01.07.2017

Furosemid - Eretic A means of which you can remove swelling caused by the pathologies of the heart and kidney, cirrhosis of the liver and other reasons.

Sometimes a diuretic drugused for efficient Reduction of blood pressure. Untiluse tool, you need to read the instruction, especially Annotations, interaction and side effects.

The medicine has non-proprietary OE M. International E N Azvani E (MNN ) Furosemide (Furosemide). Simultaneousactive The diuretic substance makes the kidneys from the urine of salt and liquid from the body, but with them the electrolytes needed (magnesium and potassium) are lost. Diureticact It is expressed quickly and bright - the more dosage, the stronger the effect. Furosemide acts on the loop of Genla - part of the nephron (filter in the kidneys), so it refers to a group of loop diuretics. According to the strength of the action, it is superior to thiazide diureticpreparations - Indapamide and hypothiazide.

Since the reception of the tablet before the start of action takes about an hour if you enter the drug in the injections, itbegins to actalready after 5 minutes. Act The active substance lasts from 3 to 6 hours.

The disadvantage of drugs consider the short-term action compared with the preparations of a new generation (diipeur).Excreted from the body Furosemide is basically kidneys, small part - liver. If the patient has problems with buds and liver, The elimination period active substance Slow out, the risk of adverse reactions will grow.

Furosemide testimony and contraindications

Like all medicines, Furacemid hasbenefit and harm. The drug is shown at edema against the background of cardiac and renal failure, as well as in the pathologies of the liver, arterial hypertension,from cystitis. There are cases when people start their owndrink diuret pills furosemid For weight loss or to remove the swelling, but it is fraught with health complications.

More efficient for today diuretics for patients with heart failure is the DiWOOROstructure which includes Toramsemed. It acts softer and side Effects He has not so much. Hypertensive doctors do not recommendpreparation FourSememidevery day, it is better to use only if necessary. For example, if it is necessary to urgently reduce the pressure during the hypertensive crisis.

With cirrhosis of liver furosemidedry From ascites, in this case it is taken in combination with spirironolactone, which saves potassium and magnesium. To start takingFurosemide indication Must evaluate the doctor - urologist, cardiologist, therapist.

Before takingFurosemid contraindicationyou need to learn in the instructions or at the doctor. The ban on the admission of funiside is the pathology of the kidneys, in which the development of urine ceases, as well as allergic to the components of the drug, the deficit in the body of potassium and sodium.

Cannot be applied ureraction drug Foursmemid With dehydration, acute glomerulonephritis, hepatic insufficiency in the threat of hepatic coma. Do not prescribe diureapreparations with aortal stenosis, gout, diabetes mellitus, after a sharp infarction, Low peoplepressure . Other contraindications: diarrhea, violation of urine outflow, pancreatitis, high level Urea in the blood, red lupus.

Diuretics receiving instructions

People The diuretic drug may experience weak, quickly get tired of familiar affairs, cannot adequately perceive the surrounding events because of this. Drivers who undergo treatmentdiuretik It is recommended to refrain the first time from transport management. We are talking about the first 5-7days then the body gets used to the medicine and his reception will besafe . Furosemide receptiona person can combine With Panangin, Asparkamka or salt substitutes that are rich in potassium.Use Such medicines can be prescribed by the doctor with compliance with the schedule anddosage reception. Doctor will definitely give recommendations - whatquantity Use liquids.

Against the background of treatment, poisoning accompanied by diarrhea, since potassium and magnesium in the body lacks, and the additional dehydration will be an extra problem. Solarium during therapy is better not to visit.

Furosemid: dosage and reception scheme

At the medicine Furosemide form form Different - is Furosemid in ampoules and in tablets, and only the doctor can decidehow to drink furosemidin a concrete case.

Important factors will be the age of the patientaside Disease, drugs taken, and others have been launched.Method of use in tabletsassumes a daily dose in 20-40 mg , sometimes 80 mg, divided into several techniques.

Ampoules Designed to doguards intramuscularly and in nutritional. Dose In this case, it is selected individually, according to the standardFurosemide injection solution Contains 20-240 mg of active substance. Sometimesdose Raises ifindications for use This requires.

Children are appointed A diuretic at the rate of 1-2 mg per 1 kg of weight. At the same time, the maximumdose - 6 mg per 1 kg. Toact Diuretics was as efficient as possible,oza A few days later, the start of treatment is adjusted in a large or smaller side. It all depends onhow furosemid acts On a specific organism and that tests showed.

Is it possible to drink furosemide every day

Patients with liver cirrhosisyou can take furosemid Every day, if the pathology has complicated ascites (liquid accumulates in the peritoneum). Earliereveryday Furosemid Tablettake patients with high pressure and heart failure. Today successfully replaceFurosemoid analogs(DiUWERs), having not so many adverse reactions. Those who still take dailyFurosemide in tabletsIt is worth discussing his replacement with a doctor to a safer drug, including to clarify,how often can be Drink another medicine.

Hypertensive should also not take this diuretic, since it has side effects. Themassign soften hypotensive medicines,mechanism of actionwhich does not worsen the state of other organs.

Sometimes people take furosemid with hypertensive crisis. It is not prohibited, but it is better to treat hypertension to prevent any crishes.

In other cases whenFurosemid diuretic Drink from edema or for weight loss every day - this is fraught with serious complications.

Not to ask laterwhy Health worsened, you should knowhow to take furosemide and from what.

Side Reactions from Furosemide

Man accepted th medicine once, may not feel whatFurosemid side effects May cause in the body. But if the drugrockets me for a long time, no Guarantees that various negative reactions will not be displayed. Even if observedindications for use And dose The following states may occur:

• dehydration;
• magnesium and potassium deficiency, which is manifested by weakness, confusion, convulsions;
• dizziness, drowsiness, loss of consciousness;
• thirst and dry mouth;
• nausea to vomiting;
• reducing the volume of the separated urine;
• tachycardia or cardiac rhythm failure.

The above effects can causestructure drug. If anxiety arose, you need to urgently apply for advice to the doctor. He will explainhow to take furosemid And how to behave to feel better. For example, if the drug is introducedintravenously , you need to lie down a bit, and during the lift it is not hurt, not to do sharp movements, otherwise the head will be spinning.

