1 tablet contains furosemide 40 mg
other ingredients:lactose, wheat starch, silicon dioxide colloidal, magnesium stearate, talc.The
basic physico-chemical properties:round biconvex tablets with a diameter of 6 mm, from white to almost white.The
Diuretics. Highly active loop diuretics.
ATX Code C0ZS A01.The
Furosemide is a loop diuretic that suppresses the absorption of sodium and chlorine ions in the ascending part of the loop of Genle, proximal and distal nephron tubules. A high degree of efficiency is due to the unique mechanism of action. The effect in the distal tubules does not depend on the inhibitory effect of carbonic anhydrase or aldosterone effect. Pharmacological action of furosemide is limited only by the kidneys. The main mechanism of action of furosemide is to inhibit active chloride transport in the ascending part of the loop. Resorption of sodium and chloride in the nephron is reduced and is formed of Hypo - or isotonic urine.
Found that the use of furosemide affects the synthesis of prostaglandins and renin-angiotensin system. Furosemide affects the permeability of the tangle relative to serum proteins.
the start of the diuretic effect begins approximately 1:00 after oral administration. The maximum therapeutic effect occurs between the first and second hour. The duration of diuretic effect is more than 4:00.
Suction. Furosemide is absorbed quickly, but not completely (about 60-70%) after oral administration. With oral administration, the drug is absorbed in a significant amount in the upper part of the duodenum at pH 5.0. Its effect lasts more than 4: 00 after oral administration and an average of about 2:00 after parenteral administration.
Distribution. Characterized by a high degree of binding to plasma proteins, mainly albumin. In healthy subjects, plasma concentrations range from 1 to 400 µg/ml, with 91-99% of furosemide bound to blood plasma proteins. Furosemide crosses the placental barrier and slowly falls into a fetus.
Metabolism. Glucuronide furosemide is the only or at least the main metabolite of its biotransformation in humans. A small amount is metabolized by cleavage of the side chain.
Output. Conclusion mainly kidneys with urine (glomerular filtration and proximal tubular secretion) is about 50% of the administered dose after oral administration, up to 80-90% after intravenous or intramuscular application, and 10-15% of the active substance is excreted with feces, within 24 hours. A small portion is excreted in the bile.
patients with kidney/liver damage.
in case of liver disease, biliary excretion is reduced to 50%. Kidney damage has a minimal effect on the rate of excretion of furosemide, but with less than 20% of residual renal function, a noticeable increase in elimination time.
in the presence of renal disease slows down the excretion of furosemide.
In some cases, the intake of furosemide within 24 hours afterchloral hydratecan cause hot flashes, sweating, restlessness, nausea, increase in blood pressure and tachycardia. Thus, simultaneous use of furosemide and chloral hydrateis not recommended .
Furosemide may increase the ototoxicity ofaminoglycosidesand otherototoxic drugs. This can cause damage that is irreversible, these drugs should not be used simultaneously with furosemide.
Combinations requiring the application of measures.
there is a risk of both ototoxic and nephrotoxic action whilecisplatinuse if furosemide is not used at low doses (40 mg in patients with normal renal function) or a positive water balance to achieve forced diuresis in the treatment ofcisplatin.Furosemide reduces the elimination oflithium saltsand can cause an increase in the level oflithiumin serum and increases the risk of toxicity oflithium preparations, including their cardio - and neurotoxic effects. For this reason, careful monitoring of the level oflithiumin patients taking the indicated combination is necessary.
in patients receiving diuretics may develop severe arterial hypotension and renal impairment to renal failure when combined withACE inhibitorsorangiotensin II receptor antagonists, especially when used for the first time or in high doses. It is necessary to consider the possible temporary discontinuation of furosemide or at least reducing its dose for three days before treatment, or before increasing the dosage of ACE inhibitors, orangiotensin II receptor antagonists.
care should be taken when using furosemide in conjunction withrisperidoneas a combination or concomitant treatment and carefully evaluate the benefit/risk ratio.
Combinations, there are fears.
Nonsteroidal anti-inflammatory drugs(includingindomethacin, acetylsalicylic acid) in combination with furosemide can significantly reduce the diuretic and antihypertensive effects of furosemide. In patients with dehydration or hypovolemiaNSAIDscan cause acute renal failure, lead to acute heart failure. Under the action of furosemide may increase toxicitysalicylatesandnephrotoxic antibiotics.
the effect of furosemide decreases with combination therapy withenzyme inductors, such asphenobarbital, phenytoin.
applicationcarbenoxolone, liquorice, ?2-sympathomimetic, licorice rootin high doses, prolonged use oflaxatives,reboxetinmay increase the risk of hypokalemia.
