Misplaced Pages

:WikiProject Chemicals/Chembox validation/VerifiedDataSandbox and Furosemide: Difference between pages - Misplaced Pages

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.
(Difference between pages)
Page 1
Page 2
Content deleted Content addedVisualWikitext
Revision as of 14:39, 17 November 2011 editBeetstra (talk | contribs)Edit filter managers, Administrators172,031 edits Saving copy of the {{drugbox}} taken from revid 452559007 of page Furosemide for the Chem/Drugbox validation project (updated: 'DrugBank').  Latest revision as of 01:52, 25 December 2024 edit Hairy Dude (talk | contribs)Extended confirmed users86,552 edits →Medical uses: copy edit (don't use US state abbreviations in this international encyclopedia)Tags: Mobile edit Mobile web edit Advanced mobile edit 
Line 1: Line 1:
{{Short description|Loop diuretic medication}}
{{ambox | text = This page contains a copy of the infobox ({{tl|drugbox}}) taken from revid of page ] with values updated to verified values.}}
{{Redirect|Lasix|the method of eye surgery|LASIK}}
{{drugbox | verifiedrevid = 443829551
{{Use dmy dates|date=October 2022}}
| IUPAC_name = 4-chloro-2-(furan-2-ylmethylamino)- 5-sulfamoylbenzoic acid
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox drug
| Watchedfields = changed
| verifiedrevid = 461114978
| image = Furosemide.svg | image = Furosemide.svg
| width =
| alt =
| image2 = Furosemide-1Z9Y-3D-balls.png | image2 = Furosemide-1Z9Y-3D-balls.png
| width2 =
| CASNo_Ref = {{cascite|correct|CAS}}
| alt2 =
| caption =

<!-- Clinical data -->
| pronounce = {{IPAc-en|f|j|ʊ|ˈ|ɹ|oʊ|s|ə|ˌ|m|aɪ|d}}
| tradename = Lasix, Furoscix, others
| Drugs.com = {{drugs.com|monograph|furosemide}}
| MedlinePlus = a682858
| DailyMedID = Furosemide
| pregnancy_AU = C
| pregnancy_AU_comment =
| pregnancy_category=
| routes_of_administration = ], ], ], ]
| class =
| ATC_prefix = C03
| ATC_suffix = CA01
| ATC_supplemental =

<!-- Legal status -->
| legal_AU = S4
| legal_AU_comment =
| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F -->
| legal_BR_comment =
| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_CA_comment =
| legal_DE = <!-- Anlage I, II, III or Unscheduled -->
| legal_DE_comment =
| legal_NZ = <!-- Class A, B, C -->
| legal_NZ_comment =
| legal_UK = POM
| legal_UK_comment =
| legal_US = Rx-only
| legal_US_comment = <ref name="Lasix FDA label">{{cite web | title=Lasix- furosemide tablet | website=DailyMed | date=26 January 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c9b4d8f-0770-482d-a9e6-9c616a440b1a | access-date=18 November 2022}}</ref><ref name="Furoscix FDA label">{{cite web | title=Furoscix- furosemide injection 80 mg/ 10 ml injection | website=DailyMed | date=21 October 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=eac958dd-8d43-e44e-e053-2995a90a4d5e | access-date=18 November 2022}}</ref>
| legal_EU =
| legal_EU_comment =
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment =
| legal_status = Rx-only

<!-- Pharmacokinetic data -->
| bioavailability = 43–69%
| protein_bound = 91–99%
| metabolism = ] and ] ]
| metabolites =
| onset = 30 to 60 min (PO), 5 min (IV)<ref name=AHFS2015/>
| elimination_half-life = up to 100 minutes
| duration_of_action =
| excretion = ] (66%), ] (33%)

