Lasix online in Australia

What is Lasix used for?

Edema of cardiac or renal origin.

Edema of hepatic origin, most often in combination with a potassium-sparing diuretic.

Arterial hypertension.

Conditions for which this medicine may be prescribed

• Edema of cardiac, renal or hepatic origin.
• Arterial hypertension

Method of administration and dosage of Lasix medicine

Dose

The dose is adjusted according to the indication and the severity of the condition.

Adult

Arterial hypertension:

The recommended starting dose is 20 mg of furosemide (i.e. 2 ml of oral solution) per day (in the morning).

In case of insufficient efficiency, we can:

Increase the doses to 40 mg (i.e. 4 ml of oral solution),

· Or combine another antihypertensive agent.

The furosemide dose can be increased above 40 mg (i.e. more than 4 ml oral solution) in case of renal failure.

Edema of cardiac, renal or hepatic origin:

The usual dose is 20 mg (or 2 ml of oral solution) to 80 mg (or 8 ml of oral solution) per day, divided into 2 doses.

Child and baby

The daily dose is 1 to 2 mg / kg of body weight, that is, 0.5 ml to 1 ml of solution per 5 kg, divided into 1 to 2 doses.

Administration form

Oral use.

Lasix oral solution can be diluted in half a glass of water or in a small amount of milk from a bottle.

Use only the dosing pipette attached to the Lasix oral solution bottle. You can withdraw up to a maximum of 2 ml of oral solution (20 mg of furosemide). The dose to be administered is adaptable to the nearest 0.1 ml (that is, to 1 mg) thanks to the graduations that go from 0.1 ml to 0.1 ml.

0.1 ml corresponds to 1 mg of furosemide.

0.5 ml corresponds to 5 mg of furosemide.

1.0 ml corresponds to 10 mg of furosemide.

1.5 ml corresponds to 15 mg of furosemide.

· 2.0 ml correspond to 20 mg of furosemide.

Possible side effects of the drug Lasix

• Hearing disorder
• Deafness
• Tinnitus
• Allergic skin reaction
• Skin reaction
• Skin itching
• Hives
• Blistering skin reaction
• Bullous pemphigoid
• Purple
• Photosensitization
• Polymorphic erythema
• Stevens-Johnson syndrome
• Lyell syndrome
• Generalized acute exanthematous pustulosis
• Drug hypersensitivity syndrome
• Rhabdomyolysis
• Increased urine output.
• Interstitial nephropathy
• Urinary retention
• Nephrocalcinosis
• Intrarenal lithiasis
• Anaphylactic reaction
• Anaphylactoid reaction
• Exacerbation of systemic lupus erythematosus
• Systemic lupus erythematosus
• Hepatic encephalopathy
• Paresthesia
• Vertigo
• Fainting
• Loss of consciousness
• Headache
• Sickness
• Vomiting
• Diarrhea
• Acute pancreatitis
• Hemoconcentration
• Thrombocytopenia
• Neutropenia
• Hyperosinophilia
• Agranulocytosis
• Spinal cord aplasia
• Cholestatic liver damage
• Increased transaminases.
• Orthostatic hypotension
• Vasculitis
• Thrombosis
• Hydro-electrolyte disorder
• Dehydration
• Hypovolemia
• Increased serum creatinine.
• Increased serum triglycerides.
• Hyponatremia
• Hypokalemia
• Increased serum cholesterol.
• Increased uricemia
• Release access
• Decreased tolerance to carbohydrates.
• Increased blood urea.
• Metabolic alkalosis
• Pseudo-Bartter syndrome
• Fever
• Increased blood sugar
• Loss of blood sugar control in diabetics.
• Severe rhythm disorder
• Torsades de pointes
• Hypercalciuria
• Hearing impairment when combined with aminoglycosides
• Allergic reaction

Show more The frequencies of adverse reactions are taken from the literature data referring to clinical studies in which furosemide has been used in a total of 1387 patients, all doses and indications combined.

When the frequency category for the same adverse reaction differs, the highest frequency category is chosen.

