Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Furosemide is a potent diuretic (water pill)
that is used to eliminate water and salt from the body. In the kidneys, salt
(composed of sodium and chloride), water, and other small molecules normally are
filtered out of the blood and into the tubules of the kidney. The filtered fluid
ultimately becomes urine. Most of the sodium, chloride and water that is
filtered out of the blood is reabsorbed into the blood before the filtered fluid
becomes urine and is eliminated from the body. Furosemide works by blocking the
absorption of sodium, chloride, and water from the filtered fluid in the kidney
tubules, causing a profound increase in the output of urine (diuresis). The
onset of action after oral administration is within one hour, and the diuresis
lasts about 6-8 hours. The onset of action after injection is five minutes and
the duration of diuresis is two hours. The diuretic effect of furosemide can
cause depletion of sodium, chloride, body water and other minerals. Therefore,
careful medical supervision is necessary during treatment. The FDA approved
furosemide in July 1982.
STORAGE: Furosemide should be stored at room temperature in a light
resistant container.
PRESCRIBED FOR: Furosemide is a powerful diuretic that is used to
treat excessive accumulation of fluid and/or swelling (edema) of the body caused
by heart failure,
cirrhosis, chronic kidney failure, and the nephrotic syndrome.
It is sometimes used alone or in conjunction with other blood pressure pills to
treat high blood pressure.
DOSING: The usual starting oral dose for treatment of edema in adults
is 20-80 mg as a single dose. The same dose or an increased dose may be
administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours
until the desired effect occurs. The effective dose may be administered once or
twice daily. Some patients may require 600 mg daily. The starting oral dose for
children is 2 mg/kg. The starting dose may be increased by 1-2 mg/kg every 6
hours until the desired effect is achieved. Doses greater than 6 mg/kg are not
recommended. The recommended dose for treating hypertension is 40 mg twice
daily.
DRUG INTERACTIONS: Administration of furosemide with aminoglycoside
antibiotics (for example, gentamicin) or [ethacrynic acid
(Edecrin) - another diuretic] may
cause hearing damage. Furosemide competes with
aspirin for elimination in the
urine by the kidneys. Concomitant use of furosemide and aspirin may, therefore,
lead to high blood levels of aspirin and aspirin toxicity. Furosemide also may
reduce excretion of lithium
(Eskalith, Lithobid) by the kidneys, causing increased blood levels of
lithium and possible side effects from lithium. Sucralfate
(Carafate) reduces the action of
furosemide by binding furosemide in the intestine and preventing its absorption
into the body. Ingestion of furosemide and sucralfate should be separated by two
hours.
PREGNANCY: There are no adequate studies of furosemide in
pregnant
women.
NURSING MOTHERS: Furosemide is secreted in breast milk. Nursing
mothers should avoid breastfeeding while taking furosemide.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Superior vena cava syndrome is compression of the superior vena cava vein located in the upper chest. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or infection. Symptoms of the syndrome include shortness of breath. Superior vena cava syndrome is diagnosed by ultrasound, chest x-ray, CT scan, and in some cases biopsy. Treatment depends upon the cause of the syndrome.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
High blood pressure or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high.
The top number, which is the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.
An elevation of the systolic and/or diastolic blood pressure incre...