FUSIX 40/MG TAB 30/TAB

Indications

Approved Uses

Edema associated with congestive heart failure, cirrhosis of the liver, and renal disease (including nephrotic syndrome), Hypertension.

Off-Label Uses

Adjunct in acute pulmonary edema (often IV in emergencies), adjunct management of hypercalcemia (with saline), and adjunct management of hyperkalemia (to enhance urinary potassium excretion when appropriate).

Dosage & Administration

Dosing by Condition

Edema (adults): 20-80 mg orally once; may repeat or increase by 20-40 mg no sooner than 6-8 hours based on response; maximum up to 600 mg/day in severe cases. Hypertension (adults): 40 mg orally twice daily initially; adjust based on blood pressure/response (not typically first-line).

Initial Dose

Edema: 20-80 mg orally once daily; Hypertension: 80 mg, usually divided into 40 mg twice a day.

Maintenance Dose

The individually determined single dose should then be given once or twice daily (e.g., at 8 am and 2 pm). The dose of furosemide may be carefully titrated up to 600 mg/day in patients with clinically severe edematous states.

Maximum Dose

600mg/day (edema); 240mg/day (hypertension)

Dose Adjustment Notes

Titrate to clinical response and monitor electrolytes/renal function; in significant renal impairment, higher doses may be required to achieve diuresis. In hepatic cirrhosis, use cautiously (often initiate/adjust under close supervision) to avoid precipitating hepatic encephalopathy from rapid fluid/electrolyte shifts.

How to Take

Swallow the tablet with water; may be taken with or without food. Take in the morning; if a second daily dose is prescribed, take it in the early afternoon (e.g., lunchtime) to reduce nocturia.

Side Effects

Common Side Effects

Increased urination, dizziness/orthostatic hypotension, dehydration, electrolyte disturbances (especially hypokalemia and hyponatremia), nausea/vomiting.

Side Effect Frequency

Common: electrolyte disturbances (especially hypokalemia, hyponatremia), dehydration/volume depletion, hypotension, hyperuricemia; GI upset (nausea) and dizziness may occur. Uncommon/Rare: ototoxicity (dose/IV/renal-risk related), blood dyscrasias (e.g., thrombocytopenia), severe cutaneous reactions (e.g., SJS/TEN), pancreatitis.

Safety & Warnings

Contraindications

Anuria, hypersensitivity to furosemide.

Warnings & Precautions

Key warnings/precautions: risk of profound diuresis with dehydration/hypotension-monitor weight, BP, fluid status; monitor electrolytes (Na/K/Mg) and renal function; ototoxicity risk with high doses/ototoxins; may worsen gout (↑ uric acid) and affect glucose control; sulfonamide cross-sensitivity possible; caution in elderly and in hepatic cirrhosis (risk of encephalopathy); NSAIDs may blunt effect; may exacerbate SLE (rare).

Age Restriction

No fixed minimum age restriction; pediatric/neonatal use requires specialist dosing and close monitoring (extra caution in premature infants/neonates).

Drug Interactions

Drug Interactions

Major clinically relevant interactions include: aminoglycosides/other ototoxins (e.g., ethacrynic acid) and cisplatin (↑ ototoxicity/nephrotoxicity); NSAIDs (↓ diuretic/antihypertensive effect, ↑ renal risk); lithium (↑ lithium levels/toxicity); digoxin (hypokalemia ↑ toxicity); ACEi/ARBs/other antihypertensives (additive hypotension/renal impairment); corticosteroids/amphotericin B (↑ hypokalemia); probenecid (↓ tubular secretion/↓ effect); sucralfate (↓ absorption-separate dosing).

Interaction Severity

MAJOR: Aminoglycosides (↑ ototoxicity/nephrotoxicity), Cisplatin (↑ ototoxicity/nephrotoxicity), Lithium (↑ lithium levels/toxicity). MODERATE: Digoxin (risk of toxicity via hypokalemia), NSAIDs (↓ diuretic/antihypertensive effect; ↑ renal risk), ACE inhibitors/ARBs and other antihypertensives (additive hypotension/renal effects), Corticosteroids/amphotericin B (↑ hypokalemia). MINOR/ADMINISTRATION: Sucralfate (↓ absorption-separate by at least 2 hours).

Special Populations

Kidney Impairment

No fixed dose reduction; reduced GFR may require higher doses to achieve diuresis; discontinue if increasing azotemia and oliguria occur; contraindicated in anuria/unresponsive renal failure.

Storage & Patient Advice

Stopping the Medicine

Do not stop abruptly without prescriber direction; discontinue/withhold if increasing azotemia and oliguria occur, and otherwise stopping may worsen edema/heart failure due to loss of diuretic effect.

Overdose

Symptoms: marked diuresis with dehydration/hypovolemia, hypotension, electrolyte disturbances (e.g., hyponatremia, hypokalemia, hypochloremic alkalosis), possible arrhythmias/renal impairment. Management: supportive care with IV/oral fluid and electrolyte replacement, monitor vitals/ECG/renal function; consider GI decontamination only if very recent ingestion per toxicology guidance; seek urgent medical care.

Patient Counseling

Take in the morning (and if a second dose is prescribed, early afternoon) to reduce nighttime urination; expect increased urination. Stand up slowly to reduce dizziness/low blood pressure. Maintain appropriate hydration and follow clinician advice on salt/potassium; report symptoms of dehydration or electrolyte imbalance (thirst, weakness, muscle cramps, palpitations), reduced urination, severe dizziness, or hearing changes. Keep scheduled labs for electrolytes and kidney function; diabetics should monitor glucose more closely.

Monitoring Requirements

Monitor blood pressure, weight/fluid status and urine output; serum electrolytes (especially potassium and sodium; also magnesium), and renal function (SCr/BUN). Consider uric acid and glucose in at-risk patients; assess hearing with high-dose/prolonged therapy or when combined with ototoxins.

Pharmacology

Mechanism of Action

Inhibits the Na+/K+/2Cl− cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, reducing sodium/chloride reabsorption and increasing excretion of water and electrolytes (including potassium).

Onset of Action

Oral: about 30-60 minutes.

Duration of Effect

Oral: approximately 6-8 hours.

Bioavailability

47-70%.

Metabolism

Minimal hepatic metabolism; a portion is conjugated to a glucuronide (predominantly in the kidney), with most drug eliminated unchanged in urine.

Protein Binding

Highly protein bound, ~95-99% (mainly to albumin).

Product Information

Available Dosage Forms

Tablet (this product: 40 mg oral tablet). Other furosemide dosage forms that may exist in general include oral solution and injectable solution (IV/IM).

Composition per Dose

Each tablet: 40mg furosemide

Generic Availability

Yes

OTC Alternatives

No OTC alternative

Cv Drug Class

Diuretic

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