<!-- Identifiers -->
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 54-31-9
| CAS_supplemental =
| PubChem = 3440
| IUPHAR_ligand =
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00695
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 3322
| UNII_Ref = {{fdacite|correct|FDA}} | UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 7LXU5N7ZO5 | UNII = 7LXU5N7ZO5
| KEGG_Ref = {{keggcite|correct|kegg}} | KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00331 | KEGG = D00331
| ChEBI_Ref = {{ebicite|correct|EBI}}
| InChI = 1/C12H11ClN2O5S/c13-9-5-10(15-6-7-2-1-3-20-7)8(12(16)17)4-11(9)21(14,18)19/h1-5,15H,6H2,(H,16,17)(H2,14,18,19)
| ChEBI = 47426
| InChIKey = ZZUFCTLCJUWOSV-UHFFFAOYAU
| ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 35 | ChEMBL = 35
| NIAID_ChemDB =
| PDB_ligand =
| synonyms = Furosemide
<!-- Chemical and physical data -->
| IUPAC_name = 4-Chloro-2--5-sulfamoylbenzoic acid
| C=12 | H=11 | Cl=1 | N=2 | O=5 | S=1
| SMILES = o1cccc1CNc(cc2Cl)c(C(=O)O)cc2S(=O)(=O)N
| StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C12H11ClN2O5S/c13-9-5-10(15-6-7-2-1-3-20-7)8(12(16)17)4-11(9)21(14,18)19/h1-5,15H,6H2,(H,16,17)(H2,14,18,19) | StdInChI = 1S/C12H11ClN2O5S/c13-9-5-10(15-6-7-2-1-3-20-7)8(12(16)17)4-11(9)21(14,18)19/h1-5,15H,6H2,(H,16,17)(H2,14,18,19)
| StdInChI_comment =
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = ZZUFCTLCJUWOSV-UHFFFAOYSA-N | StdInChIKey = ZZUFCTLCJUWOSV-UHFFFAOYSA-N
| density =
| CAS_number = 54-31-9
| density_notes =
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| melting_point =
| ChemSpiderID = 3322
| melting_high =
| ATC_prefix = C03
| melting_notes =
| ATC_suffix = CA01
| boiling_point =
| ChEBI_Ref = {{ebicite|correct|EBI}}
| boiling_notes =
| ChEBI = 47426
| PubChem = 3440 | solubility =
| sol_units =
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| specific_rotation =
| DrugBank = DB00695
}}
| smiles = O=S(=O)(N)c1c(Cl)cc(c(C(=O)O)c1)NCc2occc2

| C = 12 |H = 11 |Cl = 1 |N = 2 |O = 5 |S = 1
<!-- Definition and medical uses -->
| molecular_weight = 330.745 g/mol
'''Furosemide''', sold under the brand name '''Lasix''' among others, is a ] medication used to treat ] due to ], ], or ].<ref name=AHFS2015>{{cite web|title=Furosemide|url=https://www.drugs.com/monograph/furosemide.html|publisher=The American Society of Health-System Pharmacists|access-date=23 October 2015|url-status=live|archive-url=https://web.archive.org/web/20151119161939/http://www.drugs.com/monograph/furosemide.html|archive-date=19 November 2015}}</ref> Furosemide may also be used for the treatment of ].<ref name=AHFS2015/> It can be taken ] or ].<ref name=AHFS2015/> When given intravenously, furosemide typically takes effect within five minutes; when taken orally, it typically metabolizes within an hour.<ref name=AHFS2015/>
| bioavailability = 43-69%

| protein_bound =
<!-- Side effects and mechanism -->
| metabolism = hepatic and renal ]
Common side effects include ] (decrease in ] while standing, and associated ]), ] (ringing in the ears), and ] (sensitivity to light).<ref name=AHFS2015/> Potentially serious side effects include ], ], and ].<ref name=AHFS2015/> It is recommended that ] ] (especially ]), serum ], ], ] levels, and ] and ] functioning be monitored in patients taking furosemide. It is also recommended to be alert for the occurrence of any potential ].<ref name=AHFS2015/>
| elimination_half-life = up to 100 minutes

| excretion = renal 66%, biliary 33%
Furosemide works by decreasing the reabsorption of sodium by the kidneys.<ref name=AHFS2015/> Common side effects of furosemide injection include hypokalemia (low potassium level), hypotension (low blood pressure), and dizziness.<ref>{{cite press release | title=Coronavirus (COVID-19) Update: December 22, 2020 | website=U.S. Food and Drug Administration | date=22 December 2020 | url=https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-december-22-2020 | access-date=22 December 2020}} {{PD-notice}}</ref>
| pregnancy_AU = C

| pregnancy_US = C
<!-- History, society and culture -->
| DailyMedID = 3940
Furosemide was patented in 1959 and approved for medical use in 1964.<ref>{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=458 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA458 |language=en}}</ref> It is on the ].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> In the United States, it is available as a ].<ref name=AHFS2015/> In 2022, it was the 24th most commonly prescribed medication in the United States, with more than 23{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Furosemide Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Furosemide | access-date = 30 August 2024 }}</ref> In 2020/21 it was the twentieth most prescribed medication in England.<ref>{{cite web |title=PCA England |url=https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pca/pca_summary_narrative_2020_21_v001.html |access-date=8 August 2022 |website=NHS Business Services Authority }}</ref> It is on the ]'s banned drug list due to concerns that it may mask other drugs.<ref>{{cite web|title=World Anti-doping Code International Standard Prohibited List 2022|url=https://www.wada-ama.org/sites/default/files/resources/files/2022list_final_en.pdf|access-date=27 July 2022|page=12|date=2022|url-status=live|archive-url=https://web.archive.org/web/20220710154918/https://www.wada-ama.org/sites/default/files/resources/files/2022list_final_en.pdf|archive-date=10 July 2022}}</ref> It has also been used in race horses for the treatment and prevention of ].<ref>{{cite journal | vauthors = Sullivan S, Hinchcliff K | title = Update on exercise-induced pulmonary hemorrhage | journal = The Veterinary Clinics of North America. Equine Practice | volume = 31 | issue = 1 | pages = 187–198 | date = April 2015 | pmid = 25770069 | doi = 10.1016/j.cveq.2014.11.011 }}</ref><ref>{{cite journal | vauthors = Hinchcliff KW, Couetil LL, Knight PK, Morley PS, Robinson NE, Sweeney CR, van Erck E | title = Exercise induced pulmonary hemorrhage in horses: American College of Veterinary Internal Medicine consensus statement | journal = Journal of Veterinary Internal Medicine | volume = 29 | issue = 3 | pages = 743–758 | date = 2015 | pmid = 25996660 | pmc = 4895427 | doi = 10.1111/jvim.12593 }}</ref>
| legal_status = Rx-only

