Lasix

Lasix is a well-proven diuretic drug with the international name Furosemide and produced by the largest Indian company Sanofi India Limited.

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Indications Lasix

This drug has already managed to gain recognition both in the medical community, widely using it in many treatment protocols, and among patients, bringing them significant relief. Indications for the use of Lasix are quite extensive.

• Edema syndrome that occurs against the background of cardiac or renal failure. The pathology is chronic.
• Forced diuresis resulting from poisoning with chemical compounds.
• Acute form of renal dysfunction, including the period of pregnancy or burn injury (the drug increases the level of excretion).
• Edema that appears as a result of the patient’s body being affected by nephrotic diseases (in therapy, the primary goal is to relieve the underlying disease).
• Pathological changes in the liver leading to edema (in addition to the main treatment).
• Severe form of arterial hypertension.
• Intoxication of the body.
• Cerebral and pulmonary edema.
• Hypertensive crisis.
• Hypercalcemia is an increase in the calcium content in the blood plasma.
• Eclampsia is a disease that develops during pregnancy, obstetrics and after birth. This pathology provokes an increase in blood pressure, the indicators of which reach very high numbers, which poses a threat to the life of both the mother and the child.

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Release form

The active substance of this drug is furosemide (frusemide). The drug is available in a variety of forms on the pharmacological market.

Tablets: one unit contains 40 mg of the active compound. The tablet is white or slightly milky. On the surface of each unit there is an inscription - "DLI". The drug Lasix is presented in packaging of 50 or 250 pieces. Packages with five strips of ten tablets each are also produced. For injections, the drug can be found on the shelves of pharmacies in a solution: one ampoule contains 2 ml of liquid, which contains 20 mg of Lasix itself. The packaging box has 10 or 50 ampoules.

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Pharmacodynamics

The basic substance of Lasix is a sulfonamide derivative and is a fairly powerful and fast-acting diuretic. The pharmacodynamics of Lasix are due to its excellent ability to close the counter-current-rotational exchanger, called the Henle loop in medicine, the movement of ions of such chemical elements as chlorine (Cl-), potassium (K+), sodium (Na+). Therefore, the diuretic effectiveness of the drug depends on the amount of the active substance of Lasix entering the cavity of the renal tubules. A secondary effect of the drug is that osmotically bound water allows increasing the volume of urine excreted from the patient's body. Activation of potassium secretions in the most remote part of the renal canal also occurs. In parallel with this, an increase in the excreted ions of magnesium (Mg2+) and calcium (Ca2+) is observed.

Due to the rapid expansion of veins, in the case of sudden cardiac insufficiency, Lasix allows to quickly stop the attack. At the same time, there is a decrease in the blood load on the pulmonary artery and the left ventricle, reducing its filling. The drug in question also has hypotensive properties, promoting increased removal of sodium from the patient's body, reducing vascular spasms and reducing the amount of circulating blood.

Therapeutic effectiveness after taking 40 ml of the drug occurs within an hour after the drug is administered. The duration of its action is observed from three to six hours. In the case of intravenous administration, the effect is already visible after five to ten minutes, and the duration of action is from two to three hours, if renal function is reduced, the work of Lasix is observed up to eight hours.

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Pharmacokinetics

The main substance of the drug is very actively absorbed by the mucous membrane of the gastrointestinal tract, so the pharmacokinetics of Lasix are quite encouraging. After administration to the body, the time after which its maximum concentration in the plasma is reached is from one to one and a half hours. During studies, healthy volunteers showed bioavailability of the drug from 50% to 70%. In sick people, this figure is slightly lower and can go down to 30%, since the result is also affected by other pathological factors in the general health of the patient's body. The quantitative distribution of furosemide by systems shows from 0.1 to 0.2 liters per kilogram of weight. Furosemide is mainly combined with albumins (the protein component of blood plasma).

