Review of drugs Lasix and Furosemide | What to choose and what's the difference

Updated: 04/23/2021 15:13:42

Expert: Abramova Tsilya

Diuretics are actively used in clinical practice. They are used in nephrology and cardiology and many other related fields. Diuretics are rarely used as primary therapy. Typically, diuretics are prescribed as part of a comprehensive treatment regimen for diseases of internal organs.

Our focus today is on two diuretics – Lasix and Furosemide. They act quickly, effectively, but not for long, and are used for edema syndrome of various origins. The drugs are similar in composition and release form, and have common indications and contraindications. Read the article for a detailed review of each product.

It is important to remember: diuretics place a serious burden on the body. Self-medication is unacceptable! Only a doctor can select the right dosage, determine the duration of therapy and monitor the body’s response to the administration of medications.

Content

• Dosage regimen
• Use for liver dysfunction
• Storage conditions and periods
• special instructions
• Release form, composition and packaging
• Use for renal impairment
• Conditions for dispensing from pharmacies
• Clinical and pharmacological group
• Contraindications to the use of the drug
• Indications for use of the drug
• atx code
• During pregnancy and breastfeeding
• Registration Certificate Holder
• Side effect
• Overdose
• pharmachologic effect

Dosage regimen

General recommendations: When prescribing Lasix. Intravenous administration of Lasix versus repeated intravenous administration of the drug to patients. If a continuous intravenous infusion is not possible after one or more intravenous boluses in an acute setting, administering low doses with short intervals between administrations (approximately 4 hours) is preferable to administering higher-dose intravenous boluses with long intervals between administrations. introductions. The solution for parenteral administration has a pH of about 9 and does not have buffering properties. At a pH below 7, the active substance may precipitate, so when diluting the drug, Lasix should be used as early as possible. The recommended maximum daily intravenous dose for adults is 1500 mg. In children, the recommended dose for parenteral administration is 1 mg/kg body weight (but not more than 20 mg per day). The duration of treatment is determined by the doctor individually depending on the indications. Special recommendations for dosage regimen in adults: Edema syndrome in chronic heart failure. The recommended initial dose is 20-80 mg per day. The required dose is selected depending on the diuretic response. It is recommended that the daily dose be administered 2-3 times. Edema syndrome in acute heart failure The recommended initial dose is 20-40 mg as an intravenous bolus. If necessary, the dose of Lasix may be adjusted depending on the therapeutic effect. Edema syndrome in chronic renal failure The natriuretic response to furosemide depends on several factors, including the severity of renal failure and blood sodium levels, so the dose effect cannot be accurately predicted. In patients with chronic renal failure, careful selection of the dose is required, by gradually increasing it so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 2 kg of body weight per day is possible). In patients on hemodialysis, the usual maintenance dose is 250-1500 mg/day. When administered intravenously, the dose of furosemide can be determined as follows: treatment begins with an intravenous drip at a rate of 0.1 mg per minute, and then gradually increases the rate of administration every 30 minutes depending on the therapeutic effect. Acute renal failure (to maintain fluid excretion) Before starting treatment, Lasix can be administered as a continuous intravenous infusion, starting at an infusion rate of 50-100 mg per hour. Edema in nephrotic syndrome The recommended starting dose is 20-40 mg per day. The required dose is selected depending on the diuretic response. Edema syndrome in liver diseases Furosemide is prescribed in addition to treatment with aldosterone antagonists if they are insufficiently effective. To prevent the development of complications, such as impaired orthostatic regulation of blood circulation or disturbances in electrolyte or acid-base status, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, fluid loss of up to approximately 0.5 kg of body weight per day is possible). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg. Hypertensive crisis, cerebral edema The recommended initial dose is 20-40 mg by intravenous bolus administration. The dose may be adjusted depending on the effect. Maintaining forced diuresis in case of poisoning Furosemide is prescribed after intravenous infusion of electrolyte solutions. The recommended starting dose for intravenous administration is 20-40 mg. The dose depends on the response to furosemide. Before and during treatment with Lasix, fluid and electrolyte losses should be monitored and replaced.