| routes_of_administration = Oral, ], ]
==Medical uses==
{{stack|]}}
Furosemide is primarily used for the treatment of ], but also in some cases of ] (where there is also kidney or heart impairment).<ref name=AHFS>{{cite web|title=Furosemide|url=https://www.drugs.com/monograph/furosemide.html|work=The American Society of Health-System Pharmacists|access-date=3 April 2011|url-status=live|archive-url=https://web.archive.org/web/20110317080203/http://www.drugs.com/monograph/furosemide.html|archive-date=17 March 2011}}</ref> It is often viewed as a first-line agent in most people with edema caused by ] because of its anti-vasoconstrictor and diuretic effects.<ref name=AHFS2015/><ref>{{cite book | vauthors = King KC, Goldstein S | chapter = Congestive Heart Failure And Pulmonary Edema |date=2021 | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK554557/ | title = StatPearls|place=Treasure Island, Florida |publisher=StatPearls |pmid=32119444 |access-date=8 May 2021}}</ref> Compared with furosemide, however, ] (aka "torsemide") has been demonstrated to show improvements to heart failure symptoms, possibly lowering the rates of rehospitalization associated with heart failure, with no difference in risk of death.<ref>{{cite journal | vauthors = Täger T, Fröhlich H, Seiz M, Katus HA, Frankenstein L | title = READY: relative efficacy of loop diuretics in patients with chronic systolic heart failure-a systematic review and network meta-analysis of randomised trials | journal = Heart Failure Reviews | volume = 24 | issue = 4 | pages = 461–472 | date = July 2019 | pmid = 30874955 | doi = 10.1007/s10741-019-09771-8 | s2cid = 77394851 }}</ref><ref>{{cite journal | vauthors = Miles JA, Hanumanthu BK, Patel K, Chen M, Siegel RM, Kokkinidis DG | title = Torsemide versus furosemide and intermediate-term outcomes in patients with heart failure: an updated meta-analysis | journal = Journal of Cardiovascular Medicine | volume = 20 | issue = 6 | pages = 379–388 | date = June 2019 | pmid = 30950982 | doi = 10.2459/JCM.0000000000000794 | s2cid = 96436158 }}</ref><ref>{{cite journal | vauthors = Abraham B, Megaly M, Sous M, Fransawyalkomos M, Saad M, Fraser R, Topf J, Goldsmith S, Simegn M, Bart B, Azzo Z, Mesiha N, Sharma R | title = Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure | language = English | journal = The American Journal of Cardiology | volume = 125 | issue = 1 | pages = 92–99 | date = January 2020 | pmid = 31699358 | doi = 10.1016/j.amjcard.2019.09.039 | s2cid = 207937875 }}</ref> Torsemide may also be safer than furosemide.<ref>{{cite journal | vauthors = Roush GC, Kaur R, Ernst ME | title = Diuretics: a review and update | journal = Journal of Cardiovascular Pharmacology and Therapeutics | volume = 19 | issue = 1 | pages = 5–13 | date = January 2014 | pmid = 24243991 | doi = 10.1177/1074248413497257 | s2cid = 21204143 }}</ref><ref>{{cite journal | vauthors = Buggey J, Mentz RJ, Pitt B, Eisenstein EL, Anstrom KJ, Velazquez EJ, O'Connor CM | title = A reappraisal of loop diuretic choice in heart failure patients | journal = American Heart Journal | volume = 169 | issue = 3 | pages = 323–333 | date = March 2015 | pmid = 25728721 | pmc = 4346710 | doi = 10.1016/j.ahj.2014.12.009 }}</ref> Providing self-administered subcutaneous furosemide has been found to reduce hospital admissions in people with heart failure, resulting in significant savings in healthcare costs.<ref>{{cite journal | vauthors = Dahiya G, Bensimhon D, Goodwin MM, Mohr JF, Alexy T | title = From Oral to Subcutaneous Furosemide: The Road to Novel Opportunities to Manage Congestion | journal = Structural Heart | volume = 6 | issue = 4 | pages = 100076 | date = August 2022 | pmid = 37288336 | doi = 10.1016/j.shj.2022.100076 | pmc = 10242578 }}</ref><ref>{{cite journal | vauthors = Khan WJ, Arriola-Montenegro J, Mutschler MS, Bensimhon D, Halmosi R, Toth K, Alexy T | title = A novel opportunity to improve heart failure care: focusing on subcutaneous furosemide | journal = Heart Failure Reviews | volume = 28 | issue = 6 | pages = 1315–1323 | date = November 2023 | pmid = 37439967 | doi = 10.1007/s10741-023-10331-4 | s2cid = 259843357 }}</ref>

