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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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Improvements In Oxygenation In Albumin / Furosemide Treated Ali Patients Are Not Associated With Changes In Serum Protein Or Fluid Balance
From CHEST, 10/1/99 by Greg S Martin

Purpose: Hypoproteinemia in patients with sepsis is associated with positive fluid balance, weight gain, and increased risk of acute lung injury (ALI), which coincides with prolonged mechanical ventilation and increased mortality [AJRCCM 155: A504]. Combined albumin and furosemide therapy in hypoproteinemic ALI patients has been shown to acutely improve oxygenation and increase hemodynamic stability despite [is greater than] 10 kg of weight loss [AJRCCM 159: A376].

Methods: Thirty-seven mechanically ventilated patients with acute lung injury and serum protein levels [is less than or greater than] 5 g/dL were randomized to receive protocolized albumin with furosemide vs. placebo with placebo for 5 days. To elucidate the relative effects of each treatment component, a post hoc multi-variable regression analysis of physiologic outcome variables was undertaken. P-values [is less than] 0.05 were significant.

Results: By 24 hours, combination therapy with albumin and furosemide resulted in an increase in serum protein from 3.9 g/dL to 4.5 g/dL and a 40% improvement in the Pa[O.sub.2]/Fi[O.sub.2] ratio (179 to 250). The increase in serum protein was associated with a rise in serum albumin ([r.sup.2]=0.52, p [is less than] 0.001) and a weight loss of 2.7 kg ([r.sup.2]=0.27, p=0.02), but not with net fluid balance. The increase in the Pa[O.sub.2]/Fi[O.sub.2] ratio was not associated with changes in weight, fluid balance, or serum protein concentrations.

Conclusion: Combination therapy with albumin and furosemide in hypoproteinemic ALI patients results in increased serum protein concentrations which appear to relate to both administered albumin and degree of diuresis. Improvements in oxygenation do not appear related to diuresis or changes in serum proteins.

Clinical Implications: Treatment of ALI patients with a combination of albumin and furosemide may be monitored by changes in weight. Acute improvements in oxygenation are not accounted for by standard clinical variables, but may be related to unmeasured fluid shifts or changes in extravascular lung water. Further randomized trials of protein and fluid balance manipulation are needed to establish whether this therapy may improve outcomes for patients with acute lung injury.

Grant Support by: Financial support from NHLBI HL 07123.

Greg S Martin, MD(*); R J Mangialardi, MD and G R Bernard, MD, FCCP. The Center for Lung Research, Vanderbilt University, Nashville, TN.

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