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Loop Diuretics

Loop diuretics constitute a family of drugs that remove water from the body. They
are referred to as potassium-depleting, as they cause the body to lose potassium as
well as water. Potassium-depleting diuretics also cause the body to lose
magnesium. Loop diuretics are diuretics that act on the ascending loop of Henle in
the kidney. They are primarily used in medicine to
treat hypertension and edema often due to congestive heart failure or renal
insufficiency. While thiazide diuretics are more effective in patients with normal
kidney function, loop diuretics are more effective in patients with impaired kidney
function.

Furosemide

Conten
Furosemide
ts
Indicatio Treatment of edema associated w/ CHF, renal & hepatic
ns disorders. Management of oliguria due to renal failure &
insufficiency. Mild to moderate HTN. Severe hypercalcemia.
Adjunct to other antihypertensive agents.
Dosag Edema Tab Adults 40 mg daily. Childn 1-3 mg/kg body wt
e daily. Treatment of HTN AdultUsually, 40-80 mg daily either alone
or in conjunction w/ antihypertensives. Amp Adult 20-40 mg IV/IM
once daily to bid, may be increase at 2-hrly interval by 20
mg. Childn 0.5-1.5 mg/kg daily. Max 20 mg daily.
Contraindicati Severe renal or hepatic dysfunction. Addison's disease.
ons Electrolyte imbalance.
Special Prostatic hypertrophy. Impairment of micturition. Other
Precautions obstructive disorders.
Adverse Drug Fluid & electrolyte imbalance including hyponatremia,
Reactions hypokalemia & hypochloremic alkalosis; hyperuricemia.
View ADR Monitoring Website
Drug May potentiate actions of antihypertensives when given
Interactions concomitantly.
View more drug interactions with Diuspec

Bumetanide

Indication & Oral


Dosage Oedema
Adult: 1 mg once daily. Give 2nd dose 6-8 hr later if necessary.
Elderly: 0.5 mg daily.
Oral
Refractory oedema
Adult: Initially, 5 mg daily increased by 5 mg every 12-24 hr as
required. High doses may be divided in 2-3 doses. Max: 10
mg/day.
Oral
Hypertension
Adult: 0.5-1 mg daily. Max: 5 mg/day.
Intravenous
Pulmonary oedema
Adult: 1-2 mg IV repeated 20 min later if necessary, or 2-5 mg in
500 ml of a suitable infusion fluid given over 30-60 min.
Parenteral
Emergency cases of oedema
Adult: 0.5-1 mg via slow IV/IM inj, subsequently adjust dose
according to response.
Administrati May be taken with or without food. (May be taken w/ meals to
on reduce GI discomfort.)
Overdosa May result in acute profound water loss, volume and electrolyte
ge depletion, dehydration, reduction of blood volume and circulatory
collapse leading to vascular thrombosis and embolism.
Electrolyte depletion may be manifested by weakness, dizziness,
mental confusion, anorexia, lethargy, vomiting and cramps.
Treatment includes replacing fluid and electrolyte losses by
careful monitoring of the urine and electrolyte output and serum
electrolyte levels.
Contraindicati Hypersensitivity, progressive renal failure and anuria, hepatic
ons coma, severe electrolyte depletion.
Special Pregnancy, lactation; regular monitoring of serum electrolytes
Precautions (especially potassium, calcium, magnesium); in case of
hypokalemia, potassium supplements/potassium-sparing
diuretics added. Monitor blood-glucose, BUN, creatinine levels as
well as blood counts. Sulfonamide allergy. CHF patients on
digitalis, K losing nephropathy, hepatic cirrhosis and ascitis,
diarrhoeal states.
Adverse Drug Muscle cramps, dizziness, hypotension, headache, nausea,
Reactions impaired hearing, pruritus, ECG changes, musculoskeletal pain,
rash, chest discomfort, renal failure, premature ejaculation,
thrombocytopenia, hypokalaemia, hypomagnesaemia,
hyponatraemia, hyperuricaemia, hyperglycaemia,
hypocalcaemia.
Potentially Fatal: Encephalopathy (in patients with preexisting
liver disease).
Drug Reduced diuretic and natriuretic actions
Interactions by probenecid. Indometacin blunts action of bumetanide;
concurrent usage with antihypertensives may increase risk of
orthostatic hypotension.
Potentially Fatal: Avoid concurrent usage with ototoxic drugs
such as aminoglycoides and nephrotoxic drugs.
Reduced lithium excretion via kidneys.

Lasix

Indicatio
Oedema, ascites due to cirrhosis of liver, mild or moderate HTN.
ns
Dosag Tab Adult Initially ½-2 tab/day, maintenance: ½-1
e tab/day. Childn & infant 2 mg/kg body wt/day, max: 40
mg/day. Special tab If there is no satisfactory response to 120
mg/day, change to special tab. Increase from 250 mg/day up to
1.5 g/day. Amp Adult & adolescent ≥15 yrInitially 20-40 mg IV
or IM as a single dose. If diuretic effect is not satisfactory,
increase dose stepwise by 20 mg at 2-hrly intervals until
satisfactory diuresis is obtained. Established dose should then be
given once or bd. Forte amp If 40 mg/day by slow IV does not
lead to increased diuresis, treatment w/ 250 mg is indicated. 50-
100 mg/hr administered over the day by means of a perfusor.
Max: 1.5 g/day.
Contraindicati Acute renal failure w/ anuria, hepatic coma, hypokalemia,
ons hyponatremia, hypovolemia w/ or w/o hypotension. Impaired
renal or hepatic function.
Special Pregnancy & lactation; electrolyte & fluid imbalance; Impaired
Precautions micturition. Diabetes, gout.
Adverse Drug Minor GI upset; Ca, K & Na depletion, nephrocalcinosis in
Reactions premature infants; aggravation of metabolic alkalosis; diabetes.
Rarely, anaphylactic shock, allergic reactions, bone marrow
depression; acute pancreatitis, auditory disorders.
View ADR Monitoring Form
Drug Increased risk of ototoxicity w/ aminoglycosides, cisplatin &
Interactions nephrotoxicity w/ aminoglycosides,cefaloridine. ACE inhibitors
may cause marked fall in BP. Antagonism w/ indomethacin.
Potentiation w/ salicylates, theophylline, lithium & curare-type
muscle relaxants. Hypokalemia may precipitate digitalis toxicity.