Furosemide is also used for liver ], ], ], in adjunct therapy for ] or ] where rapid ] is required (] injection), and in the management of severe ] in combination with adequate rehydration.<ref name="AMH2004">{{cite book | veditors = Rossi S |title=Australian Medicines Handbook 2004 |edition=5th |isbn=978-0-9578521-4-3 |url=http://www.amh.net.au/ |year=2004 |publisher=] Pty Ltd |location=Adelaide, S.A. }}</ref>

===Kidney disease===
In chronic kidney diseases with ], furosemide is used along with albumin to increase diuresis.<ref name="pmid24268626">{{cite journal | vauthors = Kitsios GD, Mascari P, Ettunsi R, Gray AW | title = Co-administration of furosemide with albumin for overcoming diuretic resistance in patients with hypoalbuminemia: a meta-analysis | journal = Journal of Critical Care | volume = 29 | issue = 2 | pages = 253–259 | date = April 2014 | pmid = 24268626 | doi = 10.1016/j.jcrc.2013.10.004 }}</ref> It is also used along with albumin in ] to reduce edema.<ref name="pmid26457719">{{cite journal | vauthors = Duffy M, Jain S, Harrell N, Kothari N, Reddi AS | title = Albumin and Furosemide Combination for Management of Edema in Nephrotic Syndrome: A Review of Clinical Studies | journal = Cells | volume = 4 | issue = 4 | pages = 622–630 | date = October 2015 | pmid = 26457719 | pmc = 4695849 | doi = 10.3390/cells4040622 | doi-access = free }}</ref>

===Other information===
Furosemide is mainly excreted by tubular secretion in the kidney. In kidney impairment, clearance is reduced, increasing the risk of adverse effects.<ref name=AHFS2015/> Lower initial doses are recommended in older patients (to minimize side effects) and high doses may be needed in ].<ref name="BNF">{{cite web |title=British National Formulary |url=https://bnf.nice.org.uk/drug/furosemide.html#renalImpairment |access-date=9 November 2018}}</ref> It can also cause kidney damage; this is mainly by loss of excessive fluid (i.e., dehydration), and is usually reversible.{{fact|date=June 2022}}

Furosemide acts within 1&nbsp;hour of oral administration (after IV injection, the peak effect is within 30&nbsp;minutes). Diuresis is usually complete within 6–8&nbsp;hours of oral administration, but there is significant variation between individuals.<ref name = Ponto90>{{cite journal | vauthors = Ponto LL, Schoenwald RD | title = Furosemide (frusemide). A pharmacokinetic/pharmacodynamic review (Part I) | journal = Clinical Pharmacokinetics | volume = 18 | issue = 5 | pages = 381–408 | date = May 1990 | pmid = 2185908 | doi = 10.2165/00003088-199018050-00004 | s2cid = 32352501 }}</ref>

==Adverse effects==
Furosemide also can lead to ] caused by ]. ] is also a common side effect.<ref name="pmid28645962">{{cite journal |vauthors=Li Q, Li X, Kwong JS, Chen H, Sun X, Tian H, Li S |title=Diagnosis and treatment for hyperuricaemia and gout: a protocol for a systematic review of clinical practice guidelines and consensus statements |journal=BMJ Open |volume=7 |issue=6 |pages=e014928 |date=June 2017 |pmid=28645962 |pmc=5623447 |doi=10.1136/bmjopen-2016-014928 |url=}}</ref><ref name="pmid31446403">{{cite journal |vauthors=Li Q, Li X, Wang J, Liu H, Kwong JS, Chen H, Li L, Chung SC, Shah A, Chen Y, An Z, Sun X, Hemingway H, Tian H, Li S |title=Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements |journal=BMJ Open |volume=9 |issue=8 |pages=e026677 |date=August 2019 |pmid=31446403 |pmc=6720466 |doi=10.1136/bmjopen-2018-026677 |url=}}</ref><ref name="pmid37438830">{{cite journal |vauthors=Han Y, Cao Y, Han X, Di H, Yin Y, Wu J, Zhang Y, Zeng X |title=Hyperuricemia and gout increased the risk of long-term mortality in patients with heart failure: insights from the National Health and Nutrition Examination Survey |journal=J Transl Med |volume=21 |issue=1 |pages=463 |date=July 2023 |pmid=37438830 |pmc=10339518 |doi=10.1186/s12967-023-04307-z |url= |doi-access=free }}</ref>