When possible, the frequency of side effects is defined by the following convention: very common (≥10%), common (≥1 to at least 10%), uncommon (≥0.1 to at least 1%), rare ( ≥0.01 to minus 0.1%), very rare (minus 0.01%), undetermined (which cannot be determined from the available data).

* Adverse reactions with an asterisk are the subject of a specific description, see below.

An increase in blood sugar is sometimes observed, most often during a short, intense administration, especially intravenously. Infrequent decreases in carbohydrate tolerance have been reported.

In the event of diabetes, there may be a loss of blood sugar control.

Very frequent hydroelectrolytic disturbances (in particular, frequent hypokalemia and / or hyponatremia), dehydration, hypovolemia very frequently accompanied by orthostatic hypotension and metabolic alkalosis (frequency not known) in relation to the activity of the product can be observed, justifying the suspension of the drug or reducing the dose.

Hypovolemia and dehydration, particularly in the elderly, can cause frequent hemoconcentration with risk of thrombosis (frequency not known).

These hydro-electrolyte disturbances are favored by the association with a too strict dehydrated diet, by certain pathologies (example: cirrhosis, heart failure), by the association with other drugs (see section Interactions with other drugs and other forms of 'interactions'), by digestive and nutritional disorders that may worsen hypokalemia in particular.

Hypokalemia may or may not be associated with metabolic alkalosis. They occur more easily when using high doses or in people with cirrhosis, malnutrition, and heart failure (see Warnings and Precautions for Use section). This hypokalemia can be particularly severe in patients with heart failure and, on the other hand, can cause serious rhythm disturbances, particularly torsades de pointes (which can be fatal), especially when there is association with antiarrhythmics from the quinidine group. .

Pseudo-Bartter syndrome (which includes hypokalemia, hypochloremia, alkalosis, and hyperaldosteronism) can occur against the background of misuse and / or long-term use of the product (frequency not known).

Frequent increases in urine output can cause or worsen urinary retention (frequency not known) in patients with obstruction and / or compression of the urinary tract.

Furosemide treatment may transiently lead to a very frequent increase in serum creatinine and blood urea (frequency not known), but also to a frequent increase in cholesterol and very frequent triglycerides in the blood. Frequently, a discrete increase in uricemia (in the order of 10 to 30 mg / l) may appear during treatment and promote gout.

Cases of nephrocalcinosis and / or intrarenal lithiasis (frequency not known) associated with hypercalciuria have been observed in very premature babies treated with high doses of furosemide injection.

In case of hepatocellular insufficiency, the possibility of frequent appearance of hepatic encephalopathy (see sections Contraindications and Warnings and precautions for use).

Rare hearing disorders and rare cases of tinnitus may appear, usually transient, particularly in subjects with renal failure, hypoproteinemia (nephrotic syndrome) (see section Warnings and precautions for use).

Deafness, sometimes irreversible, has been reported infrequently after oral or intravenous administration of the product. Rare occurrence of hearing impairment has been reported with co-administration of antibiotics from the aminoglycoside group.

Rhabdomyolysis has been reported, most frequently in the setting of severe hypokalemia.

Contraindications: when not to use this medicine?

• Hypersensitivity to furosemide
• Parahydroxybenzoate hypersensitivity
• Orange-yellow hypersensitivity S
• Acute functional kidney failure
• Hepatic encephalopathy
• Obstruction in the urinary tract.
• Hypovolemia
• Dehydration
• Severe hypokalemia
• Severe hyponatremia
• Associated severe renal and hepatocellular failure
• Fructose intolerance
• Pregnancy
• Breastfeeding

View more This medication should NEVER be used if:

Hypersensitivity to the active substance or to any of the excipients included in the Composition section.

· Acute functional kidney failure.

Hepatic encephalopathy.

Obstruction in the urinary tract.

Hypovolemia or dehydration.

Severe hypokalemia (see section Undesirable effects).

Severe hyponatremia.

Evolutionary hepatitis and severe hepatocellular insufficiency in hemodialysis patients and severe renal insufficiency (creatinine clearance minus 30 ml / min) due to the risk of accumulation of furosemide, the elimination of which is mainly due to the bile duct.

