Furosemide

Combinations not recommended

— Chloral hydrate

- Intravenous infusion of furosemide within a 24-hour period after administration of chloral hydrate may lead to skin flushing, profuse sweating, anxiety, nausea, increased blood pressure and tachycardia. Therefore, the use of furosemide in combination with chloral hydrate is not recommended.

— Aminoglycosides

- slowing down the excretion of aminoglycosides by the kidneys when used simultaneously with furosemide and increasing the risk of developing ototoxic and nephrotoxic effects of aminoglycosides. For this reason, the use of this combination of drugs should be avoided, except in cases where it is necessary for health reasons, in which case an adjustment (reduction) of maintenance doses of aminoglycosides is required.

Combinations that should be used with caution

— Ototoxic drugs

- furosemide potentiates their ototoxicity. Such drugs can be used simultaneously with Furosemide only for strict medical indications, since combined use can lead to irreversible damage to the hearing organ.

— Cisplatin

- when used simultaneously with furosemide, there is a risk of ototoxicity. In addition, the nephrotoxic effect of cisplatin may be enhanced when furosemide is used for forced diuresis during treatment with cisplatin, unless furosemide is used in a low dose (for example, 40 mg in patients with normal renal function) and without combination with appropriate hydration of the patient.

— Sucralfate

- a decrease in the absorption of furosemide when taken orally and a weakening of its effect (furosemide and sucralfate when taken orally should be taken at least two hours apart).

— Lithium salts -

under the influence of furosemide, the excretion of lithium is reduced, due to which the content of lithium in the blood serum increases, which increases the risk of its toxic effects, including cardiotoxic and neurotoxic effects. Therefore, when using this combination, monitoring of lithium levels in the blood serum is required.

-
(ACE)
inhibitors - the use of ACE inhibitors or angiotensin II receptor antagonists in patients previously treated with furosemide may lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases - to the development of acute renal disease insufficiency, therefore, 3 days before starting treatment or increasing the dose of ACE inhibitors or angiotensin II receptor antagonists, it is recommended to discontinue furosemide or reduce its dose.

— Risperidone

- Caution should be exercised, carefully weighing the balance of risk and benefit, before deciding to use a combination of risperidone with furosemide or other strong diuretics, as an increase in mortality was observed in elderly patients with dementia receiving concomitant treatment with risperidone and furosemide.

— Levothyroxine

- Furosemide in high doses can inhibit the binding of thyroid hormones to carrier proteins and thus lead initially to a transient increase in the concentrations of free thyroid hormones, and then, in general, to a decrease in the total concentration of thyroid hormones. When using this combination, thyroid hormone concentrations should be monitored.

Interactions to Consider

— Nonsteroidal anti-inflammatory drugs ( NSAIDs)

- NSAIDs, including acetylsalicylic acid, can reduce the diuretic effect of furosemide. In patients with hypovolemia and dehydration (including while taking Furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may increase the toxicity of salicylates.

— Phenytoin

- reduction of the diuretic effect of furosemide.

— Glucocorticosteroids, carbenoxolone, licorice preparations

in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of developing hypokalemia.

— Cardiac glycosides, drugs known to prolong the QT interval

- in case of development of water-electrolyte balance disturbances (hypokalemia or hypomagnesemia) during the use of furosemide, the toxic effect of cardiac glycosides and drugs increases. causing prolongation of the QT interval (the risk of developing heart rhythm disturbances increases).

- Antihypertensives, diuretics or other drugs
that can lower blood pressure
- when combined with furosemide, a more pronounced decrease in blood pressure is possible.

- Probenecid, methotrexate or other drugs that, like furosemide,
are excreted in the renal tubules
, can reduce the effects of furosemide (same route of renal excretion); on the other hand, furosemide may lead to decreased renal excretion of these drugs. All this increases the risk of developing HP both with furosemide and the above-mentioned medications taken simultaneously with it.

— Hypoglycemic agents (both for oral administration and insulin preparations), pressor amines (epinephrine, norepinephrine)

- weakening of effects when combined with furosemide.

— Theophylline, diazoxide, curare-like muscle relaxants

- enhanced effects when combined with furosemide.

— Medicines with nephrotoxic effects

- when combined with furosemide, the risk of developing nephrotoxicity increases.

- High doses of some cephalosporins (excreted primarily by the kidneys)

- in combination with furosemide, the risk of nephrotoxicity of cephalosporins increases.