Corticosteroids, corticotropin and amphotericinlead to the loss of potassium. With simultaneous use with furosemide can lead to a serious reduction in plasma potassium levels.
Combined use withcarbamazepinemay increase the risk of hyponatremia, and withcorticosteroids, on the contrary, may cause sodium retention.
Some electrolyte imbalances (e.g. hypokalemia and hypomagnesemia) may increase the toxicity ofdigitalisand the toxicity of drugs causing Qt prolongation syndrome.
Furosemide increases myocardial sensitivity to the action ofcardiac glycosides.
Concurrent usemetolazone(thiazide diuretic) may cause enhanced diuresis.
Ifantihypertensive drugs,diureticsor other drugs having the property to lower blood pressure, used in conjunction with furosemide, you should expect potentiation of the actionantihypertensive drugsand even lower blood pressure.
Simultaneous use ofsucralfatand furosemide can lead to inhibition of its diuretic and antihypertensive action, which requires compliance with at least two-hour interval between taking two drugs.
Probenecid, methotrexate andand other medications like the furosemide, excreted by tubular secretion, which can reduce the effect of furosemide. Conversely, furosemide can reduce the excretion of these drugs by the kidneys. When used in high doses, their concentration in blood plasma increases and, accordingly, the risk of adverse reactions caused by furosemide or the use of concomitant therapy increases.
Furosemide can reduce the therapeutic effect of sympathomimetics, which have the property of raising blood pressure (egepinephrine, norepinephrine),oral antidiabetic agents, insulin, allopurinol.
Furosemide may increase the effects ofmuscle(curariform-type) andtheophylline.
it is Possible to increase the harmful effect of nephrotoxic drugs on the kidneys.
Combined treatment with furosemide and high doses of cephalosporinscan cause kidney damage.
Concomitant use withcyclosporine ais associated with increased risk of secondary gout arthritis through induced furosemide hyperuricemia and impaired cyclosporinewithdrawal of urates from the kidneys.
patients who have been prescribedcholesterolshould take this medicine at least 1:00 hours after furosemide administration.
in patients who belonged to the group at high risk of nephropathy due to the treatment ofRadiocontrast substances, in the treatment of furosemide, there was a high incidence of renal impairment after receivingRadiocontrast substancescompared with patients of high risk group who underwent only intravenous hydration prior to the appointment of Radiocontrast substances.
Excessive aggressive diuresis can lead to orthostatic hypotension, as well as acute hypotensive episodes.
levels of sodium, potassium, calcium, chlorine, magnesium and creatinine in serum are Observed, especially in patients at high risk of electrolyte imbalance or significant fluid loss. The development of electrolyte balance disorders is influenced by factors such as existing diseases (eg, cirrhosis of the liver, heart failure), the simultaneous use of drugs and nutrition. For example, as a result of vomiting or diarrhoea may cause potassium deficiency. When applying furosemide, it is advisable to recommend to the patient foods with a high potassium content (baked potatoes, bananas, tomatoes, spinach, dried fruits). It should be remembered that when using furosemide, you may need medication to compensate the potassium deficiency.
hypovolemia or dehydration Conditions, as well as acid-base imbalance or significant electrolyte disorders, must be corrected before treatment or in the treatment has already begun to temporarily stop it.
you Must provide the path of the outflow to the separation of urine from the body. In patients with partial obstruction of urine flow, complaints may be triggered or existing ones may be strengthened. Patients with impaired urination (prostatic hypertrophy or obstruction of the urinary tract) may develop acute urinary retention if pre-discharge of the bladder is not provided.
under extreme caution and control shall be:The
placebo-controlled trials with risperidone, involving elderly patients with dementia, showed higher mortality in patients treated with both furosemide and risperidone than those treated with furosemide or risperidone alone. In such cases, the benefit/risk ratio of such combination treatment should be assessed. There are no reports of increased mortality among patients taking other diuretics (mainly thiazide diuretics, at low doses) as concomitant treatment with risperidone.
care should be taken to carefully weigh the risks and benefits before deciding to use this combination of simultaneous treatment with other potent diuretics. Dehydration should be avoided.
simultaneous use of alcohol and furosemide should be avoided.
the composition of the drug as an auxiliary substance includes wheat starch, which can only contain traces of gluten and is considered safe for persons with celiac disease.
the Drug contains lactose. Patients with rare hereditary galactose intolerance, lactase deficiency or Lapp malabsorption of glucose-galactose should not take this drug.
Furosemide penetrates through the placental barrier. It should not be prescribed during pregnancy, except for life-time treatment. Furosemide treatment during pregnancy requires monitoring of fetal growth and development.