The tendency, as for all loop diuretics, to cause low serum potassium concentration (]) has given rise to combination products, either with potassium or with the ] ] (]). Other electrolyte abnormalities that can result from furosemide use include hyponatremia, hypochloremia, hypomagnesemia, and hypocalcemia.<ref>{{cite journal | vauthors = Oh SW, Han SY | title = Loop Diuretics in Clinical Practice | journal = Electrolyte & Blood Pressure | volume = 13 | issue = 1 | pages = 17–21 | date = June 2015 | pmid = 26240596 | pmc = 4520883 | doi = 10.5049/EBP.2015.13.1.17 }}</ref>

In the treatment of heart failure, many studies have shown that the long-term use of furosemide can cause varying degrees of ], so ] supplementation is also suggested.<ref name="Katta">{{cite journal | vauthors = Katta N, Balla S, Alpert MA | title = Does Long-Term Furosemide Therapy Cause Thiamine Deficiency in Patients with Heart Failure? A Focused Review | journal = The American Journal of Medicine | volume = 129 | issue = 7 | pages = 753.e7–753.e11 | date = July 2016 | pmid = 26899752 | doi = 10.1016/j.amjmed.2016.01.037 | doi-access = free }}</ref>

Furosemide is a known ototoxic agent generally causing transient hearing loss but can be permanent. Reported cases of furosemide-induced hearing loss appeared to be associated with rapid intravenous administration, high dosages, concomitant renal disease, and coadministration with other ototoxic medication.<ref>{{cite journal | vauthors = Favrelière S, Delaunay P, Lebreton JP, Rouby F, Atzenhoffer M, Lafay-Chebassier C, Pérault-Pochat MC | title = Drug-induced hearing loss: a case/non-case study in the French pharmacovigilance database | journal = Fundamental & Clinical Pharmacology | volume = 34 | issue = 3 | pages = 397–407 | date = June 2020 | pmid = 31912913 | doi = 10.1111/fcp.12533 | s2cid = 210087413 }}</ref><ref>{{cite journal | vauthors = Gallagher KL, Jones JK | title = Furosemide-induced ototoxicity | journal = Annals of Internal Medicine | volume = 91 | issue = 5 | pages = 744–745 | date = November 1979 | pmid = 496112 | doi = 10.7326/0003-4819-91-5-744 }}</ref> However, a recently reported longitudinal study showed that participants treated with loop diuretics over 10 years were 40% more likely to develop hearing loss and 33% more likely of progressive hearing loss compared to participants who did not use loop diuretics.<ref>{{cite journal | vauthors = Joo Y, Cruickshanks KJ, Klein BE, Klein R, Hong O, Wallhagen MI | title = The Contribution of Ototoxic Medications to Hearing Loss Among Older Adults | journal = The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences | volume = 75 | issue = 3 | pages = 561–566 | date = February 2020 | pmid = 31282945 | pmc = 7328195 | doi = 10.1093/gerona/glz166 | veditors = Newman A }}</ref> This suggests the long-term consequences of loop diuretics on hearing could be a more significant than previously thought and further research is required in this area.  

Other precautions include nephrotoxicity, sulfonamide (sulfa) allergy, and increased free thyroid hormone effects with large doses.<ref>{{cite web|url=https://www.uptodate.com/contents/furosemide-drug-information?search=furosemide&source=search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1#F174802|title=UpToDate|website=www.uptodate.com|access-date=6 November 2018}}</ref>

== Interactions ==
Furosemide has potential interactions with these medications:<ref> Prescription Drug Information, Side Effects - PDRHealth</ref>
* ] and other salicylates
* Other diuretics (e.g. ], ])
* Synergistic effects with other ]s (e.g. ])
* ]

Potentially hazardous interactions with other drugs:
* ]s: increased risk of ] with ]s; antagonism of diuretic effect with NSAIDs
* Antiarrhythmics: a risk of ] exists with ]s if ] occurs; the effects of ] and ] are antagonized.
* ]s: increased risk of ] with ]s, ]s and ]; avoid concomitant use with lymecycline
* ]s: increased risk of hypokalemia with reboxetine; enhanced ] effect with ]s; increased risk of ] with ]s
* ]s: increased risk of ] with ]
* ]s: increased risk of hypokalemia with ]
* ]s: enhanced hypotensive effect; increased risk of first dose hypotensive effect with ]s; increased risk of ventricular arrhythmias with ] if hypokalemia occurs
* ]s: increased risk of ]s with ], ], or ] (avoid with pimozide) if hypokalemia occurs; enhanced hypotensive effect with phenothiazines
* ]: hypokalemia increases risk of ventricular arrhythmias
* ]s: increased toxicity if hypokalemia occurs
* ]: variable reports of increased nephrotoxicity, ototoxicity and hepatotoxicity
* ]: risk of toxicity.

