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Furosemide

Pharmacology

Clinical Particulars

Regulatory Class

Furosemide, a sulfamoyl-anthranilic acid derivative, is a rapid-onset high-ceiling loop diuretic in all mammalian species. Furosemide demonstrates a broad spectrum of pharmacologic activity, but its principal action is a potent, fast-acting, short-duration, high-ceiling loop diuretic. It mainly works by inhibiting electrolyte reabsorption from the kidneys and enhancing water excretion from the body.  In small animal medicine, it is regarded by most as the first-line loop diuretic for managing cardiac disease. However, there are a variety of other potential applications.

Pharmacodynamics

Pharmacokinetics

Mechanism of Action

Furosemide works directly on the cells of the proximal and distal tubules of the nephron loop of Henle, reducing the absorption of electrolytes by blocking the sodium-potassium-chloride transporter, decreasing the reabsorption of sodium and chloride, as well as calcium, magnesium, and hydrogen ions and increasing potassium excretion in the distal tubules (Abbott & Kovacic, 2008; Booth, 2011; Carone et al., 2016; Chetboul et al., 2017; Cohen et al., 1976; DiBartola, 2011; Ettinger, 2024 & 2017; Harada et al., 2015; Hori et al., 2010; Lee et al., 1986; Maddison, 2008; Pichette et al., 1999; Plumb, 2024; PubChem, 2024; Sayer et al., 2009; Shankar and Brater, 2003; Uechi et al., 2003; Watson, 2011). Furosemide concentration within tubular filtrate, not blood, determines the diuretic effect  (Koyner et al., 2015).


  1. Furosemide reduces the absorption of electrolytes by blocking the sodium-potassium-chloride transporter,

  2. Furosemide decreases the reabsorption of sodium and chloride, as well as calcium, magnesium, and hydrogen ions.

  3. Furosemide increases potassium excretion in the distal tubules.

Summary of Applications

There are a variety of potential applications; Furosemide demonstrates a broad spectrum of pharmacologic activity.

Cardiology (Mammalian)

  • Acute Cardiac Disease | Acute Heart Failure (AHF): In humans and most mammalian species, initial AHF therapy typically includes the administration of parenteral furosemide, oxygen, and sedation (FOS) or furosemide, oxygen, nitroglycerine, and sedation (FONS). In patients with AHF and signs of hypo-perfusion, Clinicians should avoid diuretic administration until adequate perfusion is attained (Abbott & Kovacic, 2008; Afari et al., 2019; Chitty, 2015; Convey et al., 2024; DeFrancesco, 2013; Fitzgerald et al., 2018; Giorgi et al., 2022; Keene et al., 2019; Koster et al., 2023; Matsue et al., 2017; Ohad et al., 2018; Ponikowski et al., 2016; Roche-Catholy et al., 2021; Schnellbacher et al., 2012; Wang & Gottlieb, 2008). Detailed information, where available, is given in species-specific dosing monographs.

  • Chronic Cardiac Disease; CHF (Congestive Heart Failure): Furosemide is widely used as a loop diuretic to reduce pulmonary oedema in CHF (Adin et al., 2020; Ames et al., 2013; Ferasin & Marcora, 2007; Häggström et al., 2013, 2008; Lombard et al., 2006; Yata et al., 2019). It is the core diuretic recommended in ACVIM MMVD consensus protocols (Keene et al., 2019). CHF use in other species is also extensive (Watson, 2011). Detailed information, where available, is given in species-specific dosing monographs.

