Diusex 20mg/2ml

Furosemide 20mg

Warnings
Black Box Warnings
Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion
Careful medical supervision is required; dosing must be adjusted to patient's needs

Contraindications
Documented hypersensitivity to furosemide or sulfonamides
Anuria

Cautions
Use caution in systemic lupus erythematosus, liver disease, renal impairment
Concomitant ethacrynic acid therapy (increases risk of ototoxicity)
Risks of fluid or electrolyte imbalance (including causing hyperglycemia, hyperuricemia, gout), hypotension, metabolic alkalosis, severe hyponatremia, severe hypokalemia, hepatic coma and precoma, hypovolemia (with or without hypotension)
Do not commence therapy in hepatic coma and in electrolyte depletion until improvement is noted
IV route twice as potent as PO
Food delays absorption but not diuretic response
May exacerbate lupus
Possibility of skin sensitivity to sunlight
Prolonged use in premature neonates may cause nephrocalcinosis
Efficacy is diminished and risk of ototoxicity increased in patients with hypoproteinemia (associated with nephrotic syndrome); ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses, concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs
To prevent oliguria, reversible increases in BUN and creatinine, and azotemia, monitor fluid status and renal function; discontinue therapy if azotemia and oliguria occur during treatment of severe progressive renal disease
FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur
In cirrhosis, electrolyte and acid/base imbalances may lead to hepatic encephalopathy; prior to initiation of therapy, correct electrolyte and acid/base imbalances, when hepatic coma is present
High doses (> 80 mg) of furosemide may inhibit binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by overall decrease in total thyroid hormone levels
In patients at high risk for radiocontrast nephropathy furosemide can lead to higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast
Observe patients regularly for possible occurrence of blood dyscrasias, liver or kidney damage, or other idiosyncratic reactions
Cases of tinnitus and reversible or irreversible hearing impairment and deafness reported
Hearing loss in neonates has been associated with use of furosemide injection; in premature neonates with respiratory distress syndrome, diuretic treatment with furosemide in the first few weeks of life may increase risk of persistent patent ductus arteriosus (PDA), possibly through a prostaglandin-E-mediated process
Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients
Increases in blood glucose and alterations in glucose tolerance tests (with abnormalities of fasting and 2 hour postprandial sugar) have been observed, and rarely, precipitation of diabetes mellitus reported
Patients with severe symptoms of urinary retention (because of bladder emptying disorders, prostatic hyperplasia, urethral narrowing), the administration of furosemide can cause acute urinary retention related to increased production and retention of urine; these patients require careful monitoring, especially during initial stages of treatment
Hypokalemia may develop with furosemide, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Diusex 20mg/2ml only for the indication prescribed.