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Tablet: Although Furosemide is used in high doses for oliguria due to chronic or acute renal insufficiency it should not be given in anuria or in renal failure caused by nephrotoxic or hepatotoxic drugs nor in renal failure associated with hepatic coma. Furosemide should not be given in precomatoses states associated with hepatic cirrhosis. It should be used with care in patients with prostatic hyperplasia or impairment of micturition since it can precipitate acute urinary retention.
To reduce the risk of ototoxicity, the manufacturers recommend that Furosemide should not be injected intravenously at a rate exceeding 4 mg per minute although some authorities advise that a single dose of up to 50 mg may be given more rapidly.
Furosemide should be used with caution during pregnancy and breast feeding since it crosses the placenta and also appears in breast milk. Furosemide may compromise placental perfusion by reducing maternal blood volume; it may also inhibit lactation.
Use in Children: The half-life of Furosemide in term and preterm neonates is markedly prolonged compared with that in adults. Half lives of 4.5 to 46 hours have been reported and it has been suggested that the prolongation may be greater in preterm than in term neonates. These effects are due primarily to immature renal function and if repeated doses are necessary over a short period accumulation may occur.
Injection: If particularly higher doses are given over prolonged periods, serum electrolytes should be checked regularly. Potassium-rich diet or potassium drugs should be supplemented. The blood pressure and circulating blood volume of patients in shock should be normalized before treatment. Use with caution to patients with hypertrophy of the prostate and dysuria, as it may cause acute urine retention, elderly people, diabetic patients (increased insulin doses may be necessary), patients in liver cirrhosis associated with ascites, patients with disturbed uric acid metabolism.