==Mechanism of action==
{{Main|Loop diuretic}}
Furosemide, like other loop diuretics, acts by inhibiting the luminal ] in the ] of the ], by binding to the Na-K-2Cl transporter, thus causing more sodium, chloride, and potassium to be excreted in the urine.<ref>{{cite book| vauthors = Dowd FJ, Johnson B, Mariotti A |title=Pharmacology and Therapeutics for Dentistry - E-Book|date=3 September 2016|publisher=Elsevier Health Sciences|isbn=9780323445955|pages=324–326|url=https://books.google.com/books?id=6xT7DAAAQBAJ&pg=PA326|access-date=4 November 2017}}</ref>

The action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone; it also abolishes the corticomedullary osmotic gradient and blocks negative, as well as positive, ]. Because of the large NaCl absorptive capacity of the loop of Henle, diuresis is not limited by the development of acidosis, as it is with the carbonic anhydrase inhibitors.{{cn|date=February 2023}}

Additionally, furosemide is a noncompetitive subtype-specific blocker of GABA-A receptors.<ref name="Korpi95">{{cite journal | vauthors = Korpi ER, Kuner T, Seeburg PH, Lüddens H | title = Selective antagonist for the cerebellar granule cell-specific gamma-aminobutyric acid type A receptor | journal = Molecular Pharmacology | volume = 47 | issue = 2 | pages = 283–289 | date = February 1995 | pmid = 7870036 }}</ref><ref name="Tia95">{{cite journal | vauthors = Tia S, Wang JF, Kotchabhakdi N, Vicini S | title = Developmental changes of inhibitory synaptic currents in cerebellar granule neurons: role of GABA(A) receptor alpha 6 subunit | journal = The Journal of Neuroscience | volume = 16 | issue = 11 | pages = 3630–3640 | date = June 1996 | pmid = 8642407 | pmc = 6578841 | doi = 10.1523/JNEUROSCI.16-11-03630.1996 | doi-access = free }}</ref><ref name="Wafford96">{{cite journal | vauthors = Wafford KA, Thompson SA, Thomas D, Sikela J, Wilcox AS, Whiting PJ | title = Functional characterization of human gamma-aminobutyric acidA receptors containing the alpha 4 subunit | journal = Molecular Pharmacology | volume = 50 | issue = 3 | pages = 670–678 | date = September 1996 | pmid = 8794909 }}</ref> Furosemide has been reported to reversibly antagonize GABA-evoked currents of α<sub>6</sub>β<sub>2</sub>γ<sub>2</sub> receptors at μM concentrations, but not α<sub>1</sub>β<sub>2</sub>γ<sub>2</sub> receptors.<ref name="Korpi95"/><ref name="Wafford96"/> During development, the α<sub>6</sub>β<sub>2</sub>γ<sub>2</sub> receptor increases in expression in cerebellar granule neurons, corresponding to increased sensitivity to furosemide.<ref name="Tia95"/>