  • Feline HCM: Intravenous administration of furosemide, either as multiple boluses or a constant rate infusion, is recommended for CHF and pulmonary oedema. Thoracocentesis should be performed when respiratory distress results from pleural effusion. Intravenous fluid treatment is contraindicated in cats with clinically evident congestion, oedema or effusion and can exacerbate signs of CHF even if diuretics are administered concurrently. Ideally, measuring blood chemistries can be considered before treatment if samples can be obtained without compromising patient safety. However, diuretic treatment is recommended for acute heart failure regardless of azotemia. Cats with pulmonary oedema (stage C) must be treated with a loop diuretic – either furosemide or torsemide (torasemide). The route of administration and dosage depends on the nature and severity of clinical signs at presentation, radiographic changes, and response to initial therapy.  (Ferasin et al., 2003; Hause, 1984; Kittleson and Côté, 2021; Lee et al., 2023; Luis Fuentes et al., 2020; Ohad et al., 2018; Rush et al., 2002; Schober et al., 2021).

  • Anti-Hypertensive Agent: Furosemide has a vasodilatory effect that precedes diuresis and may confer its immediate benefit in patients with volume overload. However, in a recent systematic review, the evidence for clinical benefit was graded as modest (Abbott & Kovacic, 2008; Musini et al., 2015)

Nephrology (Mammalian)

  • Acute Kidney Injury (AKI): In humans and other mammalian species, furosemide, alongside suitable IVFT and electrolyte management, reduces the severity of hyperkalaemia, acidosis, and fluid overload in mild AKI through increased urine output (UOP). However, furosemide helps maintain urinary production but does not impact patients' survival or renal recovery rate. Instead, it may reduce the severity and duration of morbidity in recovering patients.  Some studies have shown the adverse effects of prophylactic loop diuretic administration in patients predisposed to AKI, despite theoretical reasons to use furosemide to prevent AKI. Therefore, no specific protocols are presently recommended (Escudero et al., 2022; Giorgi et al., 2022; Guan et al., 2023; Heyman et al., 1994; Ho and Power, 2010; Keir & Kellum, 2015; Li et al., 2023; Pruchnicki & Dasta, 2002; Shilliday et al., 1997; Su et al., 2024; Zhao et al., 2020). Use should be discontinued if there is any increase in a patient’s azotemic condition. Furosemide is often given as an IV bolus in cats and dogs with mild AKI. If an increased UOP is observed, the dose may be repeated every 6-12 hours if needed, or furosemide may be given as a CRI. The CRI's function is to maintain sufficient serum concentrations to allow continuous accumulation within the tubular filtrate. Dogs and cats who fail to respond to a furosemide bolus are unlikely to respond to a CRI, as they likely have adequate serum concentrations for several hours following bolus administration (Ettinger, 2024).  There may be differences in outcomes of patients with different AKI aetiologies and furosemide, alongside suitable IVFT, and suitable electrolyte management has been recommended in a variety of presentations, including AKI associated with sepsis (De Vriese, 2003; Keir and Kellum, 2015; Li et al., 2023),  AKI associated with acute lung injury (Escudero et al., 2022; Giorgi et al., 2022; Grams et al., 2011; Guan et al., 2023; Keir & Kellum, 2015; Li et al., 2023; Su et al., 2024; To et al., 2023; Zhao et al., 2020), AKI associated with Grape/Raisin and similar nephrotoxins (Downs et al., n.d.; Mazzaferro et al., 2004; Yoon et al., 2011).

  • Glomerular Disease: Furosemide is considered a first-choice drug in nephrotic syndrome dogs with pulmonary oedema or hyperkalemia, and spironolactone for dogs with pleural or abdominal effusion. The goal of diuretic treatment is a slow, progressive decrease in the oedema to a clinically acceptable condition (IRIS Canine GN Study Group et al., 2013).

Neurology (Mammalian)

  • Anti-Convulsant (AED): Furosemide has shown potential as an adjunct to antiseizure therapy in epilepsy, status epilepticus, and acute ischemic damage related to seizures. How this may benefit veterinary patients with seizure and cardiac comorbidities is yet to be investigated  (Abbott & Kovacic, 2008; Hochman, 2012; PubChem, 2024; Uwera et al., 2015; Zaccara et al., 2020).

