LASIX tablets for oral administration contain furosemide as the active ingredient and the following inactive ingredients: Chemically, it is 4-chloro-N-furfurylsulfamoylanthranilic acid. LASIX is available as white tablets for oral administration in dosage strengths of 20, 40 and 80 mg.
Furosemide is a white to off-white odorless crystalline powder. It is practically insoluble in water, sparingly soluble in alcohol, lasix and acetaminophen, freely soluble in dilute alkali solutions and act plan test in dilute acids. LASIX is indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failurelasix and acetaminophen, cirrhosis of the giving dogs acetaminophen and renal disease, including the nephrotic syndrome.
LASIX is particularly useful when an agent with greater diuretic potential is desired. Oral LASIX may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents, lasix and acetaminophen.
Hypertensive patients who cannot be adequately controlled with thiazides will probably also not be adequately controlled with LASIX alone, lasix and acetaminophen. Therapy should be individualized according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that drug reaction acyclovir alcohol. Ordinarily a prompt diuresis ensues.
If needed, the same dose can be administered 6 to 8 hours later or the dose may be increased. The dose may be raised by 20 or 40 mg and given not sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained. The individually determined single dose should then be given once or twice daily eg, lasix and acetaminophen, at 8 am and 2 pm.
Edema may be most efficiently and safely mobilized by giving LASIX on 2 to 4 consecutive lasix and acetaminophen each week, lasix and acetaminophen.
For maintenance therapy in pediatric patients, the dose should be adjusted to the minimum effective level. Dosage should then be adjusted according to response. If response is not satisfactory, add other antihypertensive agents. Changes in blood pressure must be carefully monitored when LASIX is used with other antihypertensive drugs, especially during initial therapy. To prevent excessive drop in blood pressure, the dosage of other agents should be reduced by at least 50 percent when LASIX is added to the regimen.
As the blood pressure falls under the potentiating effect lasix and acetaminophen LASIX, a further reduction in dosage or even discontinuation of other antihypertensive drugs may be lasix and acetaminophen. Dispense in well-closed, light-resistant containers.
Exposure to light might cause a slight discoloration. Discolored tablets should not be dispensed. Whenever adverse reactions are moderate or severe, LASIX dosage should be reduced or therapy withdrawn.
LASIX may increase the ototoxic empire plan insurance address of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination.
LASIX should not be used concomitantly with ethacrynic acid because of the possibility of ototoxicity. Patients receiving high doses of salicylates concomitantly with LASIX, as in rheumatic disease, may experience salicylate toxicity at lower doses because of competitive renal excretory sites.
In addition, nephrotoxicity of nephrotoxic drugs such as cisplatin may be enhanced if LASIX is not given in lower doses and with positive fluid balance when used to achieve forced diuresis during cisplatin treatment.
LASIX has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine. LASIX combined with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers may lead to severe hypotension and deterioration in renal function, including renal failure, lasix and acetaminophen.
An interruption or reduction in the dosage of LASIX, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers may be necessary. LASIX may decrease arterial responsiveness to norepinephrine. However, norepinephrine may still be used effectively. In isolated cases, intravenous administration of LASIX within 24 hours of taking chloral hydrate may lead to flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia. There is evidence that treatment with phenytoin leads to decrease lasix and acetaminophen absorption of LASIX, lasix and acetaminophen, and consequently to lower peak serum furosemide concentrations.
LASIX can increase the risk of cephalosporin-induced nephrotoxicity even in the setting of minor or transient renal impairment. Concomitant use of cyclosporine and LASIX is associated with increased risk of gouty arthritis secondary to LASIX-induced hyperurecemia and cyclosporine impairment of renal lasix and acetaminophen excretion.
One study in six subjects demonstrated that the combination of furosemide and acetylsalicylic lasix and acetaminophen temporarily reduced creatinine clearance in patients with chronic renal insufficiency. There are case reports of patients who developed increased BUNserum creatinine and serum potassium levels, and weight gain when furosemide was used in conjunction with NSAIDs.
Literature reports indicate lasix and acetaminophen coadministration of indomethacin tinfoil gun blue lithium battery acid reduce the natriuretic and antihypertensive effects of LASIX furosemide in lasix and acetaminophen patients by inhibiting prostaglandin synthesis.
Indomethacin may also affect plasma renin levels, aldosterone excretion, and renin profile evaluation. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved.
Sudden alterations of fluid and electrolyte balance in patients with cirrhosis may precipitate hepatic coma; therefore, strict observation is necessary during the period of diuresis, lasix and acetaminophen. Supplemental potassium chloride and, if required, lasix and acetaminophen, an aldosterone antagonist are helpful in preventing hypokalemia and metabolic alkalosis, lasix and acetaminophen.
If increasing azotemia and lasix and acetaminophen occur during treatment of severe progressive renal disease, LASIX should be discontinued. Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported.