Allergys may have a reaction tostructure Medicines - in this case it needs to be canceled. There is a rash on the skin, difficulty breathing, strong itch. In old age and on the background of the pathologies of the liver, kidneys adverse reactions There are more often.

What will happen if mixing furosemid with alcohol

It happens that treatment falls for holidays, and then patients are interested in what funds such asFurosemide and alcohol compatibility, and is it possible a little drink for a holiday. Doctors do not approve of combination with alcohol any medicines, including not allowed to useFurosemid with alcohol. Need to understand what Therapy is carried out, and express priorities. Describing all data aboutmedicine Furosemide Instructions for use It says that alcohol increases the risk of side effects: may fall pressure, arise headache, tachycardia and fainting.Structure The drug causes dizziness by itself with a sharp change in the position of the body, and if mixedFurosemide and alcoholThe orientation in space will deteriorate.

Alcoholic, like diuretic, removes useful minerals from the body, that choose - short-term pleasure or treatmentappointed medicine physician - on the patient's conscience.

If the diuretic is designed For therapy of serious diseases, the alcohol is prohibited. If the disease is not so dangerous, you can take a little alcohol for a holiday, but to refuse the medication on this day.

Is it possible to be treated with furosemid pregnant and nursing

Pregnant Any medicine is very gentially prescribed, especially those that are able to influence the fetus. ProFurosemide Instructions for use It says that he is able to overcome the placental barrier, so they are trying not to appoint it. Mostly,Furosemide during pregnancy It is allowed only in situations where severe illness threatens the life of the mother. At the same time on anycatch It is necessary to control the state of the fetus.

To acceptFurosemide during pregnancy strictly prohibited - animal experiments demonstrated that the medicine onlate The period may adversely affect the baby to wear the baby. There were no studies on people.

If pregnant is stilldrank Tablet, you need to undergo a survey and check the condition of the child.Furosemide during pregnancy It is forbidden, he also should not be accepted during breastfeeding. If there is an urgent need, you need to translate the baby to artificial mixtures for the period of treating the mother. However, thispharmacological group Suppresses lactation, so after the treatment of milk may not be.

Medicinal interaction and overdose

At the consultation, the doctor will tell everything that is interested in the patient, in particular aboutFurosemid from what these pills And how many days drink them, if you need, prescribeintravenously shots. Be sure to tell about all medicines that are accepted at the moment, since the diuretic does not interact very well with some drugs. If appointedFurosemide application The following drugs should be careful: hormonal agents, antibiotics, NSAIDs, preparations from constipation and diabetes. The diuretic enhances the effect of hypotensive drugs, as a result of which it can greatly fall the pressure, up to the loss of consciousness.

At tablets and injections innutritive Furosemid overdose manifests the same symptoms that side effects, onlymore And stronger. Moreover, an overdose is not always an excessive dose, sometimes recommended40 mg The drug can cause a reaction in a particularly sensitive body. Therefore, you need to carefully listen to the feelings in the first days of therapy, regardless ofintravenously Appointed medicine or pills. Overdose may cause hypotensive crisis, shock, apathy, blood blocking, cessation of urine release.

It is necessary to eliminate complications in the hospital, and before the emergency arrival, you can give a victim a lot of drink, cause vomiting. Next, the restoration of health will be engaged in doctors - it will take to eliminate dehydration, restore the acid-alkaline balance, fill the loss of electrolytes, normalize the pressure.

To remove excess fluid from the body, as well as to clean it and balance the acid-alkaline indicator, diuretics are used, which in medicine is called diuretics. They can be 2 species: synthetic and natural.

Typically discharged patients with the problems of the heart muscle, liver, kidneys, when increased pressureIf the pathology is accompanied by edema. In addition, they are written out by patients with a pulmonary edema, brain, with intoxication harmful substancesshown by the kidneys unchanged.

A diuretic is widely used in medicine drug. However, taking this remedy, few think about what influence has a furosemide on the body and with what side effects and consequences can be encountered after the reception is completed.

Principle of action of diuretica

Furosemid - pharmacological agent With a diuretic effect related to "loop" diuretics. It is able to accelerate the formation of urins, reduce the volume of fluid in the body tissues. The medicine is very powerful and launches the process almost instantly, however, the action lasts for a long time.

20 minutes after reception, the mechanism of exposure is started, the greatest effect is achieved after 2 hours and lasts 3-6 hours. The medical preparation acts in oppressing on the reabsorption of sodium ions, chlorine, contributes to the elimination of calcium, potassium ions, magnesium. Furosemide is strong ureraction effect, sodium and chloroetic effect.

When using tablets in heart failure, the load on the heart falls 20 minutes after the reception. After 60-120 minutes, blood circulation is reduced, the tone of vessels decreases and the amount of fluid in the tissues is reduced. It is at that moment that furosemid reaches the peak of its impact. Also increases the washing of sodium chloride, which helps to reduce blood pressure.

Side effects

We list which side reactions by the body may occur, as well as their symptoms:

Furosemid - dangerous medicationcapable of push to serious human resources. For this reason, the drug must be taken only on the prescription of the doctor and, if necessary, adjust the dosage.

Danger of long-term diuretics for weight loss

The long-term reception of furosemide during weight loss increases the risk of side effects, the chance of a fatal exodus is significantly increased due to the metabolic disorders and the heart stop. This is due to the fact that the body appears a brightly pronounced deficit of minerals necessary for the normal functioning of all organs and systems.

For this reason, the reception of any diuretics for a long time is prohibited. In the physical plane, a person loses performance, endurance, the body loses the ability to regulate the body temperature, which leads to dehydration, weakness, water flow circulation.

What is dangerous drug: unpleasant consequences

Due to the long-term admission of the drug, a person appears a dose-dependent effect. If more details, the increase in urin volume occurs due to the reception of a different amount of medication associated with the pathology and personal characteristics of the patient's body. In addition, over time, the kidneys stop responding to the original dose, which requires its increase.

There are cases when, when abolishing diuretics, a person appears in a psychological plan, i.e. A direct dependence on the drug appears. In particular, this is characteristic of those who independently practice the furosemide reception to reduce weight.

