Furosemide chemical structure
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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®

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Continuous Dose Furosemide Improves Outcome In Acute Respiratory Distress Syndrome - Abstract
From CHEST, 10/1/00 by Lisa Owens

Lisa Owens, MD; Akella Chendrasekhar, MD(*); Christopher Reising, MD; Donald W Moorman, MD and Gregory A Timberlake, MD. Surgery, Iowa Methodist Medical Center, Des Moines, IA.

PURPOSE: To assess the utility of continuous dose furosemide in critically Ill patients with Acute Respiratory Distress Syndrome(ARDS)

METHODS: We performed a prospective randomized study on patients with severe ARDS (Murray lung injury score, LIS [is greater than] 2.5). Demographic data(age, gender, APACHE-2 score at study entry, & initial LIS) were obtained on all patients. Patients were then randomized to receive either continuous dose furosemide (0.2 mg/kg/hour) for 48 hours along with conventional supportive therapy or supportive therapy alone. All patients were monitored for hemodynamic data. Outcome data (change in LIS at 48 hours, change in PaO2/FIO2 ratio at 48 hours, Organ dysfunction during hospitalization and survival to hospital discharge)were collected on all patients.

RESULTS: Seven women and nine men were prospectively enrolled. The average age was 45 years(Range:19-72). Demographic data between the study group and control group were comparable. The cardiac filling volumes and pressures were maintained within 10 % of starting values throughout the study. There was noted to be a significant difference in urine output between the 2 groups, without any difference in fluid intake. The outcome data is listed in table 1. Organ dysfunction, specifically the incidence of oliguric renal failure was significantly greater in the control group and directly contributed to the increased mortality.

CONCLUSION: The use of continuous dose furosemide resulted in short term improvement in LIS and PaO2/FiO2 ratio. The increased diuresis seen in the study group may be associated with the decreased incidence of oliguric renal failure. The difference in hospital mortality does not seem to be related directly to the short term improvement in pulmonary function.

CLINICAL IMPLICATIONS: Continuous dose furosemide improves short term outcomes and seems to reduce the incidence of oliguric renal failure and thereby improves survival to hospital discharge.

GRANT SUPPORT: Iowa Health System

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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