What's inside: composition and form of release of drugs

Furosemide and Lasix have a lot in common:

1. They belong to one group of drugs – diuretics (diuretics).
2. Contains one active ingredient: furosemide.
3. Available in tablets. Lasix is ​​also available as a solution for intramuscular and intravenous administration.
4. Dispensed at the pharmacy with a prescription.

The cost of drugs varies. French Lasix costs 50-100 rubles per package. Russian Furosemide is cheaper - one package of the drug will cost 20-30 rubles.

special instructions

Before starting treatment with Lasix, the presence of pronounced disturbances in the outflow of urine, including unilateral ones, should be excluded. Patients with partial urinary obstruction require careful monitoring, especially when starting treatment with Lasix. During treatment with Lasix, regular monitoring of serum sodium, potassium, and creatinine concentrations is usually required, especially in patients at high risk of developing electrolyte imbalances in cases of additional fluid and electrolyte losses (for example, due to vomiting, diarrhea, or intense sweating ). Before and during treatment with Lasix. When treating with Lasix, it is always advisable to eat foods rich in potassium (lean meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). In some cases, taking potassium supplements or prescribing potassium-sparing drugs may be indicated. In premature infants, regular monitoring of renal function and ultrasound examination of the kidneys are required (possibility of nephrolithiasis and nephrocalcinosis). Some side effects (such as a significant decrease in blood pressure and accompanying symptoms) may impair your ability to concentrate and react, which can be dangerous when driving or operating machinery. This especially applies to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use of antihypertensive drugs or alcohol. The selection of a dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out in a hospital (violations of the water-electrolyte state can lead to the development of hepatic coma). Compatibility instructions Lasix 20 mg should not be mixed in the same syringe with other drugs. Emergency measures for the development of anaphylactic shock As a rule, the following measures are recommended: at the first signs (severe weakness, cold sweat, nausea, cyanosis), stop the injection, leaving the needle in the vein. Maintain a low head and torso position and maintain a patent airway, along with other routine emergency measures. Emergency medication measures (dosage recommendations are based on an adult with normal body weight; when treating children, the dosage should be reduced in proportion to body weight): Immediate intravenous administration of epinephrine (adrenaline): after diluting 1 ml of a standard solution of epinephrine 1:1000 to 10 ml, first administer slowly 1 ml of the resulting solution (=0.1 mg of adrenaline) under the control of heart rate, blood pressure and heart rate). If necessary, the administration of epinephrine can be continued by intravenous infusion. Simultaneously with the administration of epinephrine, intravenous administration of glucocorticosteroids (250-1000 mg of methylprednisolone or prednisolone) is administered, which can be repeated if necessary. In addition to these measures, intravenous infusion of plasma substitutes and/or electrolyte solutions is performed to replenish the volume of circulating blood. If necessary: ​​artificial respiration, oxygen inhalation, antihistamines.

Reviews of Lasix

Lasix has established itself as an excellent diuretic and provides immediate relief from edema. However, due to its rapid action, negative effects also appear: the drug washes away microelements even with short-term therapy. One of the advantages is the relatively low cost of both the tablet form and the solution.

Reviews of Lasix for weight loss

The medication really allows you to lose weight without much effort, but the kilograms are reduced due to lost fluid, which is also restored immediately after stopping the medication. In addition, the drug negatively affects water and electrolyte balance, which can negatively affect overall health.

