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Furosemide

Furosemide (INN) or frusemide (former BAN) is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Aventis Pharma under the brand name Lasix. It has also been used to prevent thoroughbred race horses from bleeding through the nose during races. more...

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Along with some other diuretics, furosemide is also included on the World Anti-Doping Agency's banned drug list due to its alleged use as a masking agent for other drugs.

Mechanism of action

Like other loop diuretics, furosemide acts by inhibiting the Na/K/Cl cotransporter in the ascending loop of Henle. It also has inhibitory activity on carbonic anhydrase.

Clinical use in humans

Furosemide, as a loop diuretic, is principally used in the following indications (Aventis, 1998):

Edema associated with heart failure, hepatic cirrhosis, renal impairment, nephrotic syndrome
Hypertension
Adjunct in cerebral/pulmonary oedema where rapid diuresis is required (IV injection)

It is also sometimes used in the management of severe hypercalcemia in combination with adequate rehydration (Rossi, 2004).

It is considered ototoxic. (PMID 15311369)

Use in horses

Apparently, sometime in the early 1970s, furosemide's ability to prevent or at least greatly reduce the incidence of bleeding by horses during races was discovered accidentally. Pursuant to the racing rules of most states, horses that bleed from the nostrils three times are permanently barred from racing (for their own protection). Clinical trials followed, and by decade's end, racing commissions in some states began legalizing its use on race horses. On September 1, 1995, New York became the last state in the United States to approve such use, after years of refusing to consider doing so. Some states allow its use for all racehorses; some allow it only for confirmed "bleeders." Its use for this purpose is still prohibited in many other countries, however.

Brand names

Some of the brand names under which furosemide is marketed include: Aisemide^®; Beronald^®; Desdemin^®; Discoid^®; Diural^®; Diurapid^®; Dryptal^®; Durafurid^®; Errolon^®; Eutensin^®; Frusetic^®; Frusid^®; Fulsix^®; Fuluvamide^®; Furesis^®; Furo-Puren^®; Furosedon^®; Hydro-rapid^®; Impugan^®; Katlex^®; Lasilix^®; Lasix^®; Lowpston^®; Macasirool^®; Mirfat^®; Nicorol^®; Odemase^®; Oedemex^®; Profemin^®; Rosemide^®; Rusyde^®; Trofurit^®; Urex^®

Read more at Wikipedia.org

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Hyperkalemia and renal dysfunction in congestive heart failure patients with concomitant use of spironolactone and furosemide
From CHEST, 10/1/05 by Nobuyuki Anzai

PURPOSE: This study aimed to identify predictors of hyperkalemia and renal impairment in congestive heart failure (CHF) patients taking spironolactone and furosemide.

METHODS: Ninety (90) consecutive patients with CHF, 46M/44F, mean age 73.8 (range 56.4-91.2 yrs) were studied. We started 26 patients while 20 patients were already taking spironolactone and furosemide when the study started. We measured blood electrolytes every two months. The study started from April 2003 and lasted two years. Mean observation duration was 489 days for 124 patient years with a mean 19 visits and a mean 25 days between visits.

RESULTS: Baseline characteristics: Mean (SD) left ventricular ejection fraction (LVEF): 39.5% (15.1); mean (SD) creatinine concentration(rag/ dl): 0.91 (0.25); mean serum potassium (mEq/dl): 4.3 (0.4); mean (SD) dosage (mg/day): spironolactone: 14.9 (7.3), furosemide: 30.3 (14.1); patients needing angiotensin converting enzymes (ACE) inhibitors or angiotensin receptor blockers (ARB): n = 50 (50%), [beta] blockers: 48 (53%); mean peak creatinine concentration: 1.07 (SD 0.34) mg/dl; mean peak potassium: 5.0 (SD 0.5) mEq/dl. A total of 45 (50%) had creatinine > 1.04 mEq/dl, 16 (18%) > 1.30, 9 (10%) > 1.50. Relative to baseline, 24 (27%) patients had creatine increase by 20%, 15 (17%) by 30%, 8 (9%) by 50%, 2 (2%) by 100%. A total of 39 (43%) patients had potassium > 5.0 mEq/dl, 9 (10%) >5.5, 2 (2%) > 6.0. Patients taking spironolactone and furosemide before study started did not differ significantly from patients we started in terms of hyperkalemia (potassium >5.5) (11.5% vs. 15.2%, p = 0.54) and azotemia (creatinine > 1.30) (15.3% vs. 14.1%, p = 0.82). We logistically regressed (30% increase in serum creatinine concentrations) with age, sex, use of ACE inihihitors, ARBs, [beta] blockers, and dosage of spironolactone and furosemide. Age (odds ratio 1.24 (95% confidence index interval 1.01-2.54) for each ten years)) was an independent risk factor for azotemia. For hyperkalemia (potassium > 5.5) we added to the model baseline creatinine concentrations and found that age (1.03(0.84-2.86)) was a predictive factor.

CONCLUSION: Age was a predictor of hyperkalemia and azotemia for patients taking spironolactone and furosemide with moderately decreased LVEF.

CLINICAL IMPLICATIONS: Caution should be taken while dose adjustment and continuous monitoring may be needed in elderly patients.

DISCLOSURE: Nobuyuki Anzai, None.

Nobuyuki Anzai MD * Hiroko Anzai MD Rieko Mitobe MD Makiko Anzai MD Sadako Furuya MD Anzai Furuya Clinic, Oyama, Japan

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