Furosemide Injection T P Adverse Reactions

As with other diuretics, electrolyte and water balance may be disturbed as a result of diuresis after prolonged therapy. At the commencement of treatment, excessive diuresis may give rise, especially in elderly patients, to circulatory disturbances, e.g. a feeling of pressure in the head, dizziness, dryness of the mouth or visual impairment, as symptoms of hypovolaemia.
In extreme causes, hypovolaemia may lead to dehydration, circulatory collapse and thrombophilia. However, with individualized dosage, acute haemodynamic reactions are generally not to be expected, although diuresis sets in rapidly.
All saluretics may cause potassium depletion, especially in cases of low-potassium diet, vomiting or chronic diarrhoea. In addition, diseases e.g. cirrhosis of the liver may cause a predisposition to potassium deficiency states.
Appropriate surveillance and replacement therapy are necessary in such cases. If salt intake is restricted too much, sodium deficiency may produce a fall in blood pressure, calf muscle cramps, anorexia, weakness, dizziness, drowsiness, vomiting and confusional states.
The serum calcium level may be reduced under furosemide therapy; in very rare cases, tetany has been observed. In premature infants, calcium salts may be deposited in the renal tissue (nephrocalcinosis).
Gastrointestinal disorders (e.g. nausea, vomiting, diarrhoea) or allergic reactions (e.g. rashes, vasculitis, fever, interstitial nephritis) and changes of the blood picture (leukopenia, agranulocytosis, anaemia, thrombocytopenia) may occasionally be observed.
Anaphylactic shock, though rare, is an acute life-threatening reaction (see Emergency Measures to be Taken in the Event of Anaphylactic Shock as follows).
Symptoms of obstructed micturition (e.g. in hydronephrosis, prostatic hypertrophy, ureterostenosis) may become manifest or aggravated under the action of diuretics.
In common with other diuretics, treatment with Furosemide Injection may induce a transient rise in serum creatinine and urea.
It should be remembered that an increase in uric acid concentration in the blood may precipitate attacks of gout in predisposed patients.
Serum cholesterol and triglyceride levels may rise under furosemide treatment, but will usually return to normal, under long-term treatment within 6 months. In rare cases, manifest diabetes mellitus may be aggravated by furosemide treatment and latent diabetes may become manifest.
Isolated cases of acute pancreatitis have been reported in which the treatment with saluretics over several weeks was considered a causal factor, including also a few cases following therapy with furosemide.
Disorders of hearing after furosemide are rare and in most cases reversible. This possibility should be borne in mind, especially if furosemide is injected too rapidly and in particular in patients with renal insufficiency (see Administration under Dosage & Administration).
Preexisting metabolic alkalosis may be aggravated by furosemide treatment (e.g. in decompensated cirrhosis of the liver).
Emergency Measures to be Taken in the Event of Anaphylactic Shock: The following emergency measures are generally recommended: At the first signs (sweating, nausea, cyanosis), interrupt the injection immediately but leave the venous cannula in place or perform venous cannulation. In addition to the usual emergency measures, ensure that the patient remains lying with the legs raised and airways patent.
Emergency Drug Therapy: Immediate epinephrine (adrenaline) IV: Dilute 1 mL of commercially available epinephrine solution 1:1000 to 10 mL. In the first instance, slowly inject 1 mL of this dilution (equivalent to 0.1 mg epinephrine) while monitoring pulse and blood pressure (watch for disturbances of cardiac rhythm). Repeat as required. Then give glucocorticoids IV, e.g. 250-1000 mg methylprednisolone. Repeat as required. Subsequently, volume substitution IV, e.g. plasma expanders, human albumin, balanced electrolyte solution should be employed.
Other Therapeutic Measures: Artificial respiration, oxygen inhalation, calcium, antihistaminics.