assistants.)

DESCRIPTION

LASIX® is a diuretic which is an anthranilic acid derivative. LASIX tablets for oral administration comprise furosemide as the active ingredient and the following inactive ingredients: lactose monohydrate NF, magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF. Chemically, information technology is 4-chloro-N-furfuryl-5-sulfamoylanthranilic acrid. LASIX is available equally white tablets for oral administration in dosage strengths of xx, 40 and eighty mg. Furosemide is a white to fair odorless crystalline powder. It is practically insoluble in water, sparingly soluble in alcohol, freely soluble in dilute brine solutions and insoluble in dilute acids.

The CAS Registry Number is 54-31-ix.

The structural formula is every bit follows:

LASIX® (furosemide) Structural Formula Illustration

DOSAGE AND Assistants

Edema

Therapy should be individualized according to patient response to gain maximal therapeutic response and to make up one's mind the minimal dose needed to maintain that response.

Adults

The usual initial dose of LASIX is 20 to 80 mg given every bit a single dose. Usually a prompt diuresis ensues. If needed, the aforementioned dose can be administered vi to 8 hours later or the dose may be increased. The dose may exist raised by 20 or 40 mg and given not sooner than 6 to eight hours later the previous dose until the desired diuretic result has been obtained. The individually adamant single dose should so be given once or twice daily (eg, at 8 am and 2 pm). The dose of LASIX may be carefully titrated upwardly to 600 mg/day in patients with clinically severe edematous states.

Edema may be almost efficiently and safely mobilized past giving LASIX on 2 to four consecutive days each calendar week.

When doses exceeding 80 mg/24-hour interval are given for prolonged periods, careful clinical observation and laboratory monitoring are particularly advisable. (See PRECAUTIONS: Laboratory Tests.)

Geriatric patients

In general, dose selection for the elderly patient should be cautious, usually starting at the low end of the dosing range (see PRECAUTIONS: Geriatric Use).

Pediatric patients

The usual initial dose of oral LASIX in pediatric patients is ii mg/kg body weight, given as a single dose. If the diuretic response is not satisfactory after the initial dose, dosage may be increased by 1 or 2 mg/kg no sooner than vi to viii hours after the previous dose. Doses greater than 6 mg/kg body weight are not recommended. For maintenance therapy in pediatric patients, the dose should be adjusted to the minimum effective level.

Hypertension

Therapy should be individualized according to the patient's response to gain maximal therapeutic response and to determine the minimal dose needed to maintain the therapeutic response.

Adults

The usual initial dose of LASIX for hypertension is 80 mg, commonly divided into twoscore mg twice a mean solar day. Dosage should and so be adjusted co-ordinate to response. If response is not satisfactory, add other antihypertensive agents.

Changes in blood pressure must exist carefully monitored when LASIX is used with other antihypertensive drugs, especially during initial therapy. To prevent excessive drop in blood force per unit area, the dosage of other agents should be reduced by at least fifty percent when LASIX is added to the regimen. Equally the blood pressure falls under the potentiating effect of LASIX, a further reduction in dosage or even discontinuation of other antihypertensive drugs may be necessary.

Geriatric Patients

In general, dose selection and dose adjustment for the elderly patient should be cautious, usually starting at the low end of the dosing range (run into PRECAUTIONS: Geriatric Use).

HOW SUPPLIED

LASIX (furosemide) Tablets xx mg are supplied as white, oval, monogrammed tablets in Bottles of 100 (NDC 0039-0067-10) and 1000 (NDC 0039-0067-lxx). The twenty mg tablets are imprinted with "Lasix®" on i side.

LASIX Tablets 40 mg are supplied as white, round, monogrammed, scored tablets in Bottles of 100 (NDC 0039-0060-13), 500 (NDC 0039-0060-fifty), and 1000 (NDC 0039-0060-70). The 40 mg tablets are imprinted with "Lasix® 40" on one side.

LASIX Tablets 80 mg are supplied as white, circular, monogrammed, facetted border tablets in Bottles of 50 (NDC 0039-0066-05) and 500 (NDC 0039-0066-fifty). The 80 mg tablets are imprinted with "Lasix® eighty" on i side.

Notation: Dispense in well-airtight, light-resistant containers. Exposure to light might cause a slight discoloration. Discolored tablets should not exist dispensed.

Tested past USP Dissolution Test ii

Store at 25° C (77° F); excursions permitted to 15 -30° C (59 -86° F). [Meet USP Controlled Room Temperature.]

Manufactured for: sanofi-aventis U.S. LLC Bridgewater, NJ 08807. A Sanofi Company.. Revised: Mar 2016

DRUG INTERACTIONS

LASIX may increase the ototoxic potential of aminoglycoside antibiotics, specially in the presence of impaired renal function. Except in life-threatening situations, avert this combination.

