Furosemid

Drug Indications
Edema, due to cardiac, hepatal and renal diseases; preeclamsia and eclamsia edema; chronic cardiovascular failure; swelling in burns; arterial hypertension (when saluretics are contraindicated); in intoxications, in order to cause forced diuresis; in complex treatment of the pulmonary and intracranial edema.

Drug Contraindications
Severe liver failure (hepatal coma); acute intoxication with salicilate; renal failure, accompanied by anuria or oliguria; severe hypokaliemia; hypovolemia with or without hypotension.

Special warnings and precautions
Before the treatment with Furosemid existing hypokalemia, hyponatremia, hypovolemia and hypotension should be corrected. During the treatment a potassium-rich diet is advisable. Furosemid should be used with care in patients with auditory disorders, allergy to sulphonamydes, and micturiton disorders. In pregnant women Furosemid should be administered only after precise indications consideration. It should be kept in mind that in nursing women the preparation passes in the mother milk and depresses lactation. In such cases is advisable to stop the nursing. In drivers and machinery operating persons Furosemid may disturb capabilities to normal professional activity.

Drug interactions
Furosemid reduces the therapeutic effect of vasopressor amines and anti-diabetic medicines; potentiates the nephrotoxic effect of the cephalosporins, the ototoxic effect of aminoglycosides, and cardio- and neurotoxic effects of the lithium; potentiates effects of antihypertensive drugs and tubocurarine. In combined treatment with cardiac glycosides the preparation increases sensitivity of the myocardium to digitalis. In concomitant treatment with high dose salicylates salicylate intoxication is possibly to develop. Indometacin reduces diuretic and antihypertensive effects of Furosemid.

Adverse reactions
In high dose hypokalemia, hyponatremia, hypocalcemia, hypovolemia, dehydration, thrombosis and other violation of water-electrolyte balance may develop; in predisposed patients allergy skin rash may be seen; blood count changes (leucopenia, agranulocytosis, thrombocytopenia). In elderly patients with high dosesis is possibly to develop a circulatory collapse.

Pharmacological mechanisms
Furosemide exerts a powerful diuretic effect, causing a high (20-30%) glomerular excretion of sodium and water. It acts on the medullar portion of the ascending limb of Henle loop, where are absorbed chloride and sodium ions, but not water, blocking predominantly the active chloride transport. The sodium reabsorption inhibition is a secondary effect. The preparation increases the selective elimination of the sodium up to 35%, and, depending on the dose, stimulates renin - angiotensin - aldosterone system. This leads to reducing of the cortical-papillary osmotic gradient and significant decrease of the concentration capabilities of the kidney. Before the diuretic effect become evident Furosemid reduces the heart preload by dilation of the capacitive vessels, in case the renal function is normal and no significant edemas exist.
From : http://www.sopharma.com/