Pseudo-barttter syndrome can also develop. Pathology is characterized by water-electrolyte failures - a decrease in the concentration of potassium, sodium, chlorine in the blood, violation acid-alkaline balance, signs of dehydration of the body are manifested, the activity of renin blood plasma increases.

Use of the use of drug

However, the positive aspects the drug still has. It helps to quickly remove the poisons, toxins and excess fluid, thereby removing the swelling. That is, its initial functions performs regularly.

IMPORTANT! Reception of the doctor under the control of the doctor in a complex with other drugs does not bear any harm.

How to recover after furosemide

After the patient's diuretic abolition, the patient may be aggravated by swelling. This may occur at one of the following reasons:

1. The consequence of the disease, which was treated by Furosmid. In this case, consultation of the attending physician will be required, followed by the correction of pathology.
2. Symptom of dependence on the drug.

With a furosemaid-dependent effect, everything is a little more complicated. It will take the reception of mineral drugs with potassium and magnesium content, while useing liquid is better in small quantities. In the role of diuretic means to use herbal fees. It is advisable to drink no later than 4 o'clock in the afternoon, and the last meal to exercise to 6 pm. These recommendations will have to adhere to 30 days and more.

In order to prevent hypokalemia, it is necessary to introduce products with high potassium content - nuts, driers, raisins, beans, peas and other beans, sea cabbage, potatoes. In parallel, it is recommended to drink potassium preparations.

To replenish the magnesium deficiency, you will need chloride, or magnesium gluconate. Sodium chloride therapy reduced content In sodium blood, it is careful because the salt delays fluid in the body.

Opinion of patients and doctors

Below are real reviews of doctors and patients. We find out what kind of opinion was about a diuretic practice in medical practice and among those who used the tool for any reason.

Furosemid- high-speed diuretic with a pronounced diuretic effect. Furosemide has a pronounced diuretic, sodium-ethical, chloroetic effect, increases the elimination of potassium ions, calcium, magnesium. Inhibits the reabsorption of sodium ions, chlorine mainly in the thick segment of the ascending loop of Genela.
With heart failure, after 20 minutes, it leads to a decrease in the preload on the heart. The maximum hemodynamic effect is achieved by the second half of the action of the drug, which is due to a decrease in the tone of venous vessels, with a decrease in the volume of circulating blood and intercellular fluid. It has a hypotensive effect due to an increase in the removal of sodium chloride, reducing the reaction of the smooth muscles of the vessels on vasoconstrictor effects and as a result of a decrease in the volume of circulating blood.
When intravenous administration, the effect of furosemide develops after 5-10 minutes, reaches a maximum after 30 minutes; The diuretic effect continues for 2 hours, with a reduced kidney function - up to 8 hours.
During the period of action, sodium ions increase significantly, but after its termination, the removal rate is reduced below the initial level ("Ricochlet" or "cancellation" syndrome). The phenomenon is due to the sharp activation of renin-angiotensin and other anti-zeothetic neurohumoral links of regulation in response to massive diuresis, stimulates arginine-resistant and sympathetic system. Reduces the level of the atrial sodiumthical factor in the plasma causes vasoconstriction. Due to the phenomenon of "Ricochet" with the introduction of 1 time per day, it may not have a significant effect on the daily removal of sodium and arterial pressure.
Pharmacokinetics
The time to achieve maximum concentration (TCMAX) during intravenous administration is 30 minutes. The relative amount of distribution is 0.2 l / kg. Communication with plasma proteins is 98%. Penetrates the placental barrier, stands out with breast milk. Metabolized in the liver with the formation of 4-chloro-5-sulfamoyl-anthranyl acid. Secreted into the lumen of the renal tubules through the existing in proximal Department Nephron Anion Transport System. Clearance - 1.5 - 3 ml / min / kg. The half-life of furosemide (T ½) after intravenous administration ranges from 0.5 to 1 hour. Removed mainly (88%) kidneys unchanged and in the form of metabolites; Calves - 12%.
The absorption is high, the maximum concentration is noted in the blood plasma when taking inside after 1 t. Bioavailability - 60 - 70%. The relative amount of distribution is 0.2 l / kg. Communication with blood plasma proteins - 98%. Penetrates the placental barrier, stands out with breast milk. Metabolized in the liver. Secrets into the lumen of renal tubules through the system of transport of anions existing in the proximal department of nephrone. 60 - 70% stands out by the kidneys, the rest of the intestine. Half-life - 1 - 1.5 h.

Indications for use

Indications for the use of the drug Furosemidare: sweeping syndrome in chronic heart failure, acute heart failure, chronic renal failure, nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease); edema syndrome with liver diseases; brain swelling; Hypertensive crisis, heavy forms arterial hypertension; Maintaining a forced diurea during poisoning chemical compoundsWithdrawn by the kidneys unchanged.
For tablets: cardiac or renal swelling; edema of hepatic origin (in combination with potassium-saving means); Increased blood pressure in chronic renal failure, in the case of contraindications to the reception of thiazide diurendics (or creatinine clearance below 30 ml / min).

Mode of application

Furosemid Tablettake inside. The dose depends on the flow and severity of the disease.
Adults. Under swelling of cardiac, renal or hepatic origin:
- Middle heavy condition: ½-1 Tablet per day,
- Heavy Condition: 2-3 Tablets per day in 1 or 2 reception, or 3-4 tablets per day in 2 reception.
With elevated arterial pressure in patients with chronic renal failure: in combination with other antihypertensive agents (antagonists of the renin-angiotensin system), recommended conventional doses of 20 - 120 mg per day in one or two receptions.
Children. For the treatment of edema daily dose 1-2 mg / kg body weight in 1-2 reception.
Furosemide is administered intravenously and intramuscularly.
When intravenous administration, furosemide should be administered slowly. The rate of administration should not exceed 4 mg per minute.
Intramuscular administration is possible in exceptional cases when you can not apply intravenous or outstanding administration of the drug. The intramuscular path of the introduction is impossible in the treatment of acute states, such as, for example, pulmonary swelling.
The transition from the parenteral form to oral should be carried out as early as possible.
The question of the duration of treatment is solved by the doctor, given the nature and severity of the disease.
It is recommended to use the minimum dose of the drug that has the therapeutic effect.
Sandrome. Adults and children over 15 years are prescribed in the initial dosage of from 20 to 40 mg of Furosemide (1-2 ampoules) intravenously, in exceptional cases, intramuscularly.