LASIX should non exist used concomitantly with ethacrynic acid because of the possibility of ototoxicity. Patients receiving loftier doses of salicylates concomitantly with LASIX, equally in rheumatic disease, may feel salicylate toxicity at lower doses because of competitive renal excretory sites.

There is a take chances of ototoxic effects if cisplatin and LASIX are given concomitantly. In addition, nephrotoxicity of nephrotoxic drugs such as cisplatin may be enhanced if LASIX is not given in lower doses and with positive fluid balance when used to achieve forced diuresis during cisplatin handling.

LASIX has a trend to antagonize the skeletal musculus relaxing result of tubocurarine and may potentiate the activity of succinylcholine.

Lithium generally should not be given with diuretics because they reduce lithium's renal clearance and add a high risk of lithium toxicity.

LASIX combined with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers may atomic number 82 to severe hypotension and deterioration in renal part, including renal failure. An interruption or reduction in the dosage of LASIX, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers may be necessary.

Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs.

LASIX may decrease arterial responsiveness to norepinephrine. However, norepinephrine may all the same exist used finer.

Simultaneous assistants of sucralfate and LASIX tablets may reduce the natriuretic and antihypertensive furnishings of LASIX. Patients receiving both drugs should be observed closely to decide if the desired diuretic and/or antihypertensive effect of LASIX is achieved. The intake of LASIX and sucralfate should exist separated by at least two hours.

In isolated cases, intravenous assistants of LASIX within 24 hours of taking chloral hydrate may atomic number 82 to flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia. Use of LASIX concomitantly with chloral hydrate is therefore not recommended.

Phenytoin interferes straight with renal action of LASIX. There is evidence that treatment with phenytoin leads to decrease abdominal absorption of LASIX, and consequently to lower acme serum furosemide concentrations.

Methotrexate and other drugs that, like LASIX, undergo significant renal tubular secretion may reduce the effect of LASIX. Conversely, LASIX may decrease renal elimination of other drugs that undergo tubular secretion. High-dose treatment of both LASIX and these other drugs may result in elevated serum levels of these drugs and may potentiate their toxicity as well as the toxicity of LASIX.

LASIX can increase the adventure of cephalosporin-induced nephrotoxicity fifty-fifty in the setting of pocket-size or transient renal impairment.

Concomitant employ of cyclosporine and LASIX is associated with increased risk of gouty arthritis secondary to LASIX-induced hyperurecemia and cyclosporine impairment of renal urate excretion.

High doses ( > lxxx mg) of furosemide may inhibit the binding of thyroid hormones to carrier proteins and result in transient increase in gratuitous thyroid hormones, followed by an overall decrease in full thyroid hormone levels.

One study in six subjects demonstrated that the combination of furosemide and acetylsalicylic acid temporarily reduced creatinine clearance in patients with chronic renal insufficiency. There are instance reports of patients who developed increased BUN, serum creatinine and serum potassium levels, and weight gain when furosemide was used in conjunction with NSAIDs.

Literature reports indicate that coadministration of indomethacin may reduce the natriuretic and antihypertensive effects of LASIX (furosemide) in some patients by inhibiting prostaglandin synthesis. Indomethacin may also touch plasma renin levels, aldosterone excretion, and renin profile evaluation. Patients receiving both indomethacin and LASIX should be observed closely to determine if the desired diuretic and/or antihypertensive effect of LASIX is achieved.

WARNINGS

In patients with hepatic cirrhosis and ascites, LASIX therapy is best initiated in the infirmary. In hepatic blackout and in states of electrolyte depletion, therapy should non exist instituted until the bones condition is improved. Sudden alterations of fluid and electrolyte rest in patients with cirrhosis may precipitate hepatic coma; therefore, strict observation is necessary during the period of diuresis. Supplemental potassium chloride and, if required, an aldosterone adversary are helpful in preventing hypokalemia and metabolic alkalosis.

If increasing azotemia and oliguria occur during treatment of severe progressive renal illness, LASIX should be discontinued.

Cases of tinnitus and reversible or irreversible hearing harm and deafness have been reported. Reports usually betoken that LASIX ototoxicity is associated with rapid injection, astringent renal damage, the use of higher than recommended doses, hypoproteinemia or concomitant therapy with aminoglycoside antibiotics, ethacrynic acrid, or other ototoxic drugs. If the doc elects to use high dose parenteral therapy, controlled intravenous infusion is appropriate (for adults, an infusion rate not exceeding 4 mg LASIX per infinitesimal has been used). (Encounter PRECAUTIONS: DRUG INTERACTIONS)

PRECAUTIONS

General

Excessive diuresis may crusade dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients. Equally with whatever effective diuretic, electrolyte depletion may occur during LASIX therapy, especially in patients receiving higher doses and a restricted common salt intake. Hypokalemia may develop with LASIX, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant utilize of corticosteroids, ACTH, licorice in large amounts, or prolonged utilize of laxatives. Digitalis therapy may exaggerate metabolic effects of hypokalemia, specially myocardial effects.