Contraindications to the use of the drug

- renal failure with anuria that does not respond to the administration of furosemide; - hepatic precoma and coma; - severe hypokalemia; - severe hyponatremia; - hypovolemia (with or without arterial hypotension) or dehydration; - pronounced disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract); - pregnancy; - pond feeding period; - hypersensitivity to the active substance or to any of the components of the drug; Patients with an allergy to sulfonamides (sulfonamide antimicrobials or sulfonylureas) may develop a cross-allergy to furosemide. With caution: - with arterial hypotension; - in conditions in which an excessive decrease in blood pressure is especially dangerous (stenotic lesions of the coronary and/or cerebral arteries); - in case of acute myocardial infarction (increased risk of developing cardiogenic shock), - in case of latent or manifest diabetes mellitus; - for gout; - with hepatorenal syndrome; - with hypoproteinemia (for example, with nephrotic syndrome, when the diuretic effect may decrease and the risk of developing the ototoxic effect of furosemide may increase, so dose selection in such patients should be carried out with extreme caution); - if there is a violation of the outflow of urine (prostatic hyperplasia, narrowing of the urethra or hydronephrosis); - with hearing loss; - for pancreatitis, diarrhea; - with a history of ventricular arrhythmia; - with systemic lupus erythematosus; - in premature infants (the possibility of the formation of calcium-containing kidney stones (nephrolithiasis) and the deposition of calcium salts in the kidney parenchyma (nephrocalcinosis), therefore regular monitoring of kidney function and ultrasound examination of the kidneys is necessary).

Interaction

When used simultaneously with aminoglycoside antibiotics (including gentamicin, tobramycin), nephro- and ototoxic effects may be enhanced. Furosemide reduces the clearance of gentamicin and increases plasma concentrations of gentamicin and tobramycin. When used simultaneously with cephalosporin antibiotics, which can cause renal dysfunction, there is a risk of increased nephrotoxicity. When used simultaneously with beta-agonists (including fenoterol, terbutaline, salbutamol) and corticosteroids, hypokalemia may increase. When used simultaneously with hypoglycemic agents and insulin, the effectiveness of hypoglycemic agents and insulin may decrease, because furosemide has the ability to increase plasma glucose levels. When used simultaneously with ACE inhibitors, the antihypertensive effect is enhanced. Severe arterial hypotension is possible, especially after taking the first dose of furosemide, apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of ACE inhibitors. The risk of renal dysfunction increases and the development of hypokalemia cannot be excluded. When used simultaneously with furosemide, the effects of non-depolarizing muscle relaxants are enhanced. When used simultaneously with indomethacin and other NSAIDs, the diuretic effect may be reduced, apparently due to inhibition of prostaglandin synthesis in the kidneys and sodium retention in the body under the influence of indomethacin, which is a nonspecific COX inhibitor; decrease in antihypertensive effect. It is believed that furosemide interacts with other NSAIDs in a similar way. When used simultaneously with NSAIDs, which are selective COX-2 inhibitors, this interaction is much less pronounced or practically absent. When used simultaneously with astemizole, the risk of developing arrhythmia increases. When used simultaneously with vancomycin, oto- and nephrotoxicity may increase. When used simultaneously with digoxin and digitoxin, an increase in the toxicity of cardiac glycosides is possible, associated with the risk of developing hypokalemia while taking furosemide. There are reports of the development of hyponatremia when used simultaneously with carbamazepine. When used simultaneously with cholestyramine and colestipol, the absorption and diuretic effect of furosemide decreases. When used simultaneously with lithium carbonate, the effects of lithium may be enhanced due to an increase in its concentration in the blood plasma. When used simultaneously with probenecid, the renal clearance of furosemide decreases. When used simultaneously with sotalol, hypokalemia and the development of ventricular arrhythmias are possible. When used simultaneously with theophylline, a change in the concentration of theophylline in the blood plasma is possible. When used simultaneously with phenytoin, the diuretic effect of furosemide is significantly reduced. After intravenous administration of furosemide during therapy with chloral hydrate, increased sweating, a feeling of heat, instability of blood pressure, and tachycardia are possible. When used simultaneously with cisapride, hypokalemia may increase. It is assumed that furosemide may reduce the nephrotoxic effect of cyclosporine. When used simultaneously with cisplatin, the ototoxic effect may be enhanced.