Respiratory Medicine (Mammalian)

  • Bronchospasm: Furosemide can be nebulised or inhaled to relieve dyspnea in patients with bronchospasm. Furosemide is a known bronchodilator in horses, humans, rats and guinea pigs (Abbott & Kovacic, 2008; Boyden et al., 2015; Broadstone et al., 1991; Foresi et al., 1992; Maddison, 2008; Saba et al., 2020; Stevens et al., 2012; Sudo et al., 2000). Bronchodilatory effects in cats and dogs are unknown. It also has potential synergistic benefits if nebulised with additional bronchodilators; these effects may benefit veterinary patients of many species with asthma, chronic bronchitis, lower airway diseases and pulmonary oedema secondary to left heart failure. (Abbott and Kovacic, 2008; Boyden et al., 2015; Foresi et al., 1992; Kallet, 2007; Newton et al., 2008; Saba et al., 2020; Shimoyama and Shimoyama, 2002; Sudo et al., 2000).

Oncology (Mammalian)

  • Cyclophosphamide Therapy: IV administration of furosemide concurrently with cyclophosphamide decreased the incidence of cyclophosphamide-associated sterile hemorrhagic cystitis (SHC) (Chan et al., 2016; Charney et al., 2003).

Electrolyte Management (Mammalian)

  • Acute Hypercalcemia: Loop-active agents inhibit calcium reabsorption in the thick ascending limb of Henle's loop and have, therefore, proved helpful in treating acute hypercalcemic crises in dogs hypercalcemia by maximising sodium excretion, thereby inhibiting sodium reabsorption and promoting calciuresis. Calciuresis is induced using a combination of furosemide with 0.9% saline administration, so furosemide is an adjunct to other therapies described for hypercalcemia. In the medium and long term, the cause of hypercalcaemia requires more appropriate management (Abbott & Kovacic, 2008; Bushinsky et al., 1986; Carrick & Costner, 2018; Chakhtoura & El-Hajj Fuleihan, 2021; Malangone & Campen, 2015; Peterson & Fluegeman, 2013; Watson, 2011).

  • Hyperkalemia: Furosemide administration results in elevated levels of sodium, chloride, and water delivered to the distal collecting ducts, resulting in enhanced renal secretion of potassium and hydrogen. Potassium excretion increases with dose. Serum potassium levels can be lowered acutely using intravenous insulin and glucose, nebulised beta2 agonists, or both. Intravenous calcium effectively reverses electrocardiographic changes and reduces the risk of arrhythmias but does not lower serum potassium. Sodium polystyrene therapy, sometimes with intravenous furosemide and saline, is used in humans to decrease total body potassium levels (Abbott & Kovacic, 2008; Hollander-Rodriguez and Calvert, 2006).

Fluid Retention: Ascites, Oedema  and Effusions

In most small animal species, furosemide has been used as part of fluid retention mitigation protocols for managing cardiac, pulmonary, hepatic and renal oedema, peripheral oedema due to mechanical obstruction, venous insufficiency, hypertension, intracranial trauma, udder oedema, uremia, hypercalcemia, hypertension, inflammatory effusions and neoplastic effusions. (Watson, 2011).

Pulmonary Oedema (Mammalian)

  • Furosemide administration is a popular treatment option for pulmonary oedema. Furosemide significantly reduces de novo oedema formation by reducing pulmonary capillary pressure and blood volume, influencing the balance between oedema clearance and production. Some reviews suggest this effect can be of value even when diuresis does not occur (Agudelo et al., 2021; Caudal et al., 2018; Chetboul et al., 2017; Dumont et al., 2023; Herrería-Bustillo et al., 2022; Nemi et al., 2023; Paik et al., 2016; Pelligand et al., 2020).

Ascites (Mammalian)

  • Portal Hypertension and Ascites: Treatment goals should remove enough volume to improve patient comfort (reducing abdominal pressure), renal perfusion, and cardiac output, allowing an ongoing response to diuretic therapy. Once ascitic effusion is mobilised, diuretics can often be used intermittently with concurrent dietary sodium restriction to control ascitic accumulation.

