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Lasix - instructions for use, reviews, analogs and formulations (40 mg tablets, injections in ampoules for intramuscular and intravenous injections), a diuretic for the treatment of edematous syndrome in adults, children and pregnancy

Lasix - instructions for use, reviews, analogs and formulations (40 mg tablets, injections in ampoules for intramuscular and intravenous injections), a diuretic for the treatment of edematous syndrome in adults, children and pregnancy

In this article, you can read the instructions for using the drug Lasix. There are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists in the use of diuretic Lasix in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Lasix in the presence of existing structural analogs.Use for the treatment of edematous syndrome and hypertensive crisis in adults, children, as well as during pregnancy and lactation.

 

Lasix - strong and quick-acting diuretic, which is a derivative of sulfonamide. Lasix blocks the transport system of ions Na +, K +, Cl- in the thick segment of the ascending knee of the Henle loop, and therefore, its diuretic effect depends on the drug entering the lumen of the renal tubules (due to the mechanism of anion transport). The diuretic effect of Lasix is ​​associated with the inhibition of the reabsorption of sodium chloride in this section of the Henle loop. Secondary effects on the increase in sodium excretion are: an increase in the amount of urine released (due to osmotically bound water) and an increase in the secretion of potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. When the tubular secretion of Furosemide decreases or when the drug binds to the albumin located in the lumen of the tubules (for example, in a nephrotic syndrome), the effect of furosemide decreases.

 

At the course of taking Lasix, his diuretic activity does not decrease,since the drug interrupts the tubular-glomerular feedback in Macula densa (tubular structure closely related to the juxtaglomerular complex). Lasix causes dose-dependent stimulation of the renin-angiotensin-aldosterone system.

 

With heart failure, Lasix quickly reduces preload (by expanding the veins), reduces pulmonary artery pressure and the filling pressure of the left ventricle. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which this effect also requires sufficient preservation of kidney function.

 

The drug has an antihypertensive effect, which is caused by increased sodium excretion, a decrease in the volume of circulating blood and a decrease in the response of the smooth muscles of the vessels to vasoconstrictive stimuli (due to the natriuretic effect, furosemide decreases the response of the vessels to catecholamines, whose concentration in patients with arterial hypertension is increased).

 

After oral administration of 40 mg of Lasix, the diuretic effect begins within 60 minutes and lasts about3-6 hours

 

In healthy volunteers who received 10 to 100 mg of Lasix, there was a dose-dependent diuresis and sodium naresis.

 

Composition

 

Furosemide + excipients.

 

Pharmacokinetics

 

Furosemide is rapidly absorbed into the digestive tract. In patients, the bioavailability of Lasix can be reduced to 30%, since it can be influenced by various factors, including the underlying disease. Furosemide binds very strongly to blood plasma proteins (more than 98%), mainly with albumins. Furosemide is excreted mainly unchanged and mainly through secretion in the proximal tubules. Glucuronated furosemide metabolites are 10-20% of the kidney-excreted drug. The rest of the dose is released through the intestine, apparently through biliary secretion. Furosemide penetrates the placental barrier and is excreted in the mother's milk. Its concentration in the fetus and the newborn is the same as that of the mother.

 

With renal failure, the excretion of furosemide slows down, and the elimination half-life increases.

 

In the nephrotic syndrome, a decrease in plasma protein concentrations leads to an increase in the concentrations of unbound furosemide (its free fraction), which increases the risk of ototoxic action.On the other hand, the diuretic effect of furosemide in these patients can be reduced by binding furosemide to albumin in the tubules and reducing the tubular secretion of furosemide.

 

With hemodialysis and peritoneal dialysis and permanent outpatient peritoneal dialysis, furosemide is not significantly excreted.

 

With heart failure, severe arterial hypertension and in the elderly, the excretion of furosemide slows down due to decreased kidney function.

 

Indications

  • edematous syndrome with chronic heart failure;
  • edematous syndrome with chronic renal failure;
  • acute renal failure, including those with pregnancy and burns (to maintain fluid excretion);
  • edematous syndrome with nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease);
  • edematous syndrome with liver diseases (if necessary in addition to treatment with aldosterone antagonists);
  • cerebral edema;
  • hypertensive crisis;
  • arterial hypertension;
  • maintenance of forced diuresis in case of poisoning with chemical compounds, excreted kidneys in unchanged form.

 

Forms of release

 

Tablets of 40 mg.

 

Solution for intravenous and intramuscular injection (injections in ampoules for injection).