Indications for use of the drug

- edema syndrome in chronic heart failure; - edema syndrome in acute heart failure; - edema syndrome in chronic renal failure; - acute renal failure, including that during pregnancy and burns (to maintain fluid excretion); - edema syndrome in nephrotic syndrome (in nephrotic syndrome, treatment of the underlying disease is in the foreground); - edema syndrome in liver diseases (if necessary in addition to treatment with aldosterone antagonists); - cerebral edema. - hypertensive crisis; - maintaining forced diuresis in case of poisoning with chemical compounds excreted unchanged by the kidneys.

Side effect

From the water-electrolyte and acid-base balance: - hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypercalcemia, metabolic alkalosis, which can develop in the form of either a gradual increase in electrolyte deficiency or massive loss of electrolytes in a very short time, for example, in the case of high doses of furosemide in patients with normal renal function. Symptoms indicating the development of electrolyte and acid-base imbalances may include headache, confusion, convulsions, tetany, muscle weakness, cardiac arrhythmias and dyspeptic disorders. Factors contributing to the development of electrolyte disturbances include underlying diseases (for example, cirrhosis of the liver or heart failure), concomitant therapy and nutrition. In particular, vomiting and diarrhea may increase the risk of hypokalemia; - hypovolemia and dehydration (more often in elderly patients), which can lead to hemoconcentration with a tendency to develop thrombosis. From the cardiovascular system: - excessive decrease in blood pressure, which, especially in elderly patients, can be manifested by the following symptoms: impaired concentration and reaction, a feeling of “emptiness” in the head, a feeling of pressure in the head, headache, dizziness, drowsiness, weakness, visual disturbances, dry mouth, impaired orthostatic regulation of blood circulation. Possible development of collapse, tachycardia, arrhythmia, decrease in circulating blood volume. Metabolism: - increased serum levels of cholesterol and triglycerides; transient increase in creatinine and urea levels in the blood; increased serum concentrations of uric acid, which can cause or worsen the manifestations of gout; - decreased glucose tolerance (possible manifestation of latent diabetes mellitus). From the urinary system: - the appearance or intensification of symptoms caused by partial obstruction of the urinary tract (for example, with prostatic hyperplasia, narrowing of the urethra); - rarely - interstitial nephritis; — nephrocalcinosis/nephrolithiasis in premature infants. From the digestive tract: - rarely - nausea, vomiting, diarrhea, isolated cases of intrahepatic cholestasis, increased enzyme levels, acute pancreatitis. From the central nervous system, organ of hearing: - rarely - paresthesia; - in rare cases - hearing impairment, usually reversible, and/or tinnitus, especially in patients with renal failure or hypoproteinemia (nephrotic syndrome), as well as in the case of rapid intravenous administration of the drug. On the part of the skin, allergic reactions: - rarely - allergic skin reactions: itching, urticaria, other types of rash or bullous skin lesions, erythema multiforme, exfoliative dermatitis, purpura, fever, vasculitis, photosensitivity; - extremely rare - severe anaphylactic or anaphylactoid reactions up to shock, which until now have been described only after intravenous administration. From the peripheral blood: - rarely - thrombocytopenia, eosinophilia; - in rare cases - leukopenia; - in some cases - agranulocytosis, aplastic anemia or hemolytic anemia. Others: - in premature infants, the formation of calcium-containing kidney stones (nephrolithiasis) and the deposition of calcium salts in the kidney parenchyma (nephrocalcinosis) is possible; - in premature infants, during the first weeks of life, furosemide may increase the risk of persistence of the ductus Botallus; - with intramuscular injection, pain at the injection site. Since some adverse reactions (such as changes in the blood picture, severe anaphylactic or anaphylactoid reactions, severe allergic skin reactions) under certain conditions can threaten the lives of patients, if any side effects occur, you must immediately report them to your doctor.