This medicinal product is generally not recommended during pregnancy or in combination with lithium (see section Interactions with other medicinal products and other forms of interaction).

Presentation of this medicine

60 ml brown glass bottle with dosing pipette.

Appearance and shape

Oral solution

Lasix: its other forms

• Lasix 20 mg / 2 ml, solution for injection in ampoule, box of 5 ampoules of 2 ml.
• Lasix 20 mg / 2 ml Injectable box of 12 vials of 2 ml
• Lasix 20 mg / 2 ml Injectable box of 60 2-ml vials
• Lasix 20 mg / 2 ml Box for injection of 1 vial of 2 ml
• Lasix 40 mg, scored tablet, box of 30
• Lasix 40 mg, scored tablet, box of 100

View all forms of the drugComposition of the drug Lasix

* per unit dose Active ingredients: Furosemide excipients with known effects? : Sorbitol, methyl parahydroxybenzoate, propyl parahydroxybenzoate, orange yellow S, 96% ethanol, ethanol Other excipients: glycerol, sodium hydroxide, purified water, orange flavor: alpha-pinene, beta-pinene, myrcene, limonene, octane , decanal, Linalol Effects on ability to drive and use machines

Aimlessly.

Warnings and precautions for use

• Insufficient hepatocellular
• Diuresis monitoring
• Photosensitivity reaction
• Hypotension
• Hepatorenal syndrome
• Hypoproteinemia
• Blood sugar monitoring
• Old subject
• Malnourished subject
• Polymedicated subject
• Cirrhotic with edema and ascites.
• Coronary
• Heart failure
• Long QT
• Kalemia monitoring
• Diabetes
• Pre-diabetes
• Hyperuricemia
• Gout
• Creatinine monitoring
• Risk of electrolyte deficiency.
• Acid-base balance disorder
• Systemic lupus erythematosus
• Sports
• Premature
• Alcoholic
• Kid
• Epileptic

Show more Special warnings

With lithium, the combination is not recommended (see section Interactions with other medicinal products and other forms of interaction).

Accidental use of furosemide can cause hypovolemia with dehydration (see section Overdose).

In patients with hepatocellular insufficiency, treatment should be carried out with caution under strict hydroelectrolytic supervision, taking into account the risk of hepatic encephalopathy (see Precautions for use). Discontinuation of treatment should be immediate.

Taking furosemide in case of partial obstruction of the urinary tract may expose patients to urinary retention. Therefore, close monitoring of urine output should be instituted, particularly at the start of furosemide treatment.

Furosemide is a sulfonamide. The possibility of a cross allergy with other sulfonamides, especially antibacterials, remains theoretical and not clinically validated.

Photosensitivity reactions have been reported with furosemide (see section 4.8).

If photosensitivity reactions occur during treatment, it is recommended to discontinue treatment. If re-administration of the treatment is essential, it is recommended to protect the areas exposed to the sun or artificial UVA rays.

This medicine contains sorbitol. Its use is not recommended in patients with fructose intolerance (rare hereditary disease).

This medicine contains "parahydroxybenzoate" and can cause allergic reactions (possibly delayed).

This medicine contains an azo coloring agent (E110: orange-yellow S) and may cause allergic reactions.

Employment precautions

Furosemide treatment requires special monitoring and dose adjustment for patients with:

Hypotension, especially in patients at risk of cerebral ischemia, coronary artery or other circulatory failure,

Hepatorenal syndrome (kidney failure associated with severe liver damage),

Hypoproteinemia, especially in cases of nephrotic syndrome: possible reduction of the effects of furosemide and potentiation of undesirable effects, in particular ototoxicity.

Symptomatic hypotension that causes dizziness, fainting, or loss of consciousness may occur in some patients treated with furosemide, especially in the elderly, patients taking other treatments that may cause hypotension, and in patients with other medical problems related to the risk of hypotension. .

Hydroelectric balance:

Natrémie:

It should be checked before starting treatment, and then at regular intervals thereafter. Any diuretic treatment can cause hyponatremia, with sometimes serious consequences.

