Frusemide Pharmacology


About Frusemide
A high ceiling loop diuretic, Symporter inhibitor,anthranilic acid derivative, Diuretic ,antiedema ,antihypertensive.
Mechanism of Action of Frusemide
Furosemide is a high ceiling loop diuretic which exerts it`s diuretic action by acting at site-2(thick ascending loop of Henle). It binds to Na+K+2Cl- co transporter and inhibits Na+K+2Cl- co transport in luminal membrane of thick ascending loop of Henle. It inhibits sodium and chloride re absorption and promotes excretion of sodium, water, chloride, potassium, calcium, and magnesium. It abolishes cortico-medullary osmotic gradient and blocks positive as well as negative free water clearance. It also has weak carbonic anhydrase inhibitory action.
It increase local prostaglandin synthesis and increases systemic venous capacitance and decreases left ventricular filling pressure. This causes relief in left ventricular failure and pulmonary edema. It causes renal and peripheral vasodilatation and decrease in peripheral resistance. It is preferred in the initial treatment of congestive heart failure for rapid mobilization of oedema fluid.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure.

Pharmacokinets of Frusemide
Absorption: Absorbed orally about 60%.
Distribution: It is widely distributed in a plasma protein bound form and crosses placenta. Metabolism: It is partly metabolized by glucuronide conjugation.
Excretion: Excreted as unchanged drug mainly through urine. Some drug is excreted through faeces
Onset of Action for Frusemide
Oral: 20 to 40 minutes
I.V.: 2 to 5 minutes
I.M.: 10 to 20 minutes
Duration of Action for Frusemide
Oral: 6 to 8hours
I.V.: 2 hours
Half Life of Frusemide
30 to 120 minutes
Side Effects of Frusemide
1. Dizziness
2. Headache
3. Diarrhoea
4. Anorexia
5. Nausea
6. Polyurea
7. Vomiting
8. Constipation
9. Frequent urination
10. Nocturea
11. Altered renal function tests
12. Weakness
13. Altered liver function tests
14. Dry mouth
15. Hypo calcaemia
16. Hypo kalaemia
17. Hypo natraemia
18. Transient deafness
19. Gastro intestinal disturbances
20. Visual impairment
21. Muscle cramps
22. Decreased tolerance to carbohydrates
23. Hyper uricaemia.
24. Electrolyte imbalance
25. Orthostatic hypotension
26. Aplastic anaemia
27. Agranulocytosis
28. Paraesthesia

Contra-indications of Frusemide
1. Hypo natraemia
2. Hypo kalaemia
3. Hypo volaemia
4. Hypotension
5. Hepatic coma
6. Hypersensitivity to the drug
7. Anuric renal failure

Special Precautions while taking Frusemide
1. Hepatic impairment
2. Renal impairment
3. Gout
4. Diabetes mellitus
5. Hypersensitivity to Sulfonamides
6. Fluid and electrolyte imbalance
7. Long term purgatives
8. Hepatic cirrhosis
9. Chronic Diarrhoea and dehydration.

Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Use with caution
Indications for Frusemide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Acute pulmonary Oedema
5. Cerebral Oedema
6. Refractory Oedema
7. Hypercalcaemia
8. Oliguria
9. Forced diuresis in drug over dosage.
10. Vertigo

Interactions for Frusemide
Anticoagulants: Activity of anticoagulants may be enhanced.
Aminoglycoside antibiotics: Frusemide increases potential for ototoxicity.
Cisplatin: Frusemide increases potential for ototoxicity.
Digitalis glycosides: Diuretics induced potassium loss may precipitate digitalis toxicity, increased frequency of cardiac arrhythmias.
NSAIDs: Effect of frusemide reduced.
Lithium: Therapeutic and toxic effects of lithium increased.
Metolazone: Profound diuresis and greater than predicted electrolyte loss related to the ability of metolazone to block proximal tubular sodium reabsorption useful in patients refractory to frusemide.
Non-depolarizing muscle relaxants: Action of succinylcholine & tubocurarine potentiated by low doses reversed by high doses.
Food: Efficacy reduced when administered with food.
Propranolol: Plasma propranolol level may be increased.
Clofibrate: Increased diuretic responses.
Hydantoins: May decrease the diuretic effects.
Typical Dosage for Frusemide
Oedema: 40mg in the morning. Increased if required; based on patient`s response up to 80mg.
Maintenance dosage: 20 to 40mg daily or on alternate days.
Maximum dose: 600mg/day.
Children: 3mg/kg/day.
Adult: 20 to 50mg as slow I.V. or I.M. injection. Increased by 20mg every 2hours. Higher I.V. doses must be infused
Children: 0.5 to 1.5mg/kg/day.
Maximum child dose: 20mg/day.
Oliguria: 250mg/day. Gradually increased; by 250mg at every 4 to 6 hours.
Maximum dose: 2gm
Hypertension: 40mg orally twice daily. Adjust the dosage according to patient`s response.
Hypercalcaemia: 120mg orally/day or 80 to 100mg I.V. every 1 to 2 hours
Acute pulmonary Oedema:
Adults: 40mg slow I.V. injection. Then 80mg within 1hour if required.
Children: 1mg/kg I.V.or I.M. Every 2 hours until desired response is gained.
Maximum dose: 6mg/kg/day.

Schedule of Frusemide
Storage Requirements for Frusemide
Store at controlled room temperature at a range of 15 to 30 degree C. in a well closed container and protects from light.
Effects of Missed Dosage of Frusemide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Frusemide
Treatment is supportive and symptomatic. Monitor and support fluid and electrolyte balance by replacing fluids and electrolytes.

Home Delivery for Frusemide in Your City

Medicine India is just a publishing medium for medicine related information and does not provide services or sales of medicines including frusemide.

However, we do publish a comprehensive directory of Pharmacies, Chemists and Druggists in cities all over India. You can use this directory to find the medicine stores in your city (or area) that provide home delivery services for frusemide and other medicines and health products. Home delivery services for frusemide may be free or they may cost you depending on the pharmacy and the minimum order requirements. It would be best to get this clarified while placing the order.

Please be aware that you should take frusemide only if a doctor has recommended or prescribed it. Some or all pharmacies who provide a home delivery service for medicines might insist on a prescription for frusemide before they complete the sale. You can get this information while placing the order for frusemide with the pharmacy.

Frusemide is a generic medicine name and there are several brands available for it. Some of the brands for frusemide might be better known than frusemide itself. If the pharmacy that's willing to deliver medicines to your home doesn't have frusemide in stock, you can ask for one of the branded alternatives for frusemide.