  • Ascites Associated With Cardiac Disease: Furosemide or Spironolactone administration are popular treatment options for ascites associated with cardiac disease. Diuretic therapy is initiated after therapeutic abdominocentesis to prevent or reduce the rate of recurrent fluid accumulation. Ideally, clinicians should evaluate serum electrolytes, renal values, and systemic blood pressure before and after starting these therapies.

  • Ascites Associated With Glomerular Disease: Furosemide administration is a popular treatment option for ascites associated with glomerular nephritis and hypoproteinaemia in most mammalian veterinary species (IRIS Canine GN Study Group et al., 2013).

  • Ascites Associated With Neoplastic Effusions: These are traditionally treated using centesis aspiration and drainage, but loop diuretics may occasionally be employed after initial drainage. The evidence for benefit in the management of neoplastic effusions is weak or absent.

  • Ascites Associated With Inflammatory Effusions: Diuretics may be beneficial if fluid accumulation is acute and severe. Additional treatment modalities, such as therapeutic centesis and anti-inflammatory agents, alongside management of any underlying cause, are expected. Patients who undergo significant pleural manipulation during spinal deformity surgery may decrease the incidence of clinically symptomatic pleural effusion requiring thoracocentesis (Vora and Crawford, 2011).

Intracranial Hypertension (Mammalian)

  • Mannitol is the usual treatment option for increased intracranial pressure (ICP). In animals where mannitol fails to control ICP, or if mannitol is contraindicated because of cardiac or electrolyte abnormalities or ongoing intracranial haemorrhage is suspected, furosemide may be given. The administration of furosemide simultaneously with mannitol or hypertonic saline has reportedly been synergistic in reducing ICP; however, the additional risk of hypovolemia leaves these still to be regarded as unsuitable treatments.  (Ettinger, 2024, 2017; Silverstein and Hopper, 2009; Todd, 2013; Todd et al., 2006; Wang et al., 2013).

Pharmacodynamics

Administration

  • Traditional: Intramuscular (IM), intravenous (IV), and oral use are common in veterinary patients (SPC data 2024).

  • Alternatives: Nebulisation, intracoelomic (IC), or subcutaneous (SC), but such use may result in unpredictable efficacy, time of onset and duration of action (Watson 2011).

Absorption

  • Following oral administration, furosemide absorption from the gastrointestinal tract is variable and unpredictable. Bioavailability from both oral and injectable administration ranges from 10% to 90%, and,  in all species, it may be necessary to try several doses before the most effective one is found (PubChem, 2024).

Distribution

  • The volume of distribution following intravenous administration of 40 mg furosemide was 0.181 L/kg in healthy subjects and 0.140 L/kg in patients with heart failure. Furosemide is rapidly excreted in urine without a cumulative effect  (Ueichi et all 2003; PubChem, 2024).

Biotransformation

  • Renal: The kidney is the primary site of action, metabolism, and excretion of furosemide. Approximately 50% of the furosemide load is excreted unchanged in the urine, and the rest is metabolised into glucuronide in the kidney (Abbott and Kovacic, 2008; Booth, 2011; PubChem, 2024; Watson, 2011)

Elimination

Renal: The kidneys are responsible for 85% of total furosemide clearance, where about 43% of the drug undergoes renal excretion. More furosemide is excreted in urine following the IV injection than after the tablet or oral solution (Abbott and Kovacic, 2008;


Metabolism and Excretion

  • Renal: The kidneys are responsible for 85% of total furosemide clearance, where about 43% of the drug undergoes renal excretion. More furosemide is excreted in urine following the I.V. injection than after the tablet or oral solution. Approximately 50% of the furosemide load is excreted unchanged in urine, and the rest is metabolised into glucuronide in the kidney.

Pharmacokinetics

Precautions

Adverse Effects

Reported furosemide side effects include altered drug metabolism and interactions, electrolyte depletion, ototoxicity, mucociliary impairment, endocrine and exocrine pancreatic effects, delayed wound healing, sulfonamide toxicity, and thyroid binding interference (Abbott and Kovacic, 2008).