 

Instructions for use and dosage

 

General recommendations

 

When prescribing Lasix, it is recommended to use its lowest doses, sufficient to achieve the necessary therapeutic effect. Tablets should be taken on an empty stomach without chewing and drinking with a sufficient amount of liquid. The ampoule form of the drug is administered intravenously and in exceptional cases intramuscularly (when intravenous or oral administration is not possible). Intravenous introduction of the drug Lasix is ​​carried out only if the intake of the drug inside is not possible or there is a violation of absorption of the drug in the small intestine or if it is necessary to obtain the most rapid effect. When using intravenous lasix, it is always advisable to transfer the patient as soon as possible to oral Lasix.

 

With intravenous administration, Lasix should be administered slowly. The rate of intravenous administration should not exceed 4 mg per minute.In patients with severe renal failure (serum creatinine> 5 mg / dl), it is recommended that the intravenous rate of Lasix does not exceed 2.5 mg per minute. For optimal efficiency and suppression of the counter-regulation (activation of the renin-angiotensin and antinatriuretic neurohumoral regulating units), a prolonged intravenous intravenous injection of the Lasix preparation should be preferred as compared to the repeated intravenous administration of the drug. If after one or more bolus intravenous injections in acute conditions there is no possibility of a continuous intravenous infusion, it is more preferable to administer low doses with small intervals between administrations (approximately 4 hours) than intravenous bolus administration of higher doses with longer time intervals between introductions.

 

The solution for parenteral administration has a pH of about 9 and does not have buffer properties. At a pH below 7, the active ingredient may fall into the sediment, so when diluting Lasix it is necessary to strive,so that the pH of the resulting solution ranged from neutral to slightly alkaline. You can use physiological saline for breeding. A diluted solution of Lasix should be used as early as possible. The recommended maximum daily dose for intravenous administration for adults is 1500 mg. In children, the recommended dose for parenteral administration is 1 mg / kg body weight (but not more than 20 mg per day). The duration of treatment is determined by the doctor individually, depending on the indications.

 

Special recommendations on the dosing regimen in adults

 

Edema Syndrome in Chronic Heart Failure

 

The recommended initial dose is 20-80 mg per day. The necessary dose is selected depending on the diuretic response. It is recommended that the daily dose be administered 2-3 times.

 

Edema in acute heart failure

 

The recommended initial dose is 20-40 mg as an intravenous bolus. If necessary, the dose of Lasix can be adjusted depending on the therapeutic effect.

 

Edema Syndrome in Chronic Renal Failure

 

The natriuretic reaction to furosemide depends on several factors, including the severity of renal failure and the sodium content in the blood, so the effect of the dose can not be exactly predictable. Patients with chronic renal failure require a careful dose selection, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, a loss of fluid up to approximately 2 kg of body weight per day is possible).

 

In patients on hemodialysis, the usual maintenance dose is 250-1500 mg per day.

 

With intravenous administration, the dose of furosemide can be determined as follows: treatment is started with intravenous drip administration at a rate of 0.1 mg per minute, and then gradually increase the rate of administration every 30 minutes, depending on the therapeutic effect.

 

Acute renal failure (to maintain the excretion of fluid)

 

Before starting treatment with Lasix, hypovolemia, arterial hypotension and significant disturbances of the electrolyte and acid-base state should be eliminated. It is recommended,that the patient as soon as possible was transferred from an intravenous introduction of the preparation Lasix to taking Lasik tablets (the dose of tablets depends on the selected intravenous dose). The recommended initial intravenous dose is 40 mg. If, after its administration, the necessary diuretic effect is not achieved, then Lasix can be administered in the form of continuous intravenous infusion, starting at an administration rate of 50-100 mg per hour.

 

Edema with nephrotic syndrome

 

The recommended initial dose is 20-40 mg per day. The necessary dose is selected depending on the diuretic response.

 

Edema syndrome with liver diseases

 

Furosemide is prescribed in addition to treatment with aldosterone antagonists in case of their insufficient effectiveness. To prevent the development of complications, such as disturbing the orthostatic regulation of the circulation or disturbing the electrolyte or acid-base state, careful selection of the dose is required so that the fluid loss occurs gradually (at the beginning of the treatment, a loss of liquid up to approximately 0.5 kg of body weight per day is possible). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.

 

Hypertensive crisis, cerebral edema

 

The recommended initial dose is 20-40 mg by intravenous bolus administration. The dose can be adjusted depending on the effect.

 

Maintenance of forced diuresis in poisoning

 

Furosemide is administered after intravenous infusion of electrolyte solutions. The recommended initial dose for intravenous administration is 20-40 mg. The dose depends on the reaction to furosemide. Before and during treatment, Lasix should monitor and repair fluid and electrolyte losses.

 

Arterial hypertension

 

Lasix can be used in monotherapy or in combination with other antihypertensive drugs. The usual maintenance dose is a dose of 20-40 mg per day. With arterial hypertension in combination with chronic renal failure, higher doses of Lasix may be required.