Torasemide

ndication & Oral


Dosage Hypertension
Adult: 2.5-5 mg once daily. Max: 5 mg daily.
Oral
Oedema in patients with hepatic cirrhosis
Adult: Initially, 5-10 mg once daily, given together with an
aldosterone antagonist or a potassium-sparing diuretic, titrated
upwards until the desired diuretic response is obtained. Max: 40
mg daily.
Oral
Oedema
Adult: 5 mg once daily, increased to 20 mg once daily if
necessary. Max: 40 mg/day.
Intravenous
Oedema
Adult: 10-20 mg daily as IV inj slowly over 2 min. Max: 200 mg
daily.
Administrati
May be taken with or without food.
on
Overdosa Symptoms: Marked diuresis with severe dehydration and
ge electrolytes disturbances. Somnolence, confusion, hypotension,
circulatory collapse and GI disturbances. Management: Reduce or
stop torasemide. There is no antidote and treatment involves
simultaneous replacement of fluid and electrolytes.
Haemodialysis unlikely to be useful.
Contraindicati Hypersensitivity to sulfonylureas, renal failure with anuria,
ons hepatic coma and pre-coma, hypotension, cardiac arrhythmias.
Pregnancy and lactation.
Special Risk of hyperuricaemia, gout and DM. Correct electrolyte
Precautions distubances and disorders of micturition before treatment.
Monitor electrolyte balance, glucose, uric acid, creatinine and
lipids regularly. May impair ability to drive or operate machinery.
Adverse Drug Electrolyte disturbances e.g. hypokalaemia, dehydration, dry
Reactions mouth, headache, dizziness, hypotension, weakness, drowsiness,
confusional states, loss of appetite, cramps, increased serum uric
acid, glucose, lipids, urea and creatinine, increase in LFT,
metabolic alkalosis, tinnitus and hearing loss.
Drug Increased risk of severe hypokalaemia with amphotercin B,
Interactions corticosteroids, carbenoxolone, hypokalaemia-causing
medications. Increased risk of lithium toxicity. Increased potential
for ototoxicity and nephrotoxicity with nephrotoxic or ototoxic
medications e.g. aminoglycosides. High dose salicylates may
increase the risk of salicylate toxicity. Increased risk of toxicity
withdigoxin. Reduced diuretic effect with NSAIDs. Increased risk
of hypotension with antihypertensives.

Etacrynic acid
Indication & Oral
Dosage Oedema
Adult: Initially, 50 mg in the morning, increase if necessary, by
25-50 mg increments daily to the min effective dose. Usual
effective range: 50-150 mg daily. Max: 400 mg/day. Dose of >50
mg should be given in divided doses.
Child: >2 yr: 25 mg daily, increase cautiously if necessary, by 25
mg daily.
Intravenous
Acute pulmonary oedema
Adult: As the sodium salt: 50 mg or 0.5-1 mg/kg as 1 mg/mL
solution in glucose 5% or sodium chloride 0.9% by slow IV Inj
either directly or into the tubing of a running infusion. If a
subsequent dose is needed, inj site should be changed to
prevent thrombophlebitis. Single dose of 100 mg may be given in
critical situations.
Contraindicati Severe hepatic impairment; Addison's disease. Patients with pre-
ons existing hypercalcaemia.
Special Pregnancy and lactation. Observe for signs of fluid and electrolyte
Precautions imbalance, especially during parenteral admin. Renal
impairment. May precipitate gout attacks in susceptible patients.
May cause hyperglycaemia and aggravate or unmask DM.
Monitor blood glucose in diabetic patients. May exacerbate or
activate SLE.
Adverse Drug GI disturbances or bleeding, profuse watery diarrhoea. Tinnitus
Reactions and deafness, especially after high parenteral doses. Confusion,
fatigue, nervousness and apprehension. Local irritation and pain
may follow intravenous injection.
Drug May increase nephrotoxicity of cephalosporin antibacterials and
Interactions enhance the ototoxicity of aminoglycoside antibacterials and
other ototoxic drugs. May increase risk of GI bleeding when used
with other gastric irritants or anticoagulants.

Senadex

Indicatio Treatment of susceptible infections including those of the biliary,


ns resp & urinary tracts & skin.
Dosag
Adult 1-2 g daily in divided doses every 6-12 hr.
e
Administrati May be taken with or without food (May be taken w/ meals to
on reduce GI discomfort.).
Contraindicati
Hypersensitivity to other cephalosporins.
ons
Special
Hypersensitivity to penicillins.
Precautions
Adverse Drug Diarrhea, nausea and vomiting, abdominal discomfort, headache;
Reactions allergic reactions; disturbances in liver enzymes, transient
hepatitis, cholestatic jaundice; eosinophilia & blood disorders;
reversible interstitial nephritis, hyperactivity, nervousness, sleep
disturbances, confusion, hypertonia, dizziness

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