  • Azotaemia: Temporary elevations in BUN and creatinine may occur.

  • Compromised Cardiac Output: Reduced cardiac output can occur in animals with severe pulmonary disease, hypertrophic cardiomyopathy, pericardial or myocardial disorders, cardiac tamponade and severe hypertension (SPC data).

  • Dehydration: Due to the diuretic action of furosemide, hemoconcentration and impairment of circulation may occur.

  • Delayed wound healing: No significant publications connect furosemide with delayed wound healing in a clinical setting. However, a potential connection is implied (Abbott and Kovacic, 2008).

  • Efficacy Reduction: Increased drinking water intake may impair therapeutic efficacy may be impaired. If the animal's condition permits, water intake should be restricted to physiologically normal levels during treatment (Abbott and Kovacic, 2008).

  • Electrolyte Depletion: Electrolyte deficiency (including hypokalemia & hyponatremia) and dehydration may occur with prolonged treatment. (Abbott and Kovacic, 2008; Booth, 2011; Carone et al., 2016; DiBartola, 2011; Giorgi et al., 2022; Keir and Kellum, 2015; Langston, 2008; Maddison, 2008; McClellan et al., 2006; Watson, 2011).

  • Mucociliary impairment: Whilst unlikely to influence the outcomes of veterinary patients, Furosemide impairs mucociliary clearance in human patients under mechanical ventilation (Abbott and Kovacic, 2008; Goto et al., 2010; Kondo et al., 2002).

  • Ototoxicity: Furosemide has the potential for ototoxicity, potentiated through concurrent administration of aminoglycosides or bolus instead of CRI administration. Hearing loss associated with furosemide use is often temporary, but permanent deafness is more common with concurrent acute or chronic renal failure or administration of other ototoxic drugs. (Abbott and Kovacic, 2008; Brown, 1981; Ding et al., 2016; Göttl et al., 1985; Hori et al., 2010; Oishi et al., 2012; PubChem, 2024; Rybak, 1982; Rybak et al., 1991; Watson, 2011)

  • Pancreatic Perfusion: Minor changes in pancreatic perfusion have been identified in canine patients receiving furosemide. While the clinical significance of this is unclear, some case reports associate furosemide therapy with the onset of pancreatitis (Abbott and Kovacic, 2008; Ghatak et al., 2017; Holland and Williamson, 1984; Li and Zheng, 2023; Wallach et al., 1983).

  • Pancreatitis: Some case reports associate furosemide therapy with the onset of pancreatitis (Ghatak et al., 2017; Holland and Williamson, 1984; Wallach et al., 1983)

  • Sulfonamide Hypersensitivity: Dose-dependent adverse reactions to sulfonamides include non-regenerative anaemia, hematuria, and inhibition of thyroid hormone synthesis. The sulfa moiety is found in numerous drugs (e.g., antimicrobials, NSAIDs [deracoxib], diuretics [furosemide], drugs for colitis [sulfasalazine], and carbonic anhydrase-inhibiting antiglaucoma drugs [dichlorphenamide]) (Trepanier, 2004; Abbott and Kovacic, 2008).

  • Thyroid binding interference: Thyroid function tests must be interpreted cautiously in patients receiving either short—or long-term furosemide (Abbott and Kovacic, 2008).

Contraindications

  • Anuria And Renal Outflow Obstruction: Loop diuretics cannot function without GFR or urine output (Carone et al., 2016).

  • Circulatory Compromise: Avoid loop diuretics in hypovolaemia, hypotension and dehydration (SPC data).

  • Electrolyte Disturbances: Avoid using loop diuretics in hyperglycemia, hyperuricemia, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia, and metabolic alkalosis (Carone et al., 2016).