Furosemide passes into breast milk and may suppress lactation. Women should stop breast-feeding during treatment with furosemide.The
the Furosemide reduces the concentration and can lead to impaired ability to operate vehicles and also when working with machines. When using furosemide, some side effects (for example, an unexpected significant decrease in blood pressure) can disrupt the patient's ability to concentrate and the speed of his reaction.
therefore, you should refrain from driving or working with other mechanisms for the period of treatment.
Furosemide is usually taken orally during meals or on an empty stomach.
the dosing Regimen is set by the doctor individually according to the patient's therapeutic response, applying the minimum effective dose. You can apply 1 time per day or every other day.
the initial Recommended single dose is 40 mg. May require additional doses to achieve the maintenance dose. In mild cases, a dose of 40 mg every other day may be sufficient. In cases of resistant edema, the recommended dose is 80 mg or more, once or twice a day, or used if necessary. In severe conditions caused by edema, it may be necessary to gradually increase the dose to 600 mg per day.
the maximum daily dose of furosemide should not exceed 1500 mg.
special dosage recommendations.
Swelling in chronic congestive heart failure.
the Recommended initial dose of the drug for oral administration of 20-40 mg per day. If necessary, the dose can be adjusted depending on the therapeutic response of the patient. It is recommended to use a daily dose divided into 2 or 3 admission.
Swelling in chronic renal failure.
the Natriuretic effect of furosemide depends on a number of factors, including the severity of renal failure and sodium balance. Thus, it is impossible to accurately predict the effectiveness of the dose. For patients with chronic renal failure, the dose should be carefully titrated to ensure gradual initial fluid loss. For adult patients, this means taking a dose that results in a daily weight loss of approximately 2 kg (approximately 280 mmol Na +).
the recommended daily dose for oral administration is 40-80 mg, if necessary, you can adjust the dose depending on the therapeutic response of the patient. The daily dose can be applied once or in 2 divided doses. For patients on hemodialysis, the total daily oral dose is 250-1500 mg.
acute renal failurebefore you start taking furosemide, should compensate for the hypovolemia, arterial hypotension and significant electrolyte and acid-base imbalance.
it is Recommended as soon as possible to make the transition from injection to oral.
Swelling in nephrotic syndrome.
the Recommended starting dose for oral administration is 40-80 mg per day. If necessary, the dose can be adjusted depending on the therapeutic response of the patient. The daily dose can be prescribed once or divided into several methods.
Swelling in liver diseases.
furosemide administered as a Supplement to the treatment of aldosterone antagonists in cases where the use of aldosterone antagonists only is not enough. To prevent complications, such as orthostatic hypotension or electrolyte disorders and acid-base balance, the dose should be carefully titrate to provide the gradual primary loss of fluid. For adult patients, this means the use of such a dose leads to a daily decrease in body weight by approximately 0.5 kg.
the recommended daily oral dose is 20-80 mg., if necessary can adjust the dose depending on the therapeutic response of the patient. The daily dose can be used once or divided into several methods. If the introduction is absolutely necessary, the initial single dose is 20-40 mg.
the Drug in the form of tablets to appoint children weighing more than 10 kg.
the recommended dose of furosemide for oral admission is 2 mg/kg body weight per day, but the maximum daily dose should not exceed 40 mg per day.
there are no special recommendations for dosing. In elderly patients, furosemide is excreted more slowly. It is necessary to titrate the dose until a therapeutic effect.The
For children the dosage should be reduced in accordance with body weight (see "Method of application and doses").
for children who are unable to take dosage form for oral administration, such as premature infants and newborns, consideration should be given to the use of parenteral administration forms.
the Clinical picture of acute or chronic overdose depends mainly on the extent and effects of electrolyte and fluid loss, and manifests itself as hypovolemia, dehydration, hemoconcentration, cardiac arrhythmias (including AV blockade and ventricular fibrillation) caused by increased diuresis. In case of overdose of furosemide, which is most often manifested severe arterial hypotension (progressing to shock), cardiac arrhythmias, orthostatic collapse or other signs of hypovolemia (acute renal failure, thrombosis, delirious States, delirium, flaccid paralysis, apathy, confusion).
the medication should be stopped immediately and if necessary, an electrolyte solution should be introduced to restore the circulatory volume and water-electrolyte balance. In connection with the prevention and treatment of these disorders may require intensive treatment and monitoring of the patient. Immediately after absorption of the drug, in order to limit systemic absorption of the active substance, perform gastric lavage and use activated charcoal.
there is no Specific antidote. Therapy is symptomatic.
Metabolic and alimentary disorders.