— Cyclosporine A

- when combined with furosemide, the risk of developing gouty arthritis increases due to hyperuricemia caused by furosemide and impaired renal urate excretion under the influence of cyclosporine.

— X-ray contrast agents —

Patients at high risk of developing nephropathy due to radiocontrast administration treated with furosemide had a higher incidence of renal dysfunction after administration of radiocontrast agents, compared with patients at high risk of developing nephropathy due to radiocontrast administration who received only intravenous fluids (hydration).

Instructions for use FUROSEMIDUM

The use of furosemide requires regular medical and laboratory monitoring.

During treatment with the drug, it is necessary to ensure a constant flow of urine.

During treatment, regular monitoring of serum sodium, potassium, calcium, chloride, magnesium and creatinine levels is recommended, especially in patients at high risk of developing electrolyte imbalance or in cases of significant fluid loss (vomiting, diarrhea, intense sweating).

Hypovolemia, dehydration, and any significant disturbances in electrolyte and acid-base balance must be corrected, which may require temporary cessation of furosemide.

When using the drug, patients should be advised to eat foods high in potassium. It should be remembered that when using furosemide, it may be necessary to compensate for potassium loss with medication. Particular care should be taken when prescribing the drug and monitoring the condition:

patients in whom the latent form of diabetes can become pronounced or patients with diabetes with an increased need for insulin;
patients with gout. The use of furosemide slows down the excretion of uric acid and can provoke an attack of gout;
patients with hepatorenal syndrome;
patients with hypoproteinemia caused by nephrotic syndrome or liver cirrhosis (weaker effect of furosemide, but there is a risk of ototoxicity);
patients with urinary disorders (prostatic hypertrophy or urinary tract obstruction), who may develop acute urinary retention (while taking the drug, a constant outflow of urine must be ensured);
patients with arterial hypotension;
patients who are at particular risk due to a significant decrease in blood pressure, for example, patients with severe stenosis of the coronary arteries or blood vessels supplying blood to the brain.

There have been cases of photosensitivity reactions with the use of thiazide diuretics. If such reactions occur during treatment, it is recommended to stop treatment. If it is necessary to resume use of the drug, measures to protect skin areas exposed to sunlight or artificial UV are recommended.

Athletes

Taking furosemide may result in a false positive test result during doping control.

This medicinal product contains lactose as an excipient and may therefore pose a risk for patients with rare hereditary forms of galactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Children

The drug is not used for children weighing less than 10 kg. The dose for children should be reduced according to body weight.

The ability to influence the reaction rate when driving a vehicle or working with other mechanisms

During treatment with the drug, the ability to concentrate may decrease. Persons driving vehicles and working with dangerous machinery should refrain from using the drug.

FUROSEMIDE SOPHARMA

Interaction

When used simultaneously with phenobarbital and phenytoin, the effect of furosemide is reduced.
Increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, cisplatin, amphotericin B (due to competitive renal excretion).

With the simultaneous use of aminoglycosides with furosemide, the elimination of aminoglycosides is slowed down and the risk of developing their ototoxic and nephrotoxic effects increases. For this reason, the use of this combination of drugs should be avoided unless it is necessary for health reasons, in which case an adjustment (reduction) of doses of aminoglycosides is required.

Increases the effectiveness of diazoxide and theophylline, reduces the effectiveness of hypoglycemic agents (oral antidiabetic agents, insulin), allopurinol. Medicines with nephrotoxic effects - when combined with furosemide, the risk of developing nephrotoxic effects increases. Glucocorticosteroids, corticotropin and amphotericin B lead to potassium loss. When combined with furosemide, this may result in a severe decrease in plasma potassium levels. Carbenoxolone, liquoris, beta2-sympathomimetics in high doses, long-term use of laxatives, reboxetine may increase the risk of developing hypokalemia.

When used simultaneously with cardiac glycosides, the risk of developing digitalis intoxication increases against the background of water and electrolyte disturbances (hypokalemia or hypomagnesemia), causing long QT interval syndrome.

Strengthens the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).

Nonsteroidal anti-inflammatory drugs (NSAIDs) (including indomethadine and acetylsalicylic acid) in combination with furosemide may cause a transient decrease in creatinine clearance and an increase in serum potassium and reduce the diuretic and antihypertensive effects of furosemide. In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may enhance the toxic effect of salicylates (due to competitive renal excretion).

Sucralfate reduces the absorption of furosemide and weakens its effect (these drugs should be taken at least 2 hours apart).