  • Hypersensitivity: Avoid use in cases of hypersensitivity to furosemide, sulfonamides, or excipients. The sulfa moiety found in numerous drugs (e.g., antimicrobials, NSAIDs [deracoxib], diuretics [furosemide], drugs for colitis [sulfasalazine], carbonic anhydrase inhibiting antiglaucoma drugs [dichlorphenamide]) precludes their use in pets known to be sensitised to sulfa antimicrobials (Trepanier, 2004; Abbott and Kovacic, 2008; SPC data).

  • Hypovolaemia, Hypotension Or Dehydration: Furosemide should be used cautiously in patients with pre-existing electrolyte or water balance abnormalities, impaired hepatic function, progressive renal disease, or diabetes mellitus. Patients with conditions that may lead to electrolyte or water balance abnormalities (e.g., vomiting or diarrhoea) should be monitored carefully (SPC data).

  • Interactive Medications: Monitoring plasma potassium levels is advisable during prolonged combined therapy treatment with Cardiac Glycosides. Potassium supplements may be necessary. Allergic reactions have been associated with the use of Sulphonamides. Do not use them concurrently with Aminoglycoside antimicrobials or Cephalosporin antimicrobials.

  • Nephropathy: Do not use in animals with acute glomerular nephritis, renal failure with anuria, or electrolyte deficiency disease.

  • Nephrotoxins: Do not use concurrently with Aminoglycoside or Cephalosporin antimicrobials (SPC data).

  • Pancreatitis: A risk-benefit analysis should be undertaken. Alterations in pancreatic perfusion have been identified in canine patients receiving furosemide, and some case reports associate furosemide therapy with the onset of pancreatitis (Ghatak et al., 2017; Holland and Williamson, 1984; Wallach et al., 1983).

  • Uncontrolled Water Access: Increased drinking water intake may impair therapeutic efficacy (SPC data).

Reproductive Safety

  • Pregnancy: Furosemide crosses the placenta. Embryotoxic effects (foetal urinary tract malformation) were seen in trials with laboratory animals at maternally non-toxic doses. Furosemide has been reported to delay ductus arteriosus closure and dilate constricted ductus arteriosus in neonatal rats through disruption of prostaglandin production. Clinicians should consider the risks versus benefits when using furosemide in a pregnant animal, as there is conflicting information about its safety (van der Zande et al., 2024; Wang et al., 2018; SPC data).

  • Lactation:  Avoid Use. Furosemide is excreted in milk and may affect nursing offspring. Little information is available on using furosemide during breastfeeding, and intense diuresis from high doses might decrease lactation. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. Low doses of furosemide do not suppress lactation. There is unknown potential for ototoxicity in neonates (Cominos et al., 1976; LactMed, 2006).

  • Male Fertility: Avoid Use. The effects are unknown  (SPC data).

  • Female Fertility: Avoid Use. The effects are unknown (SPC data).

  • Neonates: Avoid Use. There is unknown potential for ototoxicity in neonates (Cominos et al., 1976; LactMed, 2006).

Potentially Significant Interactions

  • Aminoglycosides:  Increased risk of nephrotoxicity [kidney injury] and ototoxicity [deafness) (Carone et al., 2016; Plumb, 2024).

  • Amikacin: Increased risk of nephrotoxicity [kidney injury] and ototoxicity [deafness) (Carone et al., 2016; Fujimura et al., 1992; Smith and Ps, 1983; Zadrozniak et al., 2019).

  • Azathioprine: In dogs, furosemide alters thiopurine methyltransferase levels in red blood cells, which may vary the metabolism of thiopurine medications such as azathioprine (Abbott and Kovacic, 2008; Kidd et al., 2004).

  • Aspirin: Aspirin therapy inhibits furosemide-induced acute venodilation and counteracts antihypertensive benefits in CHF (Abbott and Kovacic, 2008; Jhund et al., 2001).

  • Digoxin: There is an increased risk of digoxin intoxication, and furosemide-induced hypokalaemia can increase the risk of cardiac arrhythmia. The combined use of digoxin and diuretics should be avoided (Carone et al., 2016; Patel et al., 2022; Tsutsumi et al., 1979).