As the drop in serum sodium levels may be initially asymptomatic, therefore, regular monitoring is essential and should be even more frequent in the populations at risk represented by the elderly, at greater malnutrition and those with cirrhosis (see Effects sections. undesirable and overdose).

Kalemia

Potassium depletion with hypokalemia constitutes the highest risk of loop diuretics. The risk of hypokalemia (minus 3.5 mmol / l) should be noted in certain populations at risk represented by the elderly and / or malnourished and / or polymedicated subjects, cirrhotic patients with edema and ascites, coronary heart disease, hypokalemia increases the cardiac toxicity of the digitalis and the risk of arrhythmia. In patients with a long QT space on the ECG of congenital or medicinal origin, hypokalemia favors the appearance of serious rhythm disturbances, particularly torsades de pointes, potentially fatal, especially in the presence of bradycardia. In all cases, more frequent tests for serum potassium are necessary. The first plasma potassium control should be carried out during the week following the start of treatment.

Sugar in the blood:

The hyperglycemic effect is modest. Control of blood sugar will be strengthened in diabetics and pre-diabetics.

Uricemia

Furosemide-induced hydrosodic depletion reduces urinary uric acid excretion. In patients with hyperuricemia, it can increase the tendency to gout attacks. Caution should be exercised in patients with gout.

Creatininemia:

Regular monitoring of serum creatinine levels is generally recommended during furosemide treatment.

Close monitoring of patients at risk of significant hydro-electrolyte disorders (vomiting, diarrhea, sweating, etc.). Dehydration, hypovolemia, or an acid-base imbalance require corrective treatment and can lead to temporary discontinuation of treatment.

Concomitant use with risperidone:

In placebo-controlled trials with risperidone in demented elderly patients, a higher incidence of mortality was observed in patients treated with furosemide plus risperidone (7.3%; mean age 89 years, range 75-97 years) compared to patients treated with risperidone alone (3.1%; average age 84 years, range 70-96 years) or furosemide alone (4.1%; average age 80 years, range 67-90 years).

Concomitant use of risperidone with other diuretics (mainly low-dose thiazide diuretics) was not associated with similar findings.

No pathophysiological mechanism to explain this effect has been identified, and no consistent reasons for death have been observed.

However, caution is necessary and the benefit / risk balance of this combination or concomitant treatment with other potent diuretics should be considered before making any decision.

There has been no increase in mortality in patients taking other diuretics as concomitant risperidone therapy. Regardless of treatment, dehydration is a risk factor for mortality and therefore should be carefully avoided in elderly patients with dementia (see section 4.3).

Exacerbation or activation of systemic lupus erythematosus is possible.

Athletes:

Athletes' attention will be drawn to the fact that this specialty contains an active ingredient that can induce a positive reaction from tests performed during doping tests.

Newborns and premature babies:

In neonates and premature babies, prolonged use of high doses of furosemide with risk of nephrocalcinosis and / or intrarenal lithiasis is advisable to carry out monitoring with renal ultrasound.

This medicine contains 12.3% vol of ethanol (alcohol), that is, 99 mg per ml, which is equivalent to 2.4 ml of beer, 1 ml of wine. The use of this medicine is dangerous in alcoholic subjects and should be considered in pregnant or lactating women, children and high-risk groups, such as patients with liver failure or epilepsy.

This medicine contains sodium. The sodium level is less than 1 mmol per dose, that is, "sodium free".

Mechanism of action: how does it work?

Pharmacotherapeutic group: DIURETIQUE DE L'ANSE, ATC code: C03CA01.

Salidiuretic action

At the usual therapeutic doses, furosemide acts mainly at the level of the ascending limb of the Henlé loop, where it inhibits the reabsorption of chlorine and, consequently, sodium. It has an accessory action at the level of the proximal tube and the dilution segment.

Increases renal blood flow for the benefit of the cortical area. This property is of particular interest in the case of association with beta-blockers that may have the opposite effect.

It does not alter glomerular filtration (an increase in the latter has been shown in certain circumstances). The salidiuretic action increases in proportion to the administered doses and persists in case of renal failure.

Antihypertensive action and other actions.