Intravenous administration is carried out within 1-2 minutes; In the absence of a diuretic response, every 2 hours are administered in an increased 50% dose until adequate diurea is achieved. In high doses (80 - 240 mg and above), intravenously drip, at a speed not higher than 4 mg / min. Maximum daily dose - 600 mg.
Forced diuresis during poisoning. From 20 to 40 mg of furosemide (1-2 ampoules) are additionally added to an infusion electrolyte solution. Further treatment is carried out depending on the volume of diuresis and should reimburse the lost amount of fluid and electrolytes.
Hypertensive crisis. The recommended initial dose for intravenous administration ranges from 20 to 40 mg. Dose should be adjusted as needed according to a clinical response.
Children under 15 years old average daily dose for intravenous or intramuscular administration in children up to 15 years - 0.5-1.5 mg / kg.

Side effects

From the cardiovascular system: decreased blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, reduction of the BCC.
From the CNS and the peripheral nervous system: dizziness, headache, miastic, convulsions of calf muscles (Tetania), paresthesia, apathy, adamine, weakness, lethargy, drowsiness, confusion.
From the side of the senses: violations of vision and hearing.
From side digestive system: Reducing appetite, dry mouth, thirst, nausea, vomiting, constipation or diarrhea, cholestatic jaundice, pancreatitis (exacerbation).
From the urogenital system: oliguria, acute urinary delay (in patients with hypertrophy prostatic gland), interstitial nephritis, hematuria, reduced potency.
From the system of blood formation: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia.
From water-electrolyte exchange: hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypocalemia, hyponathemia, hypochlorinemia, hypocalcemia, hypomagnemia, metabolic alkalosis.
From the metabolism: hypovolemia, hypocalemia, hyponathemia, hypochloremia, hypokalemic metabolic alkalosis (as a result of these violations - arterial hypotension, dizziness, dry mouth, thirst, arrhythmia, muscle weakness, convulsions), hyperuricemia (with a possible exacerbation of gout), hyperglycemia .
Allergic reactions: purpura, urticaria, exfoliative dermatitis, multiform exudative erythema, vasculitis, necrotic, skin itch, chills, fever, photosensitization, anaphylactic shock.
Others: When intravenous administration (additionally) - thrombophlebitis, kidney calcine in premature babies.

Contraindications

Contraindications for the use of the drug Furosemidare: hypersensitivity, acute glomerulonephritis, acute renal failure with Anuria (the magnitude of glomerular filtration is less than 3 - 5 ml / min), severe liver failure, hepatic coma and prema, urine stenosis, obstruction urinary tract Stone, Farmathous States, Hyperglycemic Coma, Hyperuricemia, Gout, Decompensated Mitral or Aortic Stenosis, Hypertrophic Obstructive Cardiomyopathy, Improving Central Venenous Pressure (Over 10 mm Hg), Arterial Hypotension, Acute Myocardial Infarction, Pancreatitis, Water-Electro Total Infarction and acid-alkaline equilibrium (hypokalemia, alkalosis, hypovolemia, hyponatremia, hypochloride, hypocalcemia, hypomagnemia), digitalisal intoxication.
Caution is used with prostate hyperplasia, systemic red lolly, hypoproteinemia (risk of diethoxicity), diabetes mellitus (reduction of glucose tolerance), stenling atherosclerosis of cerebral arteries, pregnancy (especially the first half, possibly use of life indications), during lactation.

Pregnancy

During pregnancy, the use of f ugramideperhaps only for a short time and only when the intended benefit of therapy for the mother exceeds the potential risk to the fetus.
Since furosemid may be released with breast milk, as well as suppress lactation, if necessary, use during lactation breast-feeding should be stopped.

Interaction with other medicines

With the simultaneous use of the drug Furosemidwith antibiotics of the aminoglycoside group (including with gentamicin, Tobramycin), it is possible to enhance nephro- and outotoxic effects.
Furosemoid reduces gentamicin clearance and increases the concentration in the blood plasma of gentamicin, as well as tobramycin.
With simultaneous use with antibiotics of a group of cephalosporins, which can cause impaired kidney function, there is a risk of increasing nephrotoxicity.
With simultaneous use with beta-adrenomimetics (including phenoterol, thermaltaline, salbutul) and with GCS it is possible to enhance hypokalemia.
With simultaneous use with hypoglycemic agents, insulin is possible to reduce the effectiveness of hypoglycemic agents and insulin, because Furosemide has the ability to increase the content of glucose in blood plasma.
With simultaneous use with ACE inhibitors, antihypertensive effect is enhanced. It is possible to pronounced arterial hypotension, especially after taking the first dose of Furosemide, apparently, due to hypovolemia, which leads to a transient increase in the hypotensive effect aPF inhibitors. The risk of violations of the kidney function increases and the development of hypokalemia is not excluded.
With simultaneous use with furosemide, the effects of non-polarizing muscle relaxants are enhanced.
With simultaneous use with indomethacin, other NSAIDs, it is possible to reduce the diuretic effect, as a result, due to the oppression of the synthesis of prostaglandins in the kidneys and sodium delay in the body under the influence of indomethacin, which is a non-specific COF inhibitor; Reducing antihypertensive action.
It is believed that in a similar way, furosemide interacts with other NSAIDs.
With simultaneous use with NSAIDs, which are selective inhibitors COF-2, this interaction is expressed significantly less or practically absent.
With simultaneous use with Asthemisol, the risk of developing arrhythmias increases.
With simultaneous use with vancomycin, it is possible to enhance with and nephrotoxicity.
With simultaneous use with digoxin, digitoxine is possible to increase the toxicity of cardiac glycosides associated with the risk of hypokalemia development against the background of furosemide.
There are reports on the development of hyponatremia while simultaneously use with carbamazepine.
With simultaneous use with a skewer, the absorption and the diuretic effect of furosemide decreases.
With simultaneous use with lithium carbonate it is possible to enhance lithium effects due to the increase in its blood plasma concentration.
With simultaneous use with probelacide, renal clearance of furosemide decreases.
With simultaneous use with the Sotalol, hypokalemia and the development of ventricular arrhythmia type "Piroet" are possible.
With simultaneous use with theophylline, it is possible to change the concentration of theophylline in the blood plasma.
With simultaneous use with phenytio, the diuretic effect of furosemide is significantly reduced.
After intravenous administration of furosemide against the background of chloralhydrate therapy, it is possible to increase the sweating, the feeling of heat, the instability of the blood pressure, tachycardia.
With simultaneous use with cyzispride, hypokalemia is possible.
It is assumed that the furosemide can reduce the nephrotoxic effect of cyclosporine.
With simultaneous use with cisplatin, it is possible to strengthen the isotoxic effect.