Reports usually indicate that LASIX ototoxicity is associated with rapid injection, severe renal impairment, the use of higher lasix and acetaminophen recommended doses, hypoproteinemia or concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs. If the physician elects to use high dose parenteral therapy, controlled intravenous infusion is advisable for adults, an infusion rate not exceeding 4 mg LASIX per minute has been used. Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolismparticularly in elderly patients.
As with any effective diureticelectrolyte depletion may occur during LASIX therapy, especially in patients receiving higher doses and a restricted salt intake. Hypokalemia may develop with LASIX, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives.
Digitalis therapy may exaggerate metabolic effects of hypokalemia, especially myocardial effects. All patients receiving LASIX therapy should be observed for these signs or symptoms of fluid or electrolyte imbalance hyponatremiahypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia: Increases in blood glucose and alterations in glucose tolerance tests ascorbic acid terminates chlorine abnormalities of the fasting and 2-hour postprandial sugar have been observed, and rarely, precipitation of diabetes mellitus has been reported.
In patients with severe symptoms of urinary retention because of bladder emptying disorders, prostatic hyperplasiaurethral narrowingthe administration of furosemide can cause acute urinary retention related to increased production and retention of urine. Thus, these patients require careful monitoring, especially lasix and acetaminophen the initial stages of treatment. In patients at high risk for radiocontrast nephropathy LASIX can lead to a higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast.
In patients with hypoproteinemia e. Asymptomatic hyperuricemia can occur and gout may rarely be precipitated. The possibility exists of exacerbation or activation of systemic lupus erythematosus. As with many other drugs, patients should be observed regularly for the possible occurrence of blood dyscrasias, liver or kidney damage, lasix and acetaminophen, or other idiosyncratic reactions.
Serum and urine electrolyte determinations are particularly important when the patient is vomiting profusely or receiving parenteral fluids, lasix and acetaminophen.
Abnormalities should be corrected or the drug temporarily withdrawn. Other medications may also influence serum electrolytes. Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with lasix and acetaminophen insufficiency.
Urine and lasix and acetaminophen glucose should be checked periodically in diabetics receiving LASIX, even in those suspected of latent diabetes. LASIX may lower serum levels of calcium rarely cases lasix and acetaminophen tetany have been reported and magnesium.
Accordingly, serum levels of these electrolytes should be determined periodically. Furosemide was tested for carcinogenicity by oral administration in one strain of mice and one strain of rats. A lasix and acetaminophen but significantly increased incidence of mammary gland carcinomas occurred in female mice at a dose Furosemide was devoid of mutagenic activity in various strains of Salmonella typhimurium when tested in the presence or absence of an in vitro metabolic activation system, and questionably positive for gene mutation in mouse lymphoma cells in the presence of rat liver S9 at the highest dose tested.
Furosemide did not induce sister chromatid exchange in human cells in vitro, but other studies on chromosomal aberrations in human cells in vitro gave conflicting results. In Chinese hamster cells it induced chromosomal damage but was questionably positive for sister chromatid exchange, lasix and acetaminophen.
Studies on the induction by furosemide of chromosomal aberrations in mice were inconclusive. The urine of rats treated with this drug did not induce gene conversion in Saccharomyces lasix and acetaminophen. Pregnancy Category C - Furosemide has been shown to cause unexplained maternal deaths and abortions in rabbits at 2, 4 and 8 times the maximal recommended human dose.
There are no adequate and well-controlled studies in pregnant women. LASIX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Treatment during pregnancy requires monitoring of fetal lasix and acetaminophen because of the potential for higher birth weights. The effects of furosemide on embryonic and fetal development and on pregnant dams were studied in mice, rats and rabbits.
Data from the above studies indicate fetal lethality that can precede maternal deaths. The results of the mouse study and one of the three rabbit studies also showed an increased incidence and severity of hydronephrosis distention of the renal pelvis and, in some cases, of the ureters in fetuses derived from the treated dams as compared with the incidence in fetuses from the control group.
Because it appears in breast milk, caution should be exercised when LASIX is administered to a nursing mother. Monitor renal function, and renal ultrasonography should be considered, in pediatric patients receiving LASIX. If LASIX is administered lasix and acetaminophen premature infants during the first weeks of life, it may increase the risk of persistence of patent ductus arteriosus.
Controlled clinical studies of LASIX did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for the elderly patient should be cautious, lasix and acetaminophen starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
This drug is lasix and acetaminophen to be substantially excreted by the kidney, lasix and acetaminophen, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection lasix and acetaminophen it may be useful to monitor renal function.
The principal signs and symptoms of overdose with LASIX are dehydration, blood volume reduction, hypotensionelectrolyte imbalance, hypokalemia and hypochloremic alkalosisand are extensions of its diuretic action. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats. Treatment of overdosage is supportive and consists of replacement of excessive fluid and electrolyte losses.
Serum electrolytes, carbon dioxide level and blood pressure should be determined frequently. Adequate drainage must be assured in patients with urinary bladder 8th grade lesson plan obstruction such as prostatic hypertrophy. Hemodialysis does not accelerate furosemide elimination.
LASIX is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.