DIURETICS,LOOP (Systemic)
Some commonly used brand names are:
In the U.S.?
- Bumex 1
- Edecrin 2
- Lasix 3
- Myrosemide 3
In Canada?
- Apo-Furosemide 3
- Edecrin 2
- Furoside 3
- Lasix 3
- Lasix Special 3
- Novosemide 3
- Uritol 3
Note: | For quick reference, the following loop diuretics are numbered tomatch the corresponding brand names. |
Category
- Antihypercalcemic?Bumetanide; Ethacrynic Acid; Furosemide
- Antihypertensive?Bumetanide; Ethacrynic Acid; Furosemide
- Diagnostic aid adjunct, renal disease?Furosemide
- Diuretic?Bumetanide; Ethacrynic Acid; Furosemide
Description
Loop diuretics are given to help reduce the amountof water in the body. They work by acting on the kidneys to increase the flowof urine.
Furosemide is also used to treat high blood pressure (hypertension) inthose patients who are not helped by other medicines or in those patientswho have kidney problems.
High blood pressure adds to the work load of the heart and arteries. Ifit 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, resultingin a stroke, heart failure, or kidney failure. High blood pressure may alsoincrease the risk of heart attacks. These problems may be less likely to occurif blood pressure is controlled.
Loop diuretics may also be used for other conditions as determined by yourdoctor.
This medicine is available only with your doctor's prescription, in thefollowing dosage forms:
Oral- Bumetanide
- 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
- 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 willdo. 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 orallergic reaction to bumetanide, ethacrynic acid, furosemide, sulfonamides(sulfa drugs), or thiazide diuretics (water pills). Also tell your healthcare 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 handsthat occurs during pregnancy. Diuretics should not be taken during pregnancyunless recommended by your doctor.
Breast-feeding?These medicines have not been reported to causeproblems in nursing babies. Furosemide passes into breast milk; it is notknown whether bumetanide or ethacrynic acid passes into breast milk.
Children?Although there is no specific information comparingthe use of loop diuretics in children with use in any other age group, thesemedicines are not expected to cause different side effects in children thanthey do in adults.
Older adults?Dizziness, lightheadedness, or signs of too muchpotassium loss may be more likely to occur in the elderly, who are more sensitiveto the effects of this medicine. Elderly patients may also be more likelyto develop blood clots.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingloop diuretics, it is especially important that your health care professionalknow if you are taking any other medicines.
Other medical problems?The presence of other medicalproblems may affect the use of loop diuretics. Make sure you tell your doctorif you have any other medical problems, especially:
- Type 2 diabetes mellitus?Loop diuretics may increasethe amount of sugar in the blood
- Gout or
- Hearing problems or
- Pancreatitis (inflammation of the pancreas)?Loop diureticsmay make these conditions worse
- Heart attack, recent?Use of loop diuretics after a recent heartattack may increase the chance of side effects
- Kidney disease (severe) or
- Liver disease?Higher blood levels of the loop diuretic mayoccur, which may increase the chance of side effects
- Lupus erythematosus (history of)?Ethacrynic acid and furosemidemay make this condition worse
Proper Use of This Medicine
This medicinemay cause you to have an unusual feeling of tiredness when you begin to takeit. You may also notice an increase in the amount of urine or in your frequencyof urination. After you have taken the medicine for a while, these effectsshould lessen. In general, to keep the increase in urine from affecting yoursleep:
- If you are to take a single dose a day, take it in the morning afterbreakfast.
- If you are to take more than one dose a day, take the last dose nolater than 6 p.m., unless otherwise directed by your doctor.
However, it is best to plan your dose or doses according to a schedulethat will least affect your personal activities and sleep. Ask your healthcare 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 oftaking it at the same time each day.
For patients taking the oral liquid form offurosemide:
- This medicine is to be taken by mouth even if it comes in a dropperbottle. If this medicine does not come in a dropper bottle, use a speciallymarked measuring spoon or other device to measure each dose accurately, sincethe 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 controland care in the types of foods you eat, especially foods high in sodium. Yourdoctor will tell you which factors are most important for you. You shouldcheck with your doctor before changing your diet.
- Many patients who have high blood pressure will not notice any signsof the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and thatyou keep your appointments with your doctor even if you feel well.
- Remember that this medicine will not cure your high blood pressurebut it does help control it. Therefore, you must continue to take it as directedif 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 problemssuch 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.
Dosing?The dose of loop diuretics will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of loop diuretics. If your dose isdifferent, do not change it unless your doctor tells you to do so.
The number of tablets or teaspoonfuls of solution that you take dependson the strength of the medicine. Also, the number ofdoses you take each day, the time allowed between doses, and the length oftime you take the medicine depend on the medical problem for which you aretaking loop diuretics.
For bumetanide- For oral dosage form (tablets):
- To lower the amount of water in the body:
- Adults?0.5 to 2 milligrams (mg) once a day. Your doctor mayincrease your dose if needed.
- Children?Dose must be determined by your doctor.
- For injection dosage form:
- To lower the amount of water in the body:
- Adults?0.5 to 1 mg injected into a muscle or a vein every twoto three hours as needed.
- Children?Dose must be determined by your doctor.