Characteristics of drugs

The action of diuretics is based on their ability to reduce fluid content in body tissues and stimulate the rate of formation and outflow of urine. Lasix and Furosemide are similar drugs to each other. Both products are based on the same active ingredient. This is a loop diuretic - furosemide. That is, in fact, there is no difference between the two mentioned drugs. Both products are different brand names for the same medication.

The main advantage of loop diuretics is the peculiarity of their effect on the body. Unlike other types of drugs, they do not increase cholesterol levels in the blood and do not lead to the development of diabetes. However, Lasix and Furosemide have many side effects. The use of medications is allowed only as prescribed by a doctor. Self-medication with diuretics can cause serious harm to the body.

The price of the drug in pharmacies varies from region to region. Both products are available and low cost. Furosemide is generally cheaper than Lasix. There are diuretics of domestic and foreign production on the market.

Furosemide

Overdose

The clinical picture of acute or chronic drug overdose depends mainly on the degree and consequences of loss of fluid and electrolytes; overdose may be manifested by hypovolemia, dehydration, hemoconcentration, cardiac rhythm and conduction disturbances (including atrioventricular block and ventricular fibrillation). Symptoms of these disorders are decreased blood pressure (up to the development of shock), acute renal failure, thrombosis, delirium, flaccid paralysis, apathy and confusion. Treatment is aimed at correcting clinically significant disturbances in water-electrolyte and acid-base status under the control of serum concentrations of electrolytes, acid-base status indicators, hematocrit, as well as at preventing or treating possible serious complications developing against the background of these disorders.

pharmachologic effect

Lasix is ​​associated with inhibition of sodium chloride reabsorption in this part of the loop of Henle. Secondary effects to the increase in sodium excretion are: an increase in the amount of urine excreted (due to osmotically bound water) and an increase in the secretion of potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases. With repeated administration of the drug, Lasix causes dose-dependent stimulation of the renin-angiotensin-aldosterone system. In heart failure, Lasix quickly reduces preload (by dilating the veins), reduces pulmonary artery pressure and left ventricular filling pressure. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which the realization of this effect also requires sufficient preservation of renal function. The drug has a hypotensive effect, which is caused by an increase in sodium excretion, a decrease in circulating blood volume and a decrease in the response of vascular smooth muscles to vasoconstrictor effects (due to the natriuretic effect, furosemide reduces the vascular response to catecholamines, the concentration of which is increased in patients with arterial hypertension). Dose-dependent diuresis and natriuresis are observed when taking Lasix; the diuretic effect develops after 15 minutes and lasts about 3 hours. The relationship between intratubular concentrations of unbound (free) furosemide and its natriuretic effect follows a sigmoidal curve with a minimum effective furosemide excretion rate of approximately 10 mcg/min. Therefore, continuous infusion of furosemide is more effective than repeated bolus administration. In addition, there is no significant increase in effect above a certain bolus dose. When tubular secretion of furosemide decreases or when the drug binds to albumin located in the tubular lumen (for example, in nephrotic syndrome), the effect of furosemide is reduced.

Lasix price, where to buy

The price of Lasix tablets varies in the range of 50-60 rubles. The solution costs a little more. The price of Lasix in ampoules is approximately 100 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

• Lasix tab.
  40 mg No. 45 RUR 1,370 order
• Lasix solution for injection 2ml 10mg/ml No. 10

  RUB 1,480 order

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Pharmacy24

• Lasix 40 mg No. 45 tablets Sanofi India Limited, India
  42 UAH order
• Lasix Neo 10 mg/ml 2 ml No. 10 solution S.S. Zentiva S.A., Rumunia

  70 UAH order

PaniPharmacy

• Lasix tablets Lasix tablets. 40 mg No. 45 India, Sanofi India

  47 UAH order

• Lasix neo ampoule Lasix NEO solution d/in. 10mg/ml amp. 2ml No. 10 Romania, Zentiva

  77 UAH order

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