The active substance Lasix is excreted mainly unchanged by the body. Glucuronidated metabolites of the drug, excreted by the kidneys, are approximately 10-20%. The rest leaves the human body through the intestines by biliary secretion. The half-life of Lasix, depending on the patient's condition, is approximately one to one and a half hours. Furosemide easily overcomes the placental barrier and, without any obstacles, enters breast milk. In this case, its quantitative component in the blood of the newborn is identical to the concentration in the mother's plasma.

In case of kidney dysfunction, the pharmacokinetics of Lasix weakens, the half-life is extended and can reach even 24 hours. In case of liver enzyme deficiency in the patient's body, the half-life of furosemide becomes longer, and this figure can vary from 30 to 90%. Mostly, the reason for such a change is the increase in the volume of redistribution.

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Dosing and administration

There are necessary tips that can be applied to any drug intake. The drug Lasix is especially effective if it enters the patient's body on an "empty stomach". It should be washed down with the required amount of water. The tablet should not be chewed. Initially, it is necessary to start with minimal doses, trying to achieve a therapeutic effect, if this cannot be done, the amount of the drug is increased.

The method of application and dosage are prescribed by the attending physician. Self-medication is strictly not recommended.

The daily dosage for adults should not exceed 1.5 g. For children, it is calculated using the formula 2 mg taken per kilogram of the small patient's weight, but the calculated figure should not exceed 40 mg per day. The duration of the treatment course is strictly individual and is determined by the attending physician.

It is also necessary to voice more specific recommendations for adult patients.

• The starting dose for swelling due to chronic heart failure is 20-80 mg, taken throughout the day and divided into two or three administrations.
• The starting dose of the substance for edema due to chronic renal failure is quite difficult to specify, since it depends on various indicators: the degree of renal dysfunction, the level of sodium in the blood. If this pathology is already chronic, the dosage of furosemide must be selected especially carefully: from the minimum and slightly increasing it until the therapeutic effect is achieved. Usually, the daily dosage of Lasix for patients on hemodialysis is within 0.25 - 1.5 g.
• If the patient has a history of acute renal failure at the time of drug administration, then before starting to take furosemide, it is necessary to first eliminate such problems as water-electrolyte imbalance, stop arterial hypertension or hypovolemia. In this situation, it is advisable to administer Lasix intravenously and start with a dosage of 40 mg. If the therapeutic effect is not achieved, the dosage is increased. Continuous administration of the drug directly into the vein is possible. The rate of administration can be between 50 and 100 mg of furosemide per hour. Upon achieving the desired result, the patient should be transferred to tablet administration of the drug.
• If the cause of the edema is nephrotic syndrome, the starting daily dosage of the drug is prescribed within 10 - 80 mg. The drug can be taken in one dose or divided into several.
• Due to liver diseases, furosemide is prescribed as an adjuvant therapy to prevent the development of various complications. The starting daily dosage of the drug in this case is from 20 to 80 mg. The drug is administered in one or two doses. The dosage varies depending on the patient's response.
• In case of arterial hypertension, the doctor can use Lasix as a monotherapy, but the drug in the treatment protocol can also be used in combination with other antihypertensive drugs. On average, in such a situation, furosemide is prescribed in the range of 20 to 40 mg, taken once a day.

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Use Lasix during pregnancy

A woman is expecting a child and does not want to drink something that can harm her baby. Therefore, the question: "Is it possible to use Lasix during pregnancy?" sounds quite reasonable. Doctors are not categorical about the use of furosemide during pregnancy, but they allow its use only for a fairly short period of time. If a woman is breastfeeding, it is better to stop breastfeeding during the period of taking the drug. After all, there is no problem for the active substance of the drug to penetrate the placental barrier, and then it just as easily gets into the mother's milk. Therefore, doctors do not prescribe Lasix to pregnant women without special need and obvious medical necessity. But if such a need has arisen and the drug is prescribed, careful monitoring of the condition of the pregnant woman and her fetus is necessary during its use.

Contraindications

Any non-homeopathic drug is a combination of chemical compounds that can, in certain doses, bring both benefit and harm to the human body, so there are contraindications to the use of Lasix.