For ethacrynic acid- For oral dosage form (oral solution ortablets):
- To lower the amount of water in the body:
- Adults?50 to 200 milligrams (mg) a day. This may be taken asa single dose or divided into smaller doses.
- Children?At first, 25 mg a day. Your doctor may increase yourdose as needed.
- For injection dosage form:
- To lower the amount of water in the body:
- Adults?50 mg injected into a vein every two to six hours asneeded.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1 mg per kilogram (kg) (0.45 mg per pound)of body weight injected into a vein.
For furosemide- For oral dosage form (oral solution ortablets):
- To lower the amount of water in the body:
- Adults?At first, 20 to 80 milligrams (mg) once a day. Then,your doctor may increase your dose as needed. Your doctor may tell you totake a dose once a day, two or three times a day, or every other day.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 mg per kilogram (kg) (0.91 mg per pound)of body weight for one dose. Then, your doctor may increase your dose everysix to eight hours as needed.
- For high blood pressure:
- Adults?40 mg two times a day. Your doctor may increase yourdose.
- For injection dosage form:
- To lower the amount of water in the body:
- Adults?At first, 20 to 40 mg injected into a muscle or a veinfor one dose. Then, your doctor may increase your dose every two hours asneeded. Once the medicine is working, the dose is injected into a muscle ora vein one or two times a day.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1 mg per kg (0.45 mg per pound) of bodyweight injected into a muscle or a vein for one dose. Your doctor may increaseyour dose every two hours as needed.
- For very high blood pressure:
- Adults?40 to 200 mg injected into a vein.
Missed dose?If you miss a dose of this medicine, take it assoon as possible. However, if it is almost time for your next dose, skip themissed dose and go back to your regular dosing schedule. Do not double doses.
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 otherdamp 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 surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It isimportant that your doctor check your progress at regular visits to make surethat this medicine is working properly.
This medicine may cause a loss of potassium from yourbody:
- To help prevent this, your doctor may want you to:
- eat or drink foods that have a high potassium content (for example,orange or other citrus fruit juices), or
- take a potassium supplement, or
- take another medicine to help prevent the loss of the potassium inthe first place.
- It is very important to follow these directions. Also, it is importantnot to change your diet on your own. This is more important if you are alreadyon a special diet (as for diabetes), or if you are taking a potassium supplementor a medicine to reduce potassium loss. Extra potassium may not be necessaryand, in some cases, too much potassium could be harmful.
To prevent the loss of too much water and potassium, tell your doctor ifyou become sick, especially with severe or continuing nausea and vomitingor diarrhea.
Before having any kind of surgery (including dental surgery) or emergencytreatment, make sure the medical doctor or dentist in charge knows that youare taking this medicine.
Dizziness, lightheadedness, or fainting may occur,especially when you get up from a lying or sitting position. This ismore likely to occur in the morning. Getting up slowlymay help. When you get up from lying down, sit on the edge of the bedwith your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problemcontinues or gets worse, check with your doctor.
The dizziness, lightheadedness, or fainting is also more likely to occurif you drink alcohol, stand for long periods of time, exercise, or if theweather is hot. While you are taking this medicine, becareful to limit the amount of alcohol you drink. Also, use extra care duringexercise or hot weather or if you must stand for long periods of time.
For diabetic patients:
- This medicine may affect blood sugar levels. While you are usingthis medicine, be especially careful in testing for sugar in your blood orurine.
For patients taking this medicine for high blood pressure:
- Do not take other medicines unless they havebeen discussed with your doctor. This especially includes over-the-counter(nonprescription) medicines for appetite control, asthma, colds, cough, hayfever, or sinus problems, since they may tend to increase your blood pressure.
For patients taking furosemide:
- Furosemide may cause your skin to be more sensitive to sunlight thanit is normally. Exposure to sunlight, even for brief periods of time, maycause a skin rash, itching, redness or other discoloration of the skin, ora severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a skin protection factor (SPF)of at least 15. Some patients may require a product with a higher SPF number,especially if they have a fair complexion. If you have any questions aboutthis, check with your health care professional.
- Apply a sun block lipstick that has an SPF of at least 15 to protectyour lips.
- Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from thesun, check with your doctor.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.
Check with your doctor as soon as possible if any of the following sideeffects occur:
Rare
Black, tarry stools; blood in urineor stools; cough or hoarseness; fever or chills; joint pain; lower back or side pain; painful or difficult urination; pinpoint red spots on skin; ringing or buzzing in ears or any loss of hearing?more common with ethacrynicacid; skin rash or hives; stomach pain (severe) with nausea and vomiting; unusual bleeding or bruising; yellow eyes or skin; yellow vision?for furosemide only
Signs and symptoms of too much potassium loss
Dryness of mouth; increased thirst; irregular heartbeat; mood or mentalchanges; muscle cramps or pain; nausea or vomiting; unusual tiredness or weakness; weak pulse
Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:
Other side effects not listed above may also occur in some patients. Ifyou notice any other effects, check with your doctor.
Additional Information
Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although these uses are not included in productlabeling, loop diuretics are used in certain patients with the following medicalconditions:
- Hypercalcemia (too much calcium in the blood)
- Diagnostic aid for kidney disease
Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.
Revised: 08/08/2000