It has a hemodynamic action characterized by the decrease in pulmonary capillary pressure even before the onset of any diuresis, and by the increase in the storage capacity of the venous vascular bed demonstrated by plethysmography (these properties have been more particularly studied by route IV ).

Furosemide treats all forms of fluid retention with a dose proportional response. Furosemide exerts an antihypertensive action resulting from both sodium depletion and hemodynamic action.

Interactions: do not take this medicine with ..

Hypokalemic drugs

Hypokalemia is a factor that favors the appearance of heart rhythm disturbances (torsades de pointes in particular) and increases the toxicity of certain medications, such as digoxin. As a result, medications that can cause hypokalemia are involved in a large number of interactions. These are hypokalemic diuretics, alone or in combination, stimulant laxatives, glucocorticoids, tetracosactide, and amphotericin B (route IV).

Hyponatremic drugs

Certain medications are more frequently involved in the development of hyponatremia. These are diuretics, desmopressin, antidepressants that inhibit reuptake of serotonin, carbamazepine, and oxcarbazepine. The combination of these drugs increases the risk of hyponatremia.

Ototoxic drugs

The joint use of drugs with ototoxicity increases the risk of cochlear-vestibular damage. If such a combination is necessary, monitoring of auditory function should be strengthened.

The medicinal products in question are, in particular, glycopeptides, such as vancomycin and teicoplanin, aminoglycosides, organoplatins and loop diuretics.

Associations not recommended

+ Lithium

Increased lithhemia with signs of overdose, such as during a low fat diet (decreased urinary excretion of lithium). If the combination cannot be avoided, strict monitoring of the lithhemia and adaptation of the lithium dose.

Associations subject to precautions for use.

+ Acetylsalicylic acid for anti-inflammatory doses of acetylsalicylic acid (≥ 1 g per dose and / or ≥ 3 g per day) or for analgesic or antipyretic doses (≥ 500 mg per dose and / or less 3 g per day)

Acute renal failure in the dehydrated patient, due to a reduction in glomerular filtration secondary to a reduction in the synthesis of renal prostaglandins. In addition, reduction of the antihypertensive effect. Hydrates the patient; monitor kidney function at the start of treatment.

+ Nonsteroidal anti-inflammatory drugs

Acute renal failure in the patient at risk (elderly and / or dehydrated subject) due to reduced glomerular filtration (inhibition of vasodilatory prostaglandins due to non-steroidal anti-inflammatory drugs). In addition, reduction of the antihypertensive effect.

Hydrate the patient and monitor kidney function at the start of treatment.

+ Other hypokalemic agents

Increased risk of hypokalemia. Monitoring of potassium levels with correction if necessary.

+ Digital

Hypokalemia that promotes the toxic effects of digitalis. Correct any hypokalemia beforehand and perform clinical, electrolyte and electrocardiographic monitoring.

+ Diuretics, potassium preservatives, alone or in combination (amiloride, potassium canrenoate, eplerenone, spironolactone, triamterene)

The rational combination, useful for some patients, does not exclude the appearance of hypokalemia or, in particular, in patients with renal failure and diabetic hyperkalemia. Check the potassium level, possibly the ECG and, if necessary, reconsider the treatment.

+ Aminoglycosides

Increased nephrotoxic and ototoxic risks of aminoglycosides (functional renal failure related to dehydration caused by diuretics).

Possible association under monitoring of the state of hydration and renal and cochlear-vestibular functions and possibly plasma concentrations of the aminoglycoside.

+ Phenytoin (and, by extrapolation, phosphenytoin)

Decreased diuretic effect by up to 50%. Optionally, use higher doses of furosemide.

+ Carbamazepine

Risk of symptomatic hyponatremia. Clinical and biological surveillance. If possible, use a different class of diuretics.

+ ACE inhibitors, angiotensin II receptor antagonists

Risk of sudden hypotension and / or acute kidney failure when starting or increasing the dose of ACE inhibitor or an angiotensin II antagonist in case of pre-existing depletion of water and sodium.

In hypertension, when previous diuretic treatment may have led to sodium depletion, you should:

· Stop the diuretic for 3 days before starting treatment with IEC or the angiotensin II antagonist and reintroduce a hypokalemic diuretic if necessary later.

