Lasix

DIURETICS, LOOP (Systemic)

Description—Loop diuretics are given to help reduce the amount of water in the body. They work by acting on the kidneys to increase the flow of urine.

Furosemide is also used to treat high blood pressure (hypertension) in those patients who are not helped by other medicines or in those patients who have kidney problems.

High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Loop diuretics may also be used for other conditions as determined by your doctor.

This medicine is available only with your doctor’s prescription, in the following dosage forms:

Oral

Bumetanide

•Tablets (U.S.)

Ethacrynic Acid

•Oral solution (U.S. and Canada)

•Tablets (U.S. and Canada)

Furosemide

•Oral solution (U.S. and Canada)

•Tablets (U.S. and Canada)

Parenteral

Bumetanide

•Injection (U.S.)

Ethacrynic Acid

•Injection (U.S. and Canada)

Furosemide

•Injection (U.S. and Canada)

Before Using this Medicine—In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For loop diuretics, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to bumetanide, ethacrynic acid, furosemide, sulfonamides (sulfa drugs), or thiazide diuretics (water pills). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies have not been done in pregnant women. However, studies in animals have shown this medicine to cause harmful effects.

In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. Diuretics should not be taken during pregnancy unless recommended by your doctor.

Breast-feeding—These medicines have not been reported to cause problems in nursing babies. Furosemide passes into breast milk; it is not known whether bumetanide or ethacrynic acid passes into breast milk.

Children—Although there is no specific information comparing the use of loop diuretics in children with use in any other age group, these medicines are not expected to cause different side effects in children than they do in adults.

Older adults—Dizziness, lightheadedness, or signs of too much potassium loss may be more likely to occur in the elderly, who are more sensitive to the effects of this medicine. Elderly patients may also be more likely to develop blood clots.

Other medical problems—The presence of other medical problems may affect the use of loop diuretics. Make sure you tell your doctor if you have any other medical problems, especially:

•Diabetes mellitus (sugar diabetes) — Loop diuretics may increase the amount of sugar in the blood

•Gout or

•Hearing problems or

•Pancreatitis (inflammation of the pancreas) — Loop diuretics may make these conditions worse

•Heart attack, recent — Use of loop diuretics after a recent heart attack may increase the chance of side effects

•Kidney disease (severe) or

•Liver disease — Higher blood levels of the loop diuretic may occur, which may increase the chance of side effects

•Lupus erythematosus (history of) — Ethacrynic acid and furosemide may make this condition worse

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking loop diuretics, it is especially important that your health care professional know if you are taking any other medicines.

Proper Use/Preparation of this Medicine/Test—This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:

•If you are to take a single dose a day, take it in the morning after breakfast.

•If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.

However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking the oral liquid form of furosemide:

•This medicine is to be taken by mouth even if it comes in a dropper bottle. If this medicine does not come in a dropper bottle, use a specially marked measuring spoon or other device to measure each dose accurately, since the average household teaspoon may not hold the right amount of liquid.

For patients taking this medicine for high blood pressure:

•In addition to the use of the medicine your doctor has prescribed, appropriate treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which factors are most important for you. You should check with your doctor before changing your diet.

•Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

•Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

If this medicine upsets your stomach, it may be taken with meals or milk. If stomach upset (nausea, vomiting, or stomach pain) continues or gets worse, or if you suddenly get severe diarrhea, check with your doctor.

Storage—To store this medicine:

•Keep out of the reach of children.

•Store away from heat and direct light.

•Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.

•Keep the oral liquid form of this medicine from freezing.

•Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Dosing—The dose of loop diuretics will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of loop diuretics. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets or teaspoonfuls of solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking loop diuretics.

For bumetanide

•For oral dosage form (tablets):