Overdose

Symptoms of overdose of the drug Furosemid: reduction of blood pressure, collapse, shock, hypovolemia, dehydration, hemokoncentration, arrhythmia, acute renal failure with Anuria, thrombosis, thromboembolism, drowsiness, confusion, paralysis, apathy.
Treatment: Correction water salt balance and an acid-base state, replenishment of circulating blood, symptomatic treatment. No specific antidote.

Storage conditions

A drug Furosemidit should be stored in a dry, vehicle-protected place at a temperature not higher than 25 ° C.
Shelf life - 2 years.

Form release

Furosemid tablets; Packaging 10, 20, 30, 40, 50 tablets.
Surosemide solution for intravenous and intramuscular administration; In the package 10 and 25 ampoules 2 ml.

Structure

1 tabletFurosemidcontains: Active substance: Furosemide 40 mg;
1 ml soloFurosemidfor intravenous and intramuscular administration contains: active substance: Furosemide 10 mg.

Additionally

Against the background of the course treatment, it is necessary to periodically control the blood pressure, the content of blood plasma electrolytes (including Na +, Ca2 +, K +, Mg2 +), the acid-base state, the content of residual nitrogen, creatinine, uric acid, liver function, if necessary corresponding to the correction of treatment.
Patients with increased sensitivity to sulfonyl amides and sulfonylurea derivatives may have cross-sensitization to furosemide.
When prescribing high doses of Furosemide to avoid the development of hyponatremia and metabolic alkalosis, it is impractical to limit the consumption of the cooking salt.
For the prevention of hypokalemia, it is recommended to simultaneously appoint potassium drugs or potassium-saving diuretics (spironolactone), as well as stick with a diet rich in potassium.
Selection of dosing treatment patients with ascites against the background of the liver cirrhosis, hepatic insufficiency should be carried out in stationary conditions (violation of the water and electrolyte balance can cause the development of hepatic coma). Showing regular control over the content of plasma electrolytes.
With the appearance or strengthening of azotemia and oliguria in patients with severe progressive diseases of the kidney, it is recommended to suspend treatment.
In patients with diabetes or with reduced glucose tolerance, periodic control of blood glucose levels and urine is required.
In patients in an unconscious state, with a benign hyperplasia of the prostate gland, narrowing of ureters or hydronephrosis, monitoring is needed (urinary delay is possible).
Long-term reception can lead to hypovolemia.
Due to the presence of lactose, this medicine is contraindicated in the case of congenital galactosemia, glucose and galactose and lactase deficiency syndrome.
Impact on the ability to control the car and potentially dangerous mechanisms
It should be avoided potentially hazardous species Activities requiring increased attention and speed of psychomotor reactions.

Main settings

Name:	Furosemid
ATH code:	C03CA01 -

MNN: Furosemid

Manufacturer: Borisov Plant Medical Preparations OJSC

Anatomy-therapeutic-chemical classification: Furosemide.

Registration number in Kazakhstan: No. RK-LS-5№011635

Registration period: 20.09.2013 - 20.09.2018

Instruction

Tradename

Furosemid

International non-proprietary title

Furosemid

Dosage form

Injection Solution 10 mg / ml

Structure

One ampoule contains:

active substance - Furosemid 20 mg;

excipients:sodium solution of hydroxide 1 m, sodium chloride, water for injection.

Description

Transparent colorless or slightly yellowish liquid.

F.armacotherapeutic group

"Loop" diuretics. Sulfanimide diuretics. Furosemide.

ATH Code C03S01

Pharmacological properties

Pharmacokinetics

With intravenous administration, the furosemide action is developing after 5-10 minutes, the time to achieve maximum concentration (TCmax) during intravenous administration is 30 minutes, the diuretic effect continues for 2 hours, with a reduced kidney function - up to 8 hours.

The relative amount of distribution is 0.2 l / kg. Communication with plasma proteins is 98%. Metabolized in the liver with the formation of 4-chloro-5-sulfamoylandranyl acid. Secrets into the lumen of renal tubules through the system of transport of anions existing in the proximal department of nephrone. Clearance - 1.5 - 3 ml / min / kg. The half-life of furosemide after intravenous administration ranges from 1 to 1.5 hours.

It is removed mainly (88%) kidneys unchanged and in the form of metabolites, with a fee - 12%.

Furosemide stands out in breast milk. Furosemide passes a placental barrier and slowly falls into the fruit. It is found in the organism of the fetus or in the body of newborns in the same concentrations as in the body of the mother.

Pharmacodynamics

Furosemide effective, quickly and briefly acting "loop" diuretik. Furosemide The high-speed diuretik with a pronounced diuretic effect, has a pronounced diuretic, sodium-refinery, chloroetic effect, increases the elimination of potassium ions, calcium, magnesium. Inhibits the reabsorption of sodium ions, chlorine mainly in the thick segment of the rising part of the loop of Genla. Therefore, the effectiveness of the diuretic effect of furosemide depends on the achievement of the renal channels of the renal channels through the anionic transport mechanism. The diuretic action is caused by suppressing the reabsorption of chlorine and sodium ions in this segment of the loop of Gene. As a result, partial sodium release can reach 35% of sodium glomerular filtration. The consequence of the increase in sodium secretion is the strengthening of urine (as a result of osmalically bound water) and an increase in the secretion of potassium ions in the distal part of the renal tubules. Also increases calcium and magnesium allocation.