  • Methadone: Furosemide-induced hypokalaemia can increase the risk of cardiac arrhythmia and hypotension. Monitor heart rate, rhythm, blood pressure, and clinical status (Carone et al., 2016; Plumb, 2024).

  • NSAIDs: Administration of non-steroidal COX-1 and COX-2 inhibitors (Carprofen, Deracoxib, Firoxoxib, Flunixin, Grapiprant, Ketoprofen, Ketorolac, Mavacoxib, Meloxicam,  Piroxicam, Robenacoxi,  Tolfenamic Acid )decreases the furosemide diuretic response. Nephrotoxicity increases (Abbott and Kovacic, 2008; Carone et al., 2016; Moore et al., 2015; Plumb, 2024; Trepanier, 2005; Watson, 2011)..

  • ACEi: The interaction between furosemide and an ACE inhibitor is considered a synergistic pharmacodynamic interaction, where the ACE inhibitor is a vasodilator, and furosemide, as a diuretic, will reduce cardiac preload volume. However, the risk of hypotension and nephrotoxicity is also increased(Becker et al., 1989; Effendi et al., 2023; McLay et al., 1993; Pirintr et al., 2023; Toussaint et al., 1989).

Additional interactions identified in the literature

  • Anti-Arrhythmic Medications (including Amiodarone and Sotalol): Increased risk of cardiac toxicity because of Furosemide-induced hypokalaemia. Antagonism of effects of Lidocaine, Tocainide or Mexiletine possible.

  • Anti-Diabetic Medications: Antagonism of hypoglycaemic effects.

  • Anti-Hypertensive Medications: Enhanced hypotensive effect possible with all types. Concurrent use with ACE inhibitors or Angiotensin II receptor antagonists can result in marked falls in blood pressure; Furosemide should be stopped or the dose reduced before starting an ACE inhibitor or Angiotensin II receptor antagonists. Increased risk of first-dose hypotension with post-synaptic alpha-blockers (e.g. Prazosin). Enhanced hypotensive effect with Phenothiazines.

  • Antihistamines: Hypokalaemia with increased risk of cardiac toxicity.

  • Antimicrobials: Increased risk of ototoxicity with Aminoglycosides, Polymixins or Vancomycin. Increased risk of nephrotoxicity with Aminoglycosides or Cefaloridine. Increased risk of hyponatraemia with Trimethoprim.

  • Anxiolytics and Hypnotics: Enhanced hypotensive effect of some agents.

  • Cardiac Glycosides: Increased risk of cardiac toxicity (because of Furosemide-induced hypokalaemia and electrolyte disturbances, including hypomagnesaemia).

  • Corticosteroids: Increased risk of hypokalaemia, sodium retention and possible antagonism of diuretic effect.

  • Cytotoxics: Increased risk of nephrotoxicity and ototoxicity with platinum compounds/Cisplatin.

  • NSAIDs: Increased risk of nephrotoxicity (especially with pre-existing hypovolaemia/dehydration. Indometacin and Ketorolac may antagonise the effects of Furosemide.

  • Oestrogens: Diuretic effect antagonised.

  • Other diuretics: Possible severe additive effect. Increased risk of hypokalaemia with Thiazide diuretics. Contraindicated concurrently with some potassium-sparing diuretic products (e.g. Amiloride/ Spironolactone) - increased risk of hyperkalaemia.

  • Potassium Salts: Contraindicated due to significant risk of hyperkalaemia.

  • Salicylates: Effects potentiated by Furosemide. Salicylic toxicity is increased.

  • Sympathomimetics: Increased risk of hypokalaemia with high doses of beta2 sympathomimetics.

  • Tetracyclines: Increased risk of azotaemia.

  • Torsades de pointes: Increased risk of cardiac toxicity when used alongside drugs that prolong Q-T interval because of Furosemide-induced hypokalaemia and other electrolyte disturbances.

  • Vasodilators: Enhanced hypotensive effect is possible, e.g., with Hydralazine.