All patients receiving LASIX therapy should exist observed for these signs or symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia): dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and airsickness. Increases in blood glucose and alterations in glucose tolerance tests (with abnormalities of the fasting and two-hour postprandial sugar) have been observed, and rarely, precipitation of diabetes mellitus has been reported.

In patients with astringent symptoms of urinary retention (because of bladder elimination disorders, prostatic hyperplasia, urethral narrowing), the administration of furosemide can cause acute urinary retentiveness related to increased production and retentiveness of urine. Thus, these patients require careful monitoring, especially during the initial stages of handling.

In patients at high take chances for radiocontrast nephropathy LASIX can atomic number 82 to a higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received simply intravenous hydration prior to receiving radiocontrast.

In patients with hypoproteinemia (e.g., associated with nephrotic syndrome) the issue of LASIX may be weakened and its ototoxicity potentiated.

Asymptomatic hyperuricemia tin can occur and gout may rarely be precipitated.

Patients allergic to sulfonamides may also be allergic to LASIX. The possibility exists of exacerbation or activation of systemic lupus erythematosus.

As with many other drugs, patients should exist observed regularly for the possible occurrence of blood dyscrasias, liver or kidney damage, or other idiosyncratic reactions.

Laboratory Tests

Serum electrolytes (particularly potassium), CO2, creatinine and BUN should exist adamant frequently during the commencement few months of LASIX therapy and periodically thereafter. Serum and urine electrolyte determinations are particularly important when the patient is vomiting profusely or receiving parenteral fluids. Abnormalities should be corrected or the drug temporarily withdrawn. Other medications may also influence serum electrolytes.

Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency.

Urine and blood glucose should be checked periodically in diabetics receiving LASIX, even in those suspected of latent diabetes.

LASIX may lower serum levels of calcium (rarely cases of tetany have been reported) and magnesium. Appropriately, serum levels of these electrolytes should be adamant periodically.

In premature infants LASIX may precipitate nephrocalcinosis/nephrolithiasis, therefore renal role must exist monitored and renal ultrasonography performed. (See PRECAUTIONS: Pediatric Apply)

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Furosemide was tested for carcinogenicity past oral assistants in one strain of mice and one strain of rats. A small but significantly increased incidence of mammary gland carcinomas occurred in female mice at a dose 17.5 times the maximum human dose of 600 mg. There were marginal increases in uncommon tumors in male rats at a dose of 15 mg/kg (slightly greater than the maximum human dose) but not at 30 mg/kg.

Furosemide was devoid of mutagenic activity in diverse strains of Salmonella typhimurium when tested in the presence or absence of an in vitro metabolic activation organization, and questionably positive for gene mutation in mouse lymphoma cells in the presence of rat liver S9 at the highest dose tested. Furosemide did not induce sis chromatid substitution in human cells in vitro, simply other studies on chromosomal aberrations in homo cells in vitro gave alien results. In Chinese hamster cells it induced chromosomal damage but was questionably positive for sis chromatid substitution. Studies on the induction by furosemide of chromosomal aberrations in mice were inconclusive. The urine of rats treated with this drug did not induce gene conversion in Saccharomyces cerevisiae.

LASIX (furosemide) produced no impairment of fertility in male person or female rats, at 100 mg/kg/day (the maximum effective diuretic dose in the rat and 8 times the maximal human dose of 600 mg/twenty-four hours).

Pregnancy

Pregnancy Category C -Furosemide has been shown to cause unexplained maternal deaths and abortions in rabbits at two, iv and eight times the maximal recommended human being dose. There are no acceptable and well-controlled studies in significant women. LASIX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Treatment during pregnancy requires monitoring of fetal growth because of the potential for college birth weights.

The effects of furosemide on embryonic and fetal development and on pregnant dams were studied in mice, rats and rabbits.

Furosemide caused unexplained maternal deaths and abortions in the rabbit at the lowest dose of 25 mg/kg (2 times the maximal recommended human dose of 600 mg/day). In another written report, a dose of 50 mg/kg (four times the maximal recommended human being dose of 600 mg/24-hour interval) also caused maternal deaths and abortions when administered to rabbits between Days 12 and 17 of gestation. In a third study, none of the significant rabbits survived a dose of 100 mg/kg. Data from the above studies indicate fetal lethality that can precede maternal deaths.

The results of the mouse study and i of the three rabbit studies too showed an increased incidence and severity of hydronephrosis (distention of the renal pelvis and, in some cases, of the ureters) in fetuses derived from the treated dams as compared with the incidence in fetuses from the command group.