With heart failure, after 20 minutes, it leads to a decrease in the preload on the heart. The maximum hemodynamic effect is achieved by the second half of the action of the drug, which is due to a decrease in the tone of venous vessels, with a decrease in the volume of circulating blood and intercellular fluid. It has a hypotensive effect due to an increase in the removal of sodium chloride, reducing the reaction of the smooth muscles of the vessels on vasoconstrictor effects and as a result of a decrease in the volume of circulating blood.

During the period of action, sodium ions increase significantly, but after its termination, the removal rate is reduced below the initial level ("Ricochlet" or "cancellation" syndrome). The phenomenon is due to the sharp activation of the renin-angiotensin and other anti-yielded neurohumoral regulation links in response to massive diuresis, stimulates the arginine-resistant and sympathetic system. Reduces the level of the atrial sodiumthical factor in the plasma causes vasoconstriction. Due to the phenomenon of "Ricochlet", with the introduction of 1 time per day, it may not have a significant effect on the daily removal of sodium and blood pressure.

When intravenous administration at a dose of 20 mg, the beginning of the diuretic effect is observed after 15 minutes and the duration is about 3 hours.

Furosemide continuous infusion is more efficient than repeated impact dose injections drug. It is important that the dose of over a certain impact dose of medication does not have a significant action. The effect of furosemide decreases in patients with reduced tubular secretion or with intra-tubular binding of drugs with proteins.

Indications for use

Entrance syndrome in chronic heart failure, acute heart failure, chronic renal failure, nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the main disease)

Email syndrome with liver diseases

Motor's swelling

Hypertensive crisis, severe arterial hypertension forms

Maintaining a forced diurea in poisoning by chemical compounds, withdrawn by the kidneys unchanged.

Method of application and dose

When intravenous administration, furosemide should be administered slowly. The rate of administration should not exceed 4 mg per minute. Patients with severe renal function (serum creatinine\u003e 5 mg / ml) is recommended not to exceed the rate of administration of 2.5 mg per minute.

Intramuscular administration is possible in exceptional cases when an intravenous or oral path of administration of the drug cannot be applied. The intramuscular path of the introduction is impossible in the treatment of sharp states (for example, pulmonary edema).

The transition from the parenteral form to oral should be carried out as early as possible.

The question of the duration of treatment is solved by the doctor, given the nature and severity of the disease.

Sunday syndrome

Adults and children over 15 years are prescribed in the initial dosage of from 20 to 40 mg of Furosemide (1-2 ampoules) intravenously, in exceptional cases, intramuscularly. The sodium-reaction of the furosemide depends on a number of factors, including the severity of renal failure and sodium balance, so the effect of the dosage cannot be accurately calculated. For patients with chronic renal failure, the dose of furosemide must be carefully clouded so that the initial loss of fluid is gradual. The dose that leads to loss of fluid is approximately equal to 2 kg of body weight (approximately 280 mmol sodium) per day. Dose should be adjusted as needed according to a clinical response. In the intravenous administration of furosemide, they begin to be administered by constant intravenous infusion at a dose of 0.1 mg per minute, then gradually increasing the speed of administration every half hour, taking into account the clinical response. In high doses (80 - 240 mg and above), intravenously drip, at a speed not higher than 4 mg / min. Maximum daily dose - 600 mg.

Patients with reduced glomerular filtration and low diuretic response are prescribed in large doses - 1-1.5 g. Maximum motherwise dose - 2

Forced diuresis during poisoning

From 20 to 40 mg of furosemide (1 - 2 ampoules) are additionally added to an infusion electrolyte solution. Further treatment is carried out depending on the volume of diuresis and should reimburse the lost amount of fluid and electrolytes.

Children up to 15 years

The average daily dose for intravenous or intramuscular administration in children up to 15 years - 0.5-1.5 mg / kg.

Side effects

Reduced blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, decrease in circulating blood

Dizziness, headache, paresthesia, apathy, adamusa, weakness, lethargy, drowsiness, confusion

Vision of vision and hearing

Reducing appetite, dry mouth, thirst, nausea, vomiting, diarrhea or constipation, cholestatic jaundice, pancreatitis (exacerbation)

Oliguria, acute urine delay (in patients with prostate hypertrophy), interstitial nephritis, hematuria, reducing potency

Purple, urticaria, exfoliative dermatitis, multiform exudative erythema, vasculitis, necrotic angiit, skin itching, chills, fever, photosensitization, anaphylactic shock

Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia

Hypovolemia, dehydration (risk of thrombosis and thromboembolism), hypokalemia, hyponathemia, hypochlorinemia, hypocalcemia, hypomagnemia, metabolic alkalosis

Muscle weakness, seizures of calf muscles (Tetania)

Hyperglycemia, hypercholesterolemia, hyperuricemia, glucose,

hypercalciuria

Thrombophlebitis, kidney calcine in premature babies

Contraindications

Hypersensitivity Furosemide or to any component of the drug, sulfonamide or sulfonylurea drugs, cross hypersensitivity to Furosemide may develop

Acute glomerulonephritis, acute renal failure with Anuria (the magnitude of glomerular filtration is less than 3 - 5 ml / min)

Heavy liver failure, hepatic coma and preach

Stenosis of the urinary channel, urinary tract obstruction

Premautose states

Hyperglycemic Coma

Gyperuricemia, Gong

Decompensated mitral or aortic stenosis, hypertrophic obstructive cardiomyopathy, increase central venous pressure (over 10 mm Hg), arterial hypotension, acute myocardial infarction

Pancreatitis

Disruption of water and electrolyte metabolism and acid-base equilibrium (hypokalemia, alkalosis, hypovolemia, hyponatremia, hypochlorinemia, hypocalcemia, hypomagnemia), digitalisal intoxication

Period of breastfeeding

I trimester pregnancy

Medicinal interactions

In some cases, the intravenous purpose of furosemide for 24 hours after taking chloralhydrate can lead to tides of blood, excessive sweating, concern, nausea, an increase in blood pressure, tachycardia. Therefore, the joint reception of furosemide and chloralhydrate is not recommended.

Aminoglycosides and other overoxcic drugs can be intensified with the simultaneous use of furosemide. Since the occurrence of hearing impairment may be irreversible, then the simultaneous use of life indications.