Overdose

  • Acute: Dehydration, electrolyte imbalances, and water imbalances. These may present as depressed mentation, akinesia, seizures, and cardiovascular collapse.

  • Chronic: Typically, electrolyte derangements such as hypokalemia are seen.

Precautions

Availability

Formulations

  • Injection: 50 mg/ml Solution for Injection

  • Tablets: 10 mg, 20 mg, 40 mg tablets

  • Oral Liquids: 20 mg/5 ml Oral Solution and 10mg/ml Oral Solution

UK SPCs

  1. Dimazon 50 mg/ml Solution for Injection [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/current/search-results (accessed 12.28.23).

  2. Frusedale 40 mg Oral Tablets [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A003210 (accessed 12.28.23).

  3. Frusemide 40 mg Tablets [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A005945 (accessed 12.28.23).

  4. Furosemide 10mg/ml Oral Solution - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/2460/smpc#gref (accessed 12.29.23).

  5. Furosemide 20 mg/5 ml Oral Solution - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/4576/smpc#gref (accessed 12.29.23).

  6. Furosemide Tablets BP (Vet) 20 mg [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/current/search-results (accessed 12.28.23).

  7. Furosemide Tablets BP (Vet) 40 mg [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A003335 (accessed 12.28.23).

  8. Furosivet 20 mg Tablets for Dogs and Cats [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A010184 (accessed 12.28.23).

  9. Furosoral 10 mg Tablets for Cats and Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A009114 (accessed 12.28.23).

  10. Furosoral 40 mg Tablets for Cats and Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A009115 (accessed 12.28.23).

  11. Libeo 40 mg Chewable Tablets for Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A008670 (accessed 12.28.23).

Availability

Identifiers

  • Systematic Name:  IUPAC Name 4-chloro-2-(furan-2-ylmethylamino)-5-sulfamoylbenzoic acid (PubChem, 2024).

  • Formula: C12H11ClN2O5S (PubChem, 2024).

  • Pharmacotherapeutic Group(s): Cardiovascular Medicines; High-ceiling Loop Diuretic.

  • ATC Code(s): C03CA01

  • ATC Vet Code(s): QC03CA01

Identifiers

Evidence Base

Pharmacology Bibliography

  1. Abbott, L.M., Kovacic, J., 2008. The pharmacologic spectrum of furosemide. Journal of Veterinary Emergency and Critical Care 18, 26–39. https://doi.org/10.1111/j.1476-4431.2007.00267.x

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UK SPCs

  1. Dimazon 50 mg/ml Solution for Injection [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/current/search-results (accessed 12.28.23).

  2. Frusedale 40 mg Oral Tablets [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A003210 (accessed 12.28.23).

  3. Frusemide 40 mg Tablets [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A005945 (accessed 12.28.23).

  4. Furosemide 10mg/ml Oral Solution - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/2460/smpc#gref (accessed 12.29.23).

  5. Furosemide 20 mg/5 ml Oral Solution - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/4576/smpc#gref (accessed 12.29.23).

  6. Furosemide Tablets BP (Vet) 20 mg [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/current/search-results (accessed 12.28.23).

  7. Furosemide Tablets BP (Vet) 40 mg [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A003335 (accessed 12.28.23).

  8. Furosivet 20 mg Tablets for Dogs and Cats [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A010184 (accessed 12.28.23).

  9. Furosoral 10 mg Tablets for Cats and Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A009114 (accessed 12.28.23).

  10. Furosoral 40 mg Tablets for Cats and Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A009115 (accessed 12.28.23).

  11. Libeo 40 mg Chewable Tablets for Dogs [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A008670 (accessed 12.28.23).

Evidence

Monograph Details

Criteria

  • Active Substance: Furosemide

Resources

Development Team

  • Monograph Author(s): S McArthur B Vet Med MRCVS (last updated 25/11/2024)

  • Monograph Editor(s): TBA (last updated 25/11/2024)

Monograph Contact

Mono Details
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