 

Side effect

  • hyponatremia, hypochloraemia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis;
  • headache;
  • confusion of consciousness;
  • convulsions;
  • muscle weakness;
  • heart rhythm disturbances;
  • dyspeptic disorders;
  • excessive decrease in blood pressure;
  • violation of concentration and psychomotor reactions;
  • headache;
  • dizziness;
  • drowsiness;
  • weakness;
  • dry mouth;
  • collapse;
  • increased serum cholesterol and triglyceride levels;
  • a decrease in glucose tolerance (a manifestation of latent diabetes mellitus is possible);
  • hematuria;
  • decreased potency;
  • nausea, vomiting;
  • diarrhea;
  • constipation;
  • hearing impairment, usually reversible;
  • tinnitus, especially in patients with renal insufficiency or hypoproteinemia (nephrotic syndrome);
  • allergic reactions: pruritus, urticaria, other skin rashes or bullous skin lesions, polymorphic erythema, exfoliative dermatitis, purpura, fever, vasculitis, interstitial nephritis, eosinophilia, photosensitivity;
  • Thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia or hemolytic anemia.

 

Contraindications

  • Renal failure with anuria (in the absence of reaction to furosemide);
  • hepatic coma and precoma;
  • pronounced hypokalemia;
  • severe hyponatremia;
  • hypovolemia (with or without arterial hypotension) or dehydration;
  • marked abnormalities of urine outflow from any etiology (including unilateral urinary tract damage);
  • digitalis intoxication;
  • acute glomerulonephritis;
  • decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy;
  • increased central venous pressure (more than 10 mm Hg);
  • hyperuricemia;
  • children's age up to 3 years (solid dosage form);
  • pregnancy;
  • the period of lactation.
  • hypersensitivity to the active substance or to any of the components of the drug; in patients with an allergy to sulfonamides (sulfonamide antimicrobial agents or sulfonylureas), there may be a cross-allergy to furosemide.

 

Application in pregnancy and lactation

 

Lasix penetrates the placental barrier, so it should not be administered during pregnancy. If, for vital reasons, Lasix is ​​prescribed to pregnant women, careful monitoring of the fetus is necessary.

 

During lactation, Lasik's treatment is contraindicated. Furosemide inhibits lactation.

 

Use in children

 

Contraindicated in children under 3 years of age (solid dosage form).

 

special instructions

 

Before the beginning of treatment by Lasix it is necessary to exclude presence of sharply expressed infringements of outflow of urine, including one-sided.

 

Patients with partial impairment of urinary outflow need careful monitoring, especially at the beginning of treatment with Lasix.

 

During treatment, Lasik usually requires regular monitoring of serum concentrations of sodium, potassium and creatinine, especially careful monitoring should be carried out in patients with a high risk of developing water-electrolyte balance disorders in cases of additional loss of fluid and electrolytes (eg, due to vomiting, diarrhea, or severe sweating).

 

Before and during treatment, Lasix should be monitored and, in case of occurrence, eliminated hypovolemia or dehydration, as well as clinically significant disturbances of the water-electrolyte and / or acid-base state, which may require a short-term cessation of Lasix treatment.

 

When treating Laziksom it is always advisable to eat foods rich in potassium (lean meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). In some cases, the intake of potassium preparations or the administration of potassium-sparing drugs may be indicated.

 

In everyday life there are wrong statements about the use of Lasix as a means of losing weight.Such an approach can not be scientific and correct, since the effect of using this drug to reduce excess weight will be short-term (while taking the medicine), after that a set of lost mass will occur.

 

Some side effects (for example, a significant reduction in blood pressure and the accompanying symptoms) can impair the ability to concentrate and reduce psychomotor reactions, which can be dangerous when driving or working with machinery. Especially it refers to the period of starting treatment or increasing the dose of the drug, as well as to the cases of simultaneous administration of antihypertensive drugs or ethanol (alcohol).

 

Drug Interactions

 

Cardiac glycosides, drugs that cause prolongation of the QT interval in the case of development of electrolyte disturbances (hypokalemia or hypomagnesemia) on the background of furosemide intake increase the toxic effect of cardiac glycosides and drugs that cause prolongation of the QT interval (the risk of rhythm disturbances increases).

 

Glucocorticosteroids, carbenox solon, licorice in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of hypokalemia.

 

Aminoglycosides - a delay in excretion of aminoglycosides by the kidneys when they are used simultaneously with furosemide and an increased risk of development of ototoxic and nephrotoxic action of aminoglycosides. For this reason, use of this combination of drugs should be avoided, except when necessary for life indications, in which case correction (reduction) of maintenance doses of aminoglycosides is required.

 

Medicines with nephrotoxic action - when combined with Lasix, the risk of developing their nephrotoxic effect increases.