==Pharmacokinetics==
* Molecular weight (daltons) 330.7
* % ] 47 – 70%
** Bioavailability with end-stage renal disease 43 – 46%<ref>AMA Department of Drugs: Drug Evaluations Subscription, American Medical Association, Chicago, IL, 1990.</ref><ref>Knoben JE & Anderson PO (Eds): Handbook of Clinical Drug Data, 6th. Drug Intelligence Publications, Inc, Hamilton, IL, 1988.</ref>
* % Protein binding 91 – 99<ref name=":0">{{cite web | title = Product Information: Lasix(R), furosemide. | work = Aventis Pharmaceuticals, Bridgewater, NJ | date = 2004 | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/016273s061lbl.pdf | publisher = U.S. Food and Drug Administration }}</ref>
* Volume of distribution (L/kg) 0.07 – 0.2<ref name=":1">{{cite book | vauthors = Gilman AG, Rall TW, Nies AS, etal | title = Goodman and Gilman's The Pharmacological Basis of Therapeutics | edition = 8th | publisher = Pergamon Press | location = New York, NY | date = 1990 }}</ref><ref name=":2">{{cite journal | vauthors = Kelly MR, Cutler RE, Forrey AW, Kimpel BM | title = Pharmacokinetics of orally administered furosemide | journal = Clinical Pharmacology and Therapeutics | volume = 15 | issue = 2 | pages = 178–186 | date = February 1974 | pmid = 4812154 | doi = 10.1002/cpt1974152178 | s2cid = 74223978 }}</ref>
** Volume of distribution may be higher in patients with cirrhosis or nephrotic syndrome<ref name=":1" />
* Excretion
** % Excreted in urine (% of total dose) 60 – 90<ref name=":1" /><ref name=":2" />
** % Excreted unchanged in urine (% of total dose) 53.1 – 58.8 <ref>{{cite journal | vauthors = Verbeeck RK, Patwardhan RV, Villeneuve JP, Wilkinson GR, Branch RA | title = Furosemide disposition in cirrhosis | journal = Clinical Pharmacology and Therapeutics | volume = 31 | issue = 6 | pages = 719–725 | date = June 1982 | pmid = 7075120 | doi = 10.1038/clpt.1982.101 | s2cid = 27659838 }}</ref>
** % Excreted in feces (% of total dose) 7 – 9<ref name=Ponto90 />
** % Excreted in bile (% of total dose) 6 – 9<ref name=":2" />
* Approximately 10% is metabolized by the liver in healthy individuals, but this percentage may be greater in individuals with severe kidney failure <ref name=":2" />
* Renal clearance (mL/min/kg) 2.0<ref name=":1" />
* Elimination half-life (hrs) 2<ref name=":0" />
** Prolonged in congestive heart failure (mean 3.4 hrs)<ref name=":1" /><ref>{{cite journal | vauthors = Chaturvedi PR, O'Donnell JP, Nicholas JM, Shoenthal DR, Waters DH, Gwilt PR | title = Steady state absorption kinetics and pharmacodynamics of furosemide in congestive heart failure | journal = International Journal of Clinical Pharmacology, Therapy, and Toxicology | volume = 25 | issue = 3 | pages = 123–128 | date = March 1987 | pmid = 3557737 }}</ref>
** Prolonged in severe kidney failure (4 – 6 hrs)<ref>{{cite journal | vauthors = Brater DC | title = Clinical pharmacology of loop diuretics | journal = Drugs | volume = 41 | issue = Supplement 3 | pages = 14–22 | date = 1991 | pmid = 1712712 | doi = 10.2165/00003495-199100413-00004 | s2cid = 41247401 }}</ref> and anephric patients (1.5 – 9 hrs)<ref name=":2" />
* Time to peak concentration (hrs)
** Intravenous administration 0.3<ref>{{cite journal | vauthors = Haegeli L, Brunner-La Rocca HP, Wenk M, Pfisterer M, Drewe J, Krähenbühl S | title = Sublingual administration of furosemide: new application of an old drug | journal = British Journal of Clinical Pharmacology | volume = 64 | issue = 6 | pages = 804–809 | date = December 2007 | pmid = 17875188 | pmc = 2198789 | doi = 10.1111/j.1365-2125.2007.03035.x }}</ref>
** Oral solution 0.83<ref name=":0" />
** Oral tablet 1.45<ref name=":0" />

The pharmacokinetics of furosemide are not significantly altered by food.<ref>AHFS Drug Information 2004. McEvoy GK, ed. Furosemide. American Society of Health-System Pharmacists; 2004: 2260-4.</ref>

No direct relationship has been found between furosemide concentration in the plasma and furosemide efficacy. Efficacy depends upon the concentration of furosemide in urine.<ref name=Ponto90/>

==Names==
Furosemide is the ] and ].<ref>{{cite web |url=http://www.mhra.gov.uk/Howweregulate/Medicines/Namingofmedicines/ChangestomedicinesnamesBANstorINNs/index.htm |title=Naming human medicines |access-date=18 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20100427025454/http://www.mhra.gov.uk/Howweregulate/Medicines/Namingofmedicines/ChangestomedicinesnamesBANstorINNs/index.htm |archive-date=27 April 2010 }}</ref> The previous BAN was frusemide.

Brand names under which furosemide is marketed include Aisemide, Apo-Furosemide, Beronald, Desdemin, Discoid, Diural, Diurapid, Dryptal, Durafurid, Edemid, Errolon, Eutensin, Farsiretic, Flusapex, Frudix, Frusemide, Frusetic, Frusid, Fulsix, Fuluvamide, Furantril, Furesis, Furix, Furo-Puren, Furon, Furosedon, Fusid.frusone, Hydro-rapid, Impugan, Katlex, Lasilix, Lasix, Lodix, Lowpston, Macasirool, Mirfat, Nicorol, Odemase, Oedemex, Profemin, Rosemide, Rusyde, Salix, Seguril, Teva-Furosemide, Trofurit, Uremide, and Urex.