Combinations requiring special precautions

With the simultaneous use of furosemad and cisplatin, a risk of developing a differentoxic action is possible. If, in the treatment of cisplatin, it is necessary to achieve a forced diurea with a furosemide, the latter can be assigned only in a low dosage (for example, 40 mg with a normal kidney function) and in the absence of a fluid deficiency. Otherwise, it is possible to enhance the nephrotoxic effect of cisplatin.

Under the action of Furosemid, lithium removal is reduced, due to which the damaging effect of lithium on the heart and nervous system. Lithium levels should be carefully monitored in patients receiving this combination.

Furosemide treatment can lead to severe hypotension and deterioration of kidney function, and in some cases, to the development of acute renal failure, especially when the inhibitors of angiotensin-converting enzyme (ACE) or angiotensin II receptor antagonists are for the first time or at the first reception in high dose. Cancellation of furosemide is recommended, or a decrease in the dose of furosemide 3 days before the treatment of APE inhibitors or angiotensin receptor antagonists.

Caution should be used furosemid in combination with risperidone. Elderly patients with dementia are increasing mortality with the joint use of furosemide and risperidone. Necessity shared application Must be justified with the risk and use of this combination.

Combinations that should be taken into account

The simultaneous purpose of nonsteroidal anti-inflammatory agents (NSAIDs), including acetylsalicylic acid, can reduce the effect of furosemide. In patients with dehydration or hypovelesemia, the NSAIDs can cause acute renal failure. At the same time, the toxic effect of salicylates may increase.

A reduction in the effectiveness of furosemide is also described while prescribing phenytoin.

With simultaneous treatment with glucocorticosteroids, carbenoxolone, licorice in large quantities, long use Laxatives can increase hypokalemia.

Possible hypokalemia or hypomagnation can increase the sensitivity of the heart muscle to cardiac glycosides and drugs leading to the elongation of the Qt interval.

The effect of other drugs that reduce blood pressure (blood pressure) (antihypertensive, diuretic and other drugs) can be enhanced while using furosemide.

The simultaneous use of probenecide, methotrexate and other means, which are derived from the tubular secretion (as well as furosemid) can reduce the effectiveness of furosemide. On the other hand, furosemide can lead to a decrease in the renal elimination of these drugs.

When treating large doses (furosemide and other drugs), it is possible to increase their levels in blood serum and raising the risk of side effects.

The effectiveness of hypoglycemic agents and pressor amines (for example, epinephrine (adrenaline) , Norepinephrine (norepinephrine) can be weakened, and theophylline and stripped means - Strengthened.

Furosemide can enhance the damaging effect on the kidney of nephrotoxic drugs.

In patients at the same time receiving treatment with furosemide and some cephalosporins in high doses, the renal function is possible.

With the simultaneous use of cyclosporine A and Furosemid, it is possible to increase the risk of the development of secondary gouty arthritis due to furosemid-induced hyperuricemia and the deterioration of ultrasound of the kidneys caused by the cyclosporine.

Patients with high risk of radiocontrase nephropathy, receiving the treatment of furosemide, are more susceptible to impairment of renal function after obtaining a radiocontrase substance in comparison with high risk patients, which were obtained only intravenous hydration before producing radiocontrase substances.

Intravenously entered furosemide has a slightly alkaline reaction, so it cannot be mixed with the drugs with a pH of less than 5.5.

special instructions

Against the background of treatment, it is necessary to periodically control the blood pressure, the content of plasma electrolytes (Na, Ca, k, Mg), the acid-base state, residual nitrogen, creatinine, uric acid, liver function, and carried out, if necessary, appropriate treatment correction (with greater multiplicity In patients with frequent vomiting and against the background of parenterally administered liquids).

Patients with hypersensitivity to sulfonyl amides and sulfonylurea derivatives may have cross sensitivity to Furosemide.

Patients receiving high doses of furosemide in order to avoid the development of hyponatremia and metabolic alkalosis inappropriately limit the consumption of the cooking salt.

The increased risk of developing disorders of the water-electrolytic balance is noted in patients with renal failure.

Selection of the dosing mode of patients with ascites against the background of the liver cirrhosis should be carried out in stationary conditions (violation of the water and electrolyte balance may result in the development of the hepatic coma). This category of patients is shown regular control over the content of electrolytes in plasma.

With the appearance or strengthening of azotemia and oliguria in patients with severe progressive diseases of the kidney, it is recommended to suspend treatment.

In patients with diabetes or with reduced glucose tolerance requires periodic control over blood glucose levels and urine.

In patients in an unconscious state, with prostate hypertrophy, a narrowing of ureters or hydronephrosis requires control of urinary due to the possibility of acute urine delay.

Application during pregnancy and lactation

During pregnancy (especially the first half), furosemid is adopted by life indications after a thorough assessment of the benefit ratio for the Mother / Risk for the Fetal.

It is released with milk in women during the lactation period and suppresses lactation, if necessary, applying the drug it is advisable to stop breast feeding.

Features of the influence of the medicinal product on the ability to control the vehicle or potentially hazardous mechanisms

During the period of treatment, classes should be avoided by potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Overdose

Symptoms: pronounced decrease in blood pressure, collapse, shock, hypovolemia, dehydration, hemokoncentration, arrhythmias (including AV blockade, fibrillation of ventricles), acute renal failure with Anuria, thrombosis, thromboembolism, drowsiness, confusion, sludge paralysis, apathy.

Treatment: The correction of the water-salt balance and the acid-base state, the replenishment of the volume of circulating blood, symptomatic treatment. No specific antidote.

Form release and packaging

2 ml into glass ampoules.

10 ampoules along with a knife or scarifier to autopsy ampoules are inserted into a cardboard box with a corrugated paper liner.

The box is covered with a label-parcel of paper for multicolor printing.

Boxes along with instructions for use in public and Russian languages \u200b\u200bare packaged in group packaging.

The number of instructions for software should correspond to the number of packages.

Loop diuretics.

Furosemide composition

Active substance - Furosemide.