Combined use with carbamazepine may increase the risk of hyponatremia, and with corticosteroids, on the contrary, it may cause sodium retention. Antihypertensives, diuretics or other agents that can lower blood pressure, when combined with furosemide, can lead to a more pronounced antihypertensive effect.

Prescribing angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to patients previously treated with furosemide may lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases to the development of acute renal failure, so three days before starting treatment with inhibitors ACE inhibitors or angiotensin II receptor antagonists, or increasing their dose, it is recommended to discontinue furosemide or reduce its dose.

Probenecid, methotrexate and other drugs, which, like furosemide, are secreted in the renal tubules, can reduce the effect of furosemide (the same route of renal secretion); on the other hand, furosemide can lead to a decrease in the excretion of these drugs by the kidneys. Concomitant use with metolazone (thiazide diuretic) may cause increased diuresis.

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

Concomitant use of cyclosporine A and furosemide increases the risk of developing gouty arthritis due to hyperuricemia caused by furosemide and the impairment of urate excretion by the kidneys by cyclosporine.

Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce effectiveness.

Radiocontrast agents—Patients at high risk of developing contrast agent nephropathy who received furosemide had a higher incidence of renal dysfunction compared with patients at high risk of developing contrast agent nephropathy who received only intravenous hydration before administration of radiocontrast agent.

The use of diuretics is considered potentially dangerous when used concomitantly with risperidone. In placebo-controlled trials with risperidone in elderly patients with dementia, higher mortality was observed in patients treated with both furosemide and risperidone compared with patients treated with furosemide or risperidone alone, therefore special caution is required when furosemide is used concomitantly with risperidone in such patients.

As a combination or concomitant treatment, such therapy can only be used after assessing the benefit/risk ratio.

There are no reports of increased mortality among patients taking other diuretics (mostly low-dose thiazide diuretics) as concomitant treatment with risperidone.

Patients prescribed cholestyramine. This drug should be taken at least 1 hour after taking furosemide.

Furosemide, 40 mg, tablets, 20 pcs.

When used simultaneously with phenobarbital and phenytoin, the effect of furosemide is reduced.

Increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion).

Increases the effectiveness of diazoxide and theophylline, reduces the effectiveness of hypoglycemic agents, allopurinol.

Drugs that block tubular secretion increase the concentration of furosemide in the blood serum. Medicines with nephrotoxic effects - when combined with furosemide, the risk of developing nephrotoxic effects increases.

GCS and carbenoxolone when combined with furosemide increase the risk of hypokalemia.

When used simultaneously with cardiac glycosides, the risk of developing digitalis intoxication increases against the background of water and electrolyte disturbances (hypokalemia or hypomagnesemia).

Strengthens the neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).

NSAIDs (including indomethacin and acetylsalicylic acid) in combination with furosemide may cause a temporary decrease in creatinine clearance and an increase in serum potassium and reduce the diuretic and antihypertensive effects of furosemide. In patients with hypovolemia and dehydration (including while taking furosemide), NSAIDs can cause the development of acute renal failure. Furosemide may enhance the toxic effect of salicylates (due to competitive renal excretion).

Sucralfate reduces the absorption of furosemide and weakens its effect (these drugs should be taken at least 2 hours apart).

Combined use with carbamazepine may increase the risk of hyponartaemia.

Antihypertensive drugs, diuretics or other agents that can lower blood pressure, when combined with furosemide, may lead to a more pronounced antihypertensive effect.

Prescribing ACE inhibitors to patients previously treated with furosemide can lead to an excessive decrease in blood pressure with deterioration of renal function, and in some cases to the development of acute renal failure, therefore, three days before starting treatment with ACE inhibitors or increasing their dose, it is recommended to discontinue furosemide, or reducing its dose.

Probenecid, methotrexate and other drugs, which, like furosemide, are secreted in the renal tubules, can reduce the effect of furosemide (the same route of renal secretion), on the other hand, furosemide can lead to a decrease in the renal excretion of these drugs.

Lithium salts - under the influence of furosemide, the excretion of lithium is reduced, thereby increasing the serum concentration of lithium and increasing the risk of developing the toxic effects of lithium, including its damaging effects on the heart and nervous system. Therefore, monitoring of serum lithium concentrations is required when using this combination.

Concomitant use of cyclosporine A and furosemide increases the risk of developing gouty arthritis due to hyperuricemia caused by furosemide and disruption of urate excretion by cyclosporine at night.

Pressor amines (epinephrine, norepinephrine) and furosemide mutually reduce effectiveness.