Furosemide leads to increased excretion of sodium and chloride and, consequently, water. This leads to a decrease in the amount of sodium and chlorine in the blood (hyponatremia, hypochloremia). In addition, increased excretion of other electrolytes (in particular potassium, calcium, magnesium and this leads to a decrease in their blood levels - hypokalemia, hypocalcemia, hypomagnesemia). Symptomatic electrolyte imbalance, metabolic alkalosis and pseudo-syndrome Bartter (on the background of irregular and/or prolonged use of furosemide) can proceed in the form of a gradually increasing electrolyte deficit. In patients with normal liver function of higher doses of furosemide, acute deterioration may occur as a result of a large loss of electrolytes.
The warning symptoms of disorders of electrolyte balance include increased feeling of thirst, headache, confusion, seizures, tetany, muscle weakness, heart rhythm disorder, and symptoms of gastro-intestinal tract.
the Diuretic effect of furosemide can lead to or contribute to hypovolemia and dehydration of the body, especially in elderly patients. A significant decrease in the amount of fluid in the body can lead to increased blood clotting processes with a tendency to thrombosis.
treatment with furosemide can lead to a transient increase in blood creatinine and urea levels, as well as to an increase in serum cholesterol and triglyceride levels. Serum uric acid levels may increase and gout attacks may occur.
glucose Tolerance may decrease as a result of the use of furosemide. In diabetic patients, this can lead to a deterioration in metabolic control; diabetes mellitus can move from the latent form into a pronounced form of the disease.
from the blood and lymphatic systems:aplastic anemia, thrombocytopenia, agranulocytosis, hemolytic anemia, leukopenia, eosinophilia, hemoconcentration.
there are reports of inhibition of bone marrow function, requires immediate cessation of treatment with furosemide.
from the immune system:severe anaphylactic or anaphylactoid reactions, in very rare cases up to shock.
from nervous system:paresthesia, delusional.
Hepatic encephalopathy (in patients with hepatocellular insufficiency or acute pancreatitis).
on the part of hearing and labyrinth:noise or ringing in the ears, hearing impairment. Usually transient. It is most commonly seen in patients with renal insufficiency, hypoproteinemia (nephrotic syndrome), as well as with the rapid introduction of furosemide.
cases of deafness, sometimes irreversible, have been Reported after oral administration or administration of furosemide.
from the cardiovascular system:arterial hypotension (in severe cases, occurs with symptoms of low concentration and delayed reactions, dizziness, feeling of pressure in the head, headache, feeling of rotation, drowsiness, weakness, visual impairment, dry mouth), orthostatic hypotension ( orthostatic collapse). Tendency to thrombosis, vasculitis.
from the gastrointestinal tract: acute pancreatitis, diarrhea, nausea, vomiting.
hepatic and biliary diseases:intrahepatic cholestasis, increase in liver transaminases.
on the part of the skin and subcutaneous tissue:pruritus, urticaria, other rashes or bullous dermatitis, erythema multiforme, pemphigoid, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, purpura, photosensitivity, acute generalized absentmindly pustules (AGEP) and DRESS - syndrome (drug rash with eosinophilia and systemic symptoms).
on the part of the kidneys and urinary system:increased urine volume, acute urinary retention (with partial obstruction of the urinary tract), tubulo-interstitial nephritis, an increase in the level of sodium in the urine, an increase in the level of chlorine in the urine, renal failure, nephrocalcinosis/nephrolithiasis in premature infants .
Congenital, hereditary and genetic disorders:increased risk of persistent arterial duct when furosemide is used in premature infants in the first weeks of their lives.
General disturbances and effects at the injection site (for injection form):local reactions such as pain after administration, fever.The
keep out of reach of children.
Store in its original packaging at a temperature not exceeding 25 ° C.The
10 tablets in blister from PVC film and aluminum foil. 2 blisters in a cardboard bundle.The
According to the recipe.The
JSC "Paul Smith".
the St. Iliensko shosse 16, Sofia, 1220, Bulgaria.
Homvio-Prostan drops for oral use – homeopathic medicine. The effect of the drug has a preventive and curative effect in diseases of the genitourinary tract. For easy use and accurate compliance with the dosing tool that comes in a vial-dropper.
with prolonged use, analgesic, anti-inflammatory, antispasmodic effect is observed. At the same time normalizes the muscle membrane of the bladder.
Uncontrolled self-medication may worsen physical condition, so the medication and therapy regimen are prescribed by a physician at:
If you are diagnosed with the disease in the chronic form, Homvio-prostan issued at a dosage of 10 drops up to 3 times in 24 hours. The average daily norm can be increased to 15 drops on the lack of effectiveness of therapy.