Give reduced starting doses of IEC or angiotensin II antagonist and gradually increase the dose.

In congestive heart failure treated with diuretics, start with a very low dose of IEC, possibly after reducing the dose of the associated hypokalemic diuretic.

In all cases, monitor kidney function (serum creatinine assay) in the first weeks of treatment with IEC or an angiotensin II antagonist.

+ Drugs that can cause torsades de pointes: class 1 antiarrhythmics

(quinidine, hydroquinidine, disopyramide) and class III (amiodarone, sotalol, ibutilide,

dofetilide), certain phenothiazine neuroleptics (chlorpromazine, ciamemazine,

fluphenazine, levomepromazine, pipotiazine), benzamides (amisulpride, sulpiride, sultopride,

thiapride), butyrophenones (droperidol, haloperidol, pipamrenone), other neuroleptics

(pimozide, sertindole, flupentixol, zuclopentixol), others: bepridil, cisapride, diphemanil,

dolasetron IV, dronedarone, spiramycin IV, erythromycin IV, mizolastine, levofloxacin,

halofantrine, lumefantrine, pentamidine, vincamine IV, moxifloxacin, mequitazine, methadone,

pracalopride, toremifene, arsenieux, citalopram, escitalopram ...

Increased risk of ventricular rhythm disturbances, especially torsades de pointes. Correct any hypokalemia before administering the product and carry out clinical, electrolyte and electrocardiographic monitoring.

+ Metformin

Lactic acidosis due to metformin, triggered by a possible functional renal failure linked to diuretics and more particularly to loop diuretics. Do not use metformin when serum creatinine exceeds 15 mg / l (135 micromol / l) in men and 12 mg / l (110 micromol / l) in women.

+ Iodinated contrast media

In case of dehydration caused by diuretics, increased risk of acute functional renal failure, especially when large doses of iodinated contrast agents are used. Rehydration before administration of the iodized product.

+ Baclofen

Increased risk of hypotension, especially orthostatic. Control of blood pressure and dose adjustment of the antihypertensive if necessary.

Associations to consider

+ Cyclosporine

Risk of increased serum creatinine without changing cyclosporine blood levels, even in the absence of sodium depletion. In addition, the risk of hyperuricemia and complications such as gout.

+ Neuroleptics

Increased risk of hypotension, especially orthostatic.

+ Imipramine antidepressants

Increased risk of hypotension, especially orthostatic.

+ Amifostine

Increased risk of hypotension, especially orthostatic.

+ Alpha-blockers for urological purposes: alfuzosin, doxazosin, prazosin, terazosin, tamsulosin

Increased hypotensive effect. Increased risk of orthostatic hypotension.

+ Alpha-blocking antihypertensive drugs

Increased hypotensive effect. Increased risk of orthostatic hypotension.

+ Organoplatins

Risk of adding ototoxic and / or nephrotoxic effects.

+ Nitrates and related derivatives

Increased risk of hypotension, especially orthostatic.

Incompatibilities

Aimlessly.

How to react in case of overdose?

Hypovolemia due to dehydration with electrolyte disturbances can be observed in case of overdose. The treatment consists of compensation for losses.

Lasix: pregnancy, lactation and fertility

Pregnancy

Animal studies have shown a teratogenic effect.

In clinical practice, there is currently insufficiently relevant data to assess a possible malformative effect of furosemide when administered during pregnancy.

As a general rule, the administration of furosemide should be avoided in pregnant women and should never be prescribed during physiological edema (and therefore does not require treatment) during pregnancy.

Diuretics can, in fact, lead to fetoplacental ischemia, with the risk of fetal hypotrophy.

Fetal growth must be closely monitored.

However, diuretics (in oral form) remain an essential element in the treatment of edema of cardiac, hepatic and renal origin that occur in pregnant women.

Breastfeeding

Furosemide is excreted in breast milk. The risk of adverse effects in the newborn cannot be excluded. On the other hand, loop diuretics decrease milk secretion and lactation is inhibited with a single 40 mg dose.

As a result, it is best not to breastfeed while taking furosemide.