Nursing Mothers

Because information technology appears in breast milk, caution should be exercised when LASIX is administered to a nursing mother.

LASIX may inhibit lactation.

Pediatric Use

In premature infants LASIX may precipitate nephrocalcinosis/nephrolithiasis. Nephrocalcinosis/nephrolithiasis has likewise been observed in children under 4 years of historic period with no history of prematurity who accept been treated chronically with LASIX. Monitor renal part, and renal ultrasonography should be considered, in pediatric patients receiving LASIX.

If LASIX is administered to premature infants during the first weeks of life, it may increase the chance of persistence of patent ductus arteriosus

Geriatric Use

Controlled clinical studies of LASIX did non include sufficient numbers of subjects anile 65 and over to decide whether they respond differently from younger subjects. Other reported clinical experience has non identified differences in responses between the elderly and younger patients. In general, dose option for the elderly patient should be cautious, usually starting at the low terminate of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to take decreased renal function, care should be taken in dose selection and it may be useful to monitor renal function. (Run across PRECAUTIONS: Full general and DOSAGE AND ADMINISTRATION.)

Overdosage & Contraindications

OVERDOSE

The master signs and symptoms of overdose with LASIX are aridity, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, and are extensions of its diuretic activity.

The acute toxicity of LASIX has been determined in mice, rats and dogs. In all 3, the oral LD50 exceeded 1000 mg/kg body weight, while the intravenous LD50 ranged from 300 to 680 mg/kg. The astute intragastric toxicity in neonatal rats is vii to ten times that of adult rats.

The concentration of LASIX in biological fluids associated with toxicity or death is not known.

Treatment of overdosage is supportive and consists of replacement of excessive fluid and electrolyte losses. Serum electrolytes, carbon dioxide level and claret pressure should be determined frequently. Adequate drainage must be assured in patients with urinary bladder outlet obstruction (such as prostatic hypertrophy).

Hemodialysis does non accelerate furosemide emptying.

CONTRAINDICATIONS

LASIX is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.

SLIDESHOW

Middle Disease: Symptoms, Signs, and Causes See Slideshow

CLINICAL PHARMACOLOGY

Investigations into the mode of action of LASIX have utilized micropuncture studies in rats, end flow experiments in dogs and various clearance studies in both humans and experimental animals. It has been demonstrated that LASIX inhibits primarily the absorption of sodium and chloride not merely in the proximal and distal tubules but besides in the loop of Henle. The high degree of efficacy is largely due to the unique site of activity. The action on the distal tubule is independent of any inhibitory outcome on carbonic anhydrase and aldosterone.

Contempo prove suggests that furosemide glucuronide is the just or at least the major biotransformation product of furosemide in man. Furosemide is extensively spring to plasma proteins, mainly to albumin. Plasma concentrations ranging from 1 to 400 μg/mL are 91 to 99% bound in healthy individuals. The unbound fraction averages 2.iii to 4.1% at therapeutic concentrations.

The onset of diuresis post-obit oral administration is within 1 hour. The height issue occurs within the starting time or second 60 minutes. The duration of diuretic effect is 6 to viii hours.

In fasted normal men, the hateful bioavailability of furosemide from LASIX Tablets and LASIX Oral Solution is 64% and 60%, respectively, of that from an intravenous injection of the drug. Although furosemide is more rapidly captivated from the oral solution (50 minutes) than from the tablet (87 minutes), pinnacle plasma levels and area under the plasma concentration-time curves practice not differ significantly. Peak plasma concentrations increase with increasing dose but times-topeak do not differ among doses. The terminal half-life of furosemide is approximately 2 hours.

Significantly more furosemide is excreted in urine following the 4 injection than afterward the tablet or oral solution. There are no significant differences between the two oral formulations in the amount of unchanged drug excreted in urine.

Geriatric Population

Furosemide binding to albumin may be reduced in elderly patients. Furosemide is predominantly excreted unchanged in the urine. The renal clearance of furosemide after intravenous administration in older healthy male person subjects (60-70 years of age) is statistically significantly smaller than in younger healthy male subjects (20-35 years of age). The initial diuretic effect of furosemide in older subjects is decreased relative to younger subjects. (See PRECAUTIONS: Geriatric Employ.)

PATIENT INFORMATION

Patients receiving LASIX should exist brash that they may experience symptoms from excessive fluid and/or electrolyte losses. The postural hypotension that sometimes occurs tin can usually exist managed past getting up slowly. Potassium supplements and/or dietary measures may exist needed to command or avert hypokalemia.

Patients with diabetes mellitus should be told that furosemide may increase blood glucose levels and thereby affect urine glucose tests. The pare of some patients may exist more sensitive to the effects of sunlight while taking furosemide.

Hypertensive patients should avoid medications that may increase blood pressure, including over-the-counter products for appetite suppression and cold symptoms.

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