==Veterinary uses==
]
The diuretic effects are put to use most commonly in horses to prevent bleeding during a race. In the United States of America, under the racing rules of most states, horses that bleed from the nostrils (]) three times are permanently barred from racing. Sometime in the early 1970s, furosemide's ability to prevent, or at least greatly reduce, the incidence of bleeding by horses during races was discovered accidentally. Clinical trials followed, and by the decade's end, racing commissions in some states in the USA began legalizing its use on race horses. In 1995, ] became the last state in the United States to approve such use, after years of refusing to consider doing so.<ref>{{cite web |url=https://www.latimes.com/archives/la-xpm-1995-05-28-sp-6875-story.html |title= COMMENTARY : New York Buckles and Allows Lasix Use |website= ] |access-date = 22 January 2022 |date=28 May 1995}}</ref> Some states allow its use for all racehorses; some allow it only for confirmed "bleeders". Its use for this purpose is still prohibited in many other countries.{{cn|date=February 2023}}

Furosemide is also used in horses for pulmonary edema, congestive heart failure (in combination with other drugs), and allergic reactions. Although it increases circulation to the kidneys, it does not help kidney function and is not recommended for kidney disease.<ref>{{cite journal | vauthors = Hinchcliff KW, Muir WW | title = Pharmacology of furosemide in the horse: a review | journal = Journal of Veterinary Internal Medicine | volume = 5 | issue = 4 | pages = 211–218 | date = January 2022 | pmid = 1941755 | doi = 10.1111/j.1939-1676.1991.tb00951.x | doi-access = free }}</ref>

It is also used to treat congestive heart failure (pulmonary edema, pleural effusion, and/or ascites) in cats and dogs.<ref>{{cite book | vauthors = Kittleson M, Kienle R |author-link1=Mark Kittleson |date=1998 |title=Small Animal Cardiovascular Medicine |publisher=Mosby |url=https://archive.org/details/smallanimalcardi0000kitt |url-access=registration |isbn=978-0-8151-5140-1}}</ref>

===Horses===
Furosemide is injected either ] or ], usually 0.5-1.0&nbsp;mg/kg twice/day, although less before a horse is raced. As with many diuretics, it can cause ] and ], including loss of ], ], ], and ]. Excessive use of furosemide will most likely lead to a ] due to ] and ]. The drug should, therefore, not be used in horses that are dehydrated or experiencing kidney failure. It should be used with caution in horses with liver problems or electrolyte abnormalities. Overdose may lead to dehydration, change in drinking patterns and urination, seizures, gastrointestinal problems, kidney damage, lethargy, collapse, and coma.

Furosemide should be used with caution when combined with corticosteroids (as this increases the risk of electrolyte imbalance), aminoglycoside antibiotics (increases the risk of kidney or ear damage), and trimethoprim sulfa (causes decreased platelet count). It may also cause interactions with anesthetics, so its use should be related to the veterinarian if the animal is going into surgery, it decreases the kidneys' ability to excrete ], so dosages will need to be adjusted if combined with that drug.

Furosemide may increase the risk of ] toxicity due to hypokalemia.

It is recommended that furosemide not be used during pregnancy or in a lactating mare, as it is passed through the placenta and milk in studies with other species. It should not be used in horses with ] (Equine Cushing's Disease).

Furosemide is detectable in urine 36–72 hours following injection. Its use is restricted by most equestrian organizations.

US major racetracks ban the use of furosemide on race days.<ref>{{cite web|url=https://www.espn.com/horse-racing/story/_/id/26552958/us-racetracks-ban-race-day-lasix-2021|title = U.S. Racetracks to ban race-day Lasix in 2021|date = 18 April 2019}}</ref>

== References ==
{{Reflist}}

== Further reading ==
* ] (1998). ''Lasix Approved Product Information''. Lane Cove: Aventis Pharma Pty Ltd.
* {{cite book | vauthors = Forney B |title=Understanding Equine Medications, Revised Edition (Horse Health Care Library) |publisher=Eclipse Press |year=2007 |isbn=978-1-58150-151-3 }}

== External links ==
* {{cite web | title=Furosemide Injection | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a616046.html }}
*

{{Diuretics}}
{{Navboxes
| title = ]
| titlestyle = background:#ccccff
| list1 =
{{GABA receptor modulators}}
{{Glutamate metabolism and transport modulators}}
{{Glycine receptor modulators}}
{{Ionotropic glutamate receptor modulators}}
{{Symporter inhibitors}}
}} }}
{{Portal bar | Medicine}}
{{Authority control}}

]
]
]
]
]
]
]
]
]
]
]
]
]
]
]
]