Manufacturers

Biology ITALY laboratories S.R.L. (Italy), Biomed (Russia), Biosynthesis of OJSC (Russia), Biochemist OJSC (Russia), Borisov Plant of Medical Drugs (Belarus), Dalkhimfarm (Russia), Ipka Laboratories LTD (India), Life Pharma (Italy), Moscow Endocrine factory (Russia), MoschimFarPreparations them. ON THE. Semashko (Russia), Novosibhimfarm (Russia), Experienced Plant "GGTSLS" (Ukraine), Panelharma Pharmaceutical Plant (Poland), Samson (Russia), Samson-Med (Russia), Ufavita (Russia), Khinoin (Hungary)

pharmachologic effect

Diuretic, sodium systemic.

Operates throughout the thick segment of the rising knee of the loop of Genla and blocks reabsorption of 15-20% of sodium profilt-contained ions.

Secrets into the lumen of proximal renal tubules.

Increases the removal of bicarbonates, phosphates, calcium, magnesium and potassium, increases pH urine.

It has secondary effects due to the release of intravenous mediators and the redistribution of intravenous blood flow.

Quickly and fully absorbed with any way of administration.

The half-life is 0.5-1 hours.

Excreted by 88% by kidneys and 12% - with biliary.

The diuretic effect is characterized by considerable severity, short-term and dose.

After oral administration, it occurs after 15-30 minutes, reaches a maximum after 1-2 hours and lasts 6-8 hours.

When in / in injection, it is manifested in 5 minutes, peak - after 30 minutes, duration - 2 hours.

During the period of action, the excretion of sodium ions increases significantly, but after its termination, the rate of sodium ions decreases below the source level (the phenomenon of the "ricochet" or return).

The phenomenon is caused by a sharp activation of renin-angiotensin and other anti-zeothetic neurohumoral regulation links in response to massive diuresis.

Stimulates the arginine-vasopressic and sympathetic system, reduces the level of the atrial sodiumthical factor in plasma, causes vasoconstriction.

Due to the phenomenon of "Ricochlet" when taking 1 time per day, may not have a significant effect on the daily excretion of sodium ions.

Effective in heart failure (both acute and chronic), improves the functional class of heart failure, because Reduces the pressure of the left ventricle.

Reduces peripheral swelling, stagnant phenomena in the lungs, vascular pulmonary resistance, pressure of the sludge of pulmonary capillaries in pulmonary artery And the right of atrium.

Keeps efficiency at low glass filtration rate, therefore it is used to treat arterial hypertension in patients with renal failure.

Side effect Furosemid

Hypotension, incl. Postural, collapse, thromboembolism, thrombophlebitis (mainly in the elderly), hypokalemia, hypomagnemia, hyponatremia, violation of glucose tolerance, hyperuricemia, gout, increase the level of cholesterol LDL (with large doses), violation of KSHC (hypochlorine alkalosis), hypercalciuria, liver function , intrahepacine cholestasis, pancreatitis, diarrhea, constipation, nausea, vomiting, anorexia, defeat inner ear, Hearing Loss, Bulking Vision, Connection, Consciousness, Nursing, Headache, Dizziness, Parentesia, Weakness, Muscle Spazm bladder, chills, fever, thrombocytopenia, aplastic anemia, leukopenia, systemic vasculitis, interstitial jade, hematuria, necrite, exfoliative dermatitis, multiform erythema, impotence, photosensibination, urticaria, skin itch.

Indications for use

Chronic heart failure, pulmonary edema, hypertensive crisis, eccho-ascitic syndrome in cirrhosis, renal failure, nephrotic syndrome, pronounced hypernatremia, hypercalcemia and hypermagnias.

Contraindications Foursmemid

Increased sensitivity (including sulfonamides), hepatic coma, severe violations of the electrolyte balance, hypokalemia, pronounced lack of liver and kidney function, Oliguria for more than 24 hours, Anuria, gout, hyperuricemia, diabetes or violation of tolerance to carbohydrates, decompensated mitral or aortic stenosis, increase pressure in yarema Vienna Over 10 mm Hg, hypertrophic cardiomyopathy with obstruction of the output tract of the left ventricle, hypotension, myocardial infarction, systemic red lupus, pancreatitis, metabolic alkalosis.

Method of application and dosage

Intramuscularly or intravenously - once, 20-40 mg (if necessary, an increase in dose by 20 mg every 2 h).

Jet intravenous administration produce slowly, within 1-2 minutes.

In high doses (80-240 mg and more) administered intravenously drip, at a speed not higher than 4 mg / min.

Maximum daily dose - 600 mg.

Overdose

Symptoms:

• hypotenzi
• reduced by
• hypokalemia and hypochloremic alkalosis.

Treatment:

• maintain vital functions.

Interaction

Aminoglycosides, etcinic acid and cisplatin increase the isotoxicity (especially with the impaired kidney function).

Enhances the danger of kidney damage against amphotericin B.

When prescribing high doses of salicylate increases the risk of solicyness, cardiac glycosides - hypokalemia and related arrhythmias, corticosteroids - electrolyte imbalance.

Reduces the Miorolaxing activity of tubaurine, potentiates the effect of succinylcholine.

Reduces the kidney clearance lithium.

Under the influence of furosemide, the effect of ACE inhibitors and antihypertensive agents, warfarin, diazoxide, theophylline, weakens - antidiabetic drugs, norepinephrine.

Sukralfat and indomethacin reduce efficiency.

Slovecid increases serum concentration.

special instructions

If there are ascites without peripheral edema, it is recommended to apply in doses providing additional diuresis in the amount of no more than 700-900 ml / day to avoid the development of oliguria, azotemia and electrolyte violations.

In order to exclude the phenomenon of the "Ricochet" in the treatment of arterial hypertension, prescribe at least 2 times a day.

It should be borne in mind that a long-lasting technique can lead to the appearance of weakness, fatigue, decreased blood pressure and heart Emission, and excessive diuresis with myocardial infarction with stagnation in a small circulation circle can contribute to the development of cardiogenic shock.

Temporary cancellation is needed (for several days) before appointing ACE inhibitors.

During the first months of treatment, blood pressure is recommended, the level of electrolytes (especially potassium), CO2, creatinine, urea nitrogen, uric acid, periodic determination of the activity of hepatic enzymes, calcium and magnesium levels, blood glucose content in the urine (with diabetes mellitus).

When conserving Oliguria, within 24 hours, the furosemide should be canceled.

Should not be used while driving drivers vehicle and people whose profession is associated with increased concentration of attention.