Monitor 

Monitor for possible occurrence of blood dyscrasia and liver damage. Monitor urine and blood glucose in diabetes. Frequently monitor serum electrolytes, magnesium, calcium, CO 2 , uric acid, and renal function early in therapy and periodically thereafter during active diuresis. Assess patients for signs or symptoms of fluid or electrolyte imbalance. 

Pregnancy 

Category C . 

Lactation 

Excreted in breast milk. 

Children 

May increase incidence of patent ductus arteriosus in premature infants with respiratory distress syndrome, especially in first few weeks of life. 

Hypersensitivity 

Patients with known sulfonamide sensitivity may show  allergic reactions to furosemide. 

Renal Function 

Discontinue if increasing azotemia  and oliguria occur during treatment of severe progressive renal disease. 

Photosensitivity 

May occur. 

Dehydration 

Excessive diuresis may cause dehydration  and decreased blood volume with circulatory collapse and possible vascular thrombosis and embolism,  especially in elderly cardiac patients. 

Diarrhea 

Furosemide solution vehicle contains sorbitol and may induce diarrhea, especially in children. 

Glucose intolerance 

May increase  blood glucose; precipitation of diabetes mellitus has been reported rarely. 

Hepatic cirrhosis 

Sudden alterations of electrolyte balance may precipitate hepatic  and coma; monitor carefully. 

Hyperuricemia/gout 

Asymptomatic hyperuricemia can occur; gout may rarely be precipitated. 

Ototoxicity (deafness, tinnitus, vertigo) 

Associated with rapid injection, severe renal impairment, very large doses,  or concurrent use of other ototoxic drugs. Usually reversible within  1 to 24 h, but may be permanent in some patients. Infusion rates not exceeding 4 mg/min may reduce risk. 

Systemic lupus erythematosus 

May be exacerbated  or activated. 

Overdosage 

Symptoms 

Dehydration, electrolyte imbalance, hypochloremic alkalosis, hypokalemia, hypotension, reduction of blood volume. 

Patient Information 

• Injection 
• Advise patient  or caregiver that injection is used when a rapid onset of diuresis is needed, when GI absorption is impaired,  or when taking oral medications is not practical, and that conversion to oral therapy will be made as soon as possible. 
• Tablets and oral solution 
• Advise patient to take prescribed dose without regard to meals but to take with food  if stomach upset occurs. 
• Advise patient or caregiver using oral solution  to measure and administer prescribed dose using supplied dosing cup, calibrated dosing syringe,  or calibrated dosing spoon. 
• Advise patient that medication will increase urination and  not to take before bedtime or before activities in which increased urination would be a problem. Instruct patient that if dose is delayed to take the dose later in the day to prevent interference with activities. Caution patient not to skip doses. 
• Caution patient not to change the dose or stop  taking unless advised by health care provider. 
• Ensure patient understands how to implement fluid and salt restriction if prescribed as part of therapeutic regimen. 
• Instruct patient to lie or sit down  if they experience dizziness  or lightheadedness when standing. 
• Caution patient  that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting. 
• Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings. 
• Caution patient  to avoid unnecessary exposure to UV light (sunlight, tanning booths)  and to use sunscreen and  wear protective clothing when exposed  to UV light until tolerance is determined. 
• Advise women to notify health care provider if pregnant, planning to become pregnant,  or breastfeeding. 
• Instruct patient to inform health care provider  if any of  the following occur: muscle pain, weakness, or cramps; persistent nausea or vomiting; diarrhea; excessive thirst; unexplained tiredness; drowsiness; dizziness or feeling of  the room spinning; ringing in the ears or decreased hearing; confusion or changes in thinking; increased heart rate; unexplained joint pain; abnormal skin sensations.