 

High doses of some cephalosporins (especially those with a predominantly renal excretory pathway) - in combination with furosemide, the risk of nephrotoxic action increases.

 

Cisplatin - with simultaneous use with furosemide, there is a risk of developing an ototoxic effect. In addition, in the case of co-administration of Cisplatin and furosemide in doses above 40 mg (with normal renal function), the risk of developing nephrotoxic effects of cisplatin increases.

 

Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid, can reduce the diuretic effect of Lasix.In patients with hypovolemia and dehydration (including those taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide can enhance the toxic effect of salicylates.

 

Phenytoin - a decrease in the diuretic effect of Lasix.

 

Hypotensive drugs, diuretics or other means that can reduce blood pressure - when combined with furosemide, a more pronounced hypotensive effect is expected.

 

Angiotensin converting enzyme (ACE) inhibitors - the appointment of an ACE inhibitor to patients previously treated with furosemide may lead to an excessive decrease in blood pressure with impaired renal function, and in some cases to the development of acute renal failure, so three days before initiation of treatment with inhibitors ACE or increase in their dose, it is recommended that furosemide be withdrawn or reduced.

 

Probenicides, methotrexate, or other drugs that, like furosemide, are secreted in the renal tubules, can reduce the effects of furosemide (the same pathway of kidney secretion), on the other hand furosemide can lead to a decrease in the excretion of these drugs by the kidneys.

 

Hypoglycemic drugs, pressor amines (epinephrine, norepinephrine) - attenuation effects when combined with Lasix.

 

Theophylline, diazoxide, curare-like muscle relaxants - enhancing effects when combined with furosemide.

 

Lithium salts - under the influence of furosemide, lithium excretion decreases, which increases the serum concentration of lithium and increases the risk of toxic effects of lithium, including its damaging effects on the heart and nervous system. Therefore, when using this combination, control of serum lithium concentrations is required.

 

Sucralfate - reducing suction furosemide and its attenuation effect (furosemide and sucralfate should be taken at intervals of not less than two hours).

 

Cyclosporin A - when combined with Lasix increased risk of gout due to hyperuricemia caused furosemide, cyclosporin and impaired kidney urate excretion.

 

Radiopaque substances - in patients with a high risk of developing nephropathy for the introduction of radiocontrast preparations receiving furosemide, a higher incidence of renal dysfunction was observed compared to patients at high risk of developing nephropathy for the introduction of radiocontrast preparations,who received only intravenous hydration before the introduction of the radiopaque preparation.

 

Analogues of the drug Lasix

 

Structural analogs for the active substance:

  • Furon;
  • Furosemide;
  • Fursemide.

 

Analogues for the pharmacological group (diuretics):

  • Aquaphor;
  • Acrypamide;
  • Acrypamide retard;
  • Acutor Sanovel;
  • Aldactone;
  • Arindap;
  • Arifon;
  • Brinaldiks;
  • Brusniver;
  • Bufenox;
  • Verospilactone;
  • Veroshpiron;
  • Hygroton;
  • Hydrochlorothiazide;
  • Hypothiazide;
  • Diakarb;
  • Diver;
  • Isobar;
  • Indap;
  • Indapamide;
  • Inder;
  • Ionik;
  • Kanefron H;
  • Clopamid;
  • Cristepin;
  • Lespenefril;
  • Lasersflain;
  • Lescopryl;
  • Lauras;
  • Mannitol;
  • Mannitol;
  • Urea;
  • Niebelong H;
  • Normatens;
  • Oxodoline;
  • Spironol;
  • Spironolactone;
  • Torasemide;
  • Triamtel;
  • Urakton;
  • Urological (diuretic) collection;
  • Phytolysin;
  • Cimalon.

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Reviews (2):
Guests
Rifat
My brother is lying with a spinal injury for 41 years. Among other sores, there are problems with urination. Recently, after poisoning with sleeping pills, the nurse put the Sodium Chloride system at 0.9%. There and then pierced and Lasix. Leaving the nurse recommended to continue to continue to prick Lasix: "If you can not do it intravenously, you can also intramuscularly." Kohl once a day at night, very helpful. It is a pity, there is no one to consult about the frequency and duration of application of Lasix and others. To the local doctor and paramedics, the ambulance's confidence dropped to zero. Judge for yourself - after acute poisoning, the brother is unconscious, and they prescribed him to take activated charcoal tablets and that's it. Wash your hands and went with a clear conscience.
Guests
Sergej
Boiling oil got on the shin, managed to use the panthenol. The burn area was 17 cm2.
After 7 days, legs began to swell (both in the region of the shins), not one foot did not fit into one's shoes. The doctor among the main methods of anti-burn treatment, prescribed lasix for 40 mg tablets once a day. After three days of taking the tumor, the burn was healed, the doctor canceled taking the pills.
Thank you very much for the drug.

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