• Hypersensitivity of the patient's body to the components of the drug, especially to sulfonamides and sulfonamides.
• Stenosis of the urethra.
• Kidney dysfunction, up to and including complete cessation of urine excretion (anuria).
• Arterial hypotension.
• Acute form of glomerulonephritis.
• Hypokalemia is a decrease in the level of potassium ions in the blood.
• Hyponatremia is a decrease in the concentration of sodium ions in plasma.
• Liver precomatose and comatose state.
• Gout.
• Violation of water-electrolyte-salt balance.
• Severe liver dysfunction.
• Blockage of the urinary tract by a stone.
• Aortic or mitral stenosis in the decompensated phase.
• Myocardial infarction in its acute form.
• Systemic lupus erythematosus.
• Increase in venous tension by more than 10 units.
• Hypovolemia.
• Pancreatitis is a malfunction of the pancreas.
• Diabetes mellitus.
• Cardiac glycoside intoxication.
• Stenosing atherosclerosis of cerebral arteries.
• Pregnancy (especially the first trimester).
• Breastfeeding time.
• Caution for elderly people.
• Age of children up to three years.

Side effects Lasix

Any drug, when taken, is expected to have a positive effect on a specific pathological fact. But the body is a single whole and using the drug to relieve a specific problem, we also get side effects of Lasix, which can manifest themselves in various symptoms. The level of its manifestation depends on the state of the patient's body and his immune forces in opposition.

• The cardiovascular system may react to taking furosemide with orthostatic hypotension or low blood pressure, increased heart rate, and irregular heartbeat.
• The gastrointestinal tract may respond with nausea and an increase in the frequency of the gag reflex, loss of appetite, diarrhea, constipation, thirst and dry mouth, and exacerbation of pancreatitis.
• From the nervous system, one can expect headaches and dizziness, loss of strength and drowsiness, as well as some confusion and myasthenia.
• Problems with hearing and vision may occur.
• The genitourinary system may also react: this may result in urinary retention, hematuria, oliguria, and decreased potency in men.
• The patient's body can react to the intake of Lasix with an allergic reaction in various forms of its manifestation. This reaction can even lead the patient to anaphylactic shock.
• The circulatory system can also suffer. This is expressed by a decrease in the quantitative indicators of leukocytes and thrombocytes in the blood. Aplastic anemia or agranulocytosis may also appear.
• Water-electrolyte-salt metabolism also suffers.

Due to the fact that some side effects of Lasix, when unforeseen factors coincide, can threaten the general health, or even the life of the patient, if even minor side effects appear, it is necessary to immediately notify your doctor about them.

Overdose

Whatever one may say, Lasix consists of chemical compounds. Therefore, any overdose is fraught with unpleasant and sometimes dangerous consequences. The symptoms of the consequences of taking a large amount of this drug include:

• A sharp drop in blood pressure.
• Acute vascular insufficiency or collapse.
• Rapid dehydration of the body.
• Interruptions in the rhythmic work of the heart muscle.
• Decreased circulating blood volume (hypovolemia).
• State of shock.
• Lethargy in behavior and drowsiness.
• An increase in the number of red blood cells in the blood associated with a decrease in plasma volume (hemoconcentration).
• Confusion of consciousness.
• Minor paralysis of the limbs.
• Acute form of renal dysfunction, up to the onset of anuria (complete cessation of urine excretion).
• Thrombosis and/or thromboembolism.

If similar symptoms begin to appear after taking Lasix, it is necessary to inform your doctor. There is currently no specific antidote for Lasix overdose. Therefore, only a doctor can adjust the drug and prescribe measures to eliminate the consequences of an overdose. If not much time has passed since furosemide "poisoning", the first thing to do is to reduce the absorption of the drug into the gastrointestinal mucosa. This can be done by inducing vomiting or using gastric lavage. Only after this should the patient take an adsorption drug, such as activated carbon.

After such measures, the doctor will prescribe therapy aimed at restoring the water-electrolyte-salt balance, as well as the acidity indicators of the gastrointestinal tract.

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Interactions with other drugs

It is necessary to be quite scrupulous when prescribing the dosage of any drug if it is used as a therapeutic monotherapy, but it is even more necessary to approach this issue carefully if the drug must be administered together with other drugs. Therefore, before including it in the treatment protocol, it is worth familiarizing yourself with the consequences of Lasix interaction with other drugs.

The use of Lasix together with nonsteroidal anti-inflammatory drugs (NSAIDs) reduces its diuretic effectiveness. At the same time, the possibility of poisoning the patient's body with cardiac glycosides increases, which can lead to hypokalemia, which develops on the basis of glucocorticoids. Such a tandem can create oto- and / or nephrotoxic manifestations. Taking furosemide can increase the effectiveness of the properties of curare-like drugs, activate the process of lithium reabsorption Li +, which occurs in the renal ducts (while the clearance of lithium ions decreases, which increases the risk of intoxication of the body).

Lasix enhances the quality of theophylline and diazoxide, while completely or partially blocking the action of allopurinol, as well as hypoglycemic drugs. Taking furosemide together with hypotensive drugs enhances the action of the latter, and also increases the muscular-neuralgic block, which is provoked by depolarized muscle relaxants (called suxamethonium in medicine), while reducing the capabilities of non-polar muscle relaxants (tubocurarines).

A decrease in mutual effectiveness is observed when using the drug in question together with pressor amines. Contributes to an increase in the concentration of the active substance of Lasix in the blood, the use of drugs for therapeutic purposes that prevent the production of tubular secretion.

The combined use of glucocorticosteroids (GCS) and Lasix can cause digitalis intoxication, developing on the basis of hypokalemia. The active substance of the drug in question can increase the toxicity of salicylates. It is necessary to very carefully select the dose of furosemide if it is administered intravenously, because this drug slightly deviates towards alkalinity. Therefore, drugs used in tandem with it should have an acidity pH below 5.5.

The possibility of rapid progression of nephrotoxic and/or ototoxic manifestations of aminoglycosides can be facilitated by their paired use with the basic substance of Lasix. Such a tandem is not recommended, an exception may be a strict medical need (in this case, the dosage of aminoglycosides is significantly reduced). The same recommendations can be given for joint use with ototoxic drugs.

It is not recommended to administer Lasix to the patient within 24 hours after taking chloral hydrate, as this combination leads to uncomfortable symptoms: increased sweating, increased blood pressure, nausea, increased heart rate, and hyperemia of the skin.

The amount of risperidone used together with any strong diuretics, including Lasix, must be calculated very carefully. A fairly high percentage of fatal outcomes is recorded in elderly people with a history of acquired dementia.

Furosemide enhances the action of some cephalosporins, leading to an increased risk of developing the nephrotoxic component of cephalosporins. Reduces the properties of the diuretic phenytoin. The combined use of Lasix with methotrexate or probenecid reduces the effectiveness of the former, while the diuretic reduces the quantitative excretion of the decay products of these drugs by the kidneys, which provokes the development of various side effects.

Furosemide and sucralfate should be taken at different times (at least two hours apart), since this combination reduces the ability of the diuretic to be absorbed, reducing its effectiveness. The use of Lasix and cyclosporine A sharply provokes the development of progressive gouty arthritis, the cause of which is hyperuricemia, as well as failures in the excretion of uric acid salts from the body.

The use of furosemide in combination with radiocontrast agents may provoke proliferation of contrast agent nephropathy.

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Storage conditions

The drug should be stored in a room protected from direct sunlight, while the temperature should not exceed 30 ° C. These are the storage conditions for Lasix. At the same time, the storage location of the drug should not be accessible to children.

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Shelf life

Different forms of release have their own expiration date, and it ranges from four to five years. Before taking the drug, it is necessary to look at the packaging and clarify it. If the expiration date has already expired, you should not use the drug.

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