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Intravenous Dilution Guidelines

Furosemide (Lasix ® )

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

[All doses] [50 ml] [As directed]

May administer undiluted.

Maximum rate = 4mg/ min IV.

Stability / Miscellaneous

EXP: 1 DAY (RT).
Label: Do not Refrigerate.

Recommended routes: IM, IV-push, Continuous infusion.
Doses up to 6 grams/day have been used in patients with renal failure.

Dosing: 20 to 40 mg initially. Increase by 20 mg increments q1 to 2 hours until response.

Continuous infusion: 20 to 160 mg/hr.
IV bolus: Usual doses (eg <80 mg) can be given slowly over 1-2 minutes. If higher doses are needed, a continuous infusion is recommended-usually greater efficacy as well as decreased risk of side effects.

DOSAGE AND ADMINISTRATION
Adults - Parenteral therapy with furosemide injection should be used only in patients unable to take oral medication or in emergency situations and should be replaced with oral therapy as soon as practical.

Edema
The usual initial dose of furosemide is 20 mg to 40 mg given as a single dose, injected intramuscularly or intravenously. The intravenous dose should be given slowly (1 to 2 minutes). Ordinarily a prompt diuresis ensues. If needed, another dose may be administered in the same manner 2 hours later or the dose may be increased. The dose may be raised by 20 mg and given not sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained. This individually determined single dose should then be given once or twice daily.

Therapy should be individualized according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that response. Close medical supervision is necessary. If the physician elects to use high dose parenteral therapy, add the furosemide to either Sodium Chloride Injection, USP, 0.9%, Lactated Ringer’s Injection, USP, or Dextrose (5%) Injection, USP, after pH has been adjusted to above 5.5, and administer as a controlled intravenous infusion at a rate not greater than 4 mg/min. Furosemide injection is a buffered alkaline solution with a pH of about 9 and drug may precipitate at pH values below 7. Care must be taken to ensure that the pH of the prepared infusion solution is in the weakly alkaline to neutral range. Acid solutions, including other parenteral medications (e.g., labetalol, ciprofloxacin, amrinone, milrinone) must not be administered concurrently in the same infusion because they may cause precipitation of the furosemide. In addition, furosemide injection should not be added to a running intravenous line containing any of these acidic products.

Acute Pulmonary Edema
The usual initial dose of furosemide is 40 mg injected slowly intravenously (over 1 to 2 minutes). If a satisfactory response does not occur within 1 hour, the dose may be increased to 80 mg injected slowly intravenously (over 1 to 2 minutes).

IIf necessary, additional therapy (e.g., digitalis, oxygen) may be administered concomitantly.

Pediatric Patients- Parenteral therapy should be used only in patients unable to take oral medication or in emergency situations and should be replaced with oral therapy as soon as practical.

The usual initial dose of furosemide injection (intravenously or intramuscularly) in infants and children is 1 mg/kg body weight and should be given slowly under close medical supervision. If the diuretic response to the initial dose is not satisfactory, dosage may be increased by 1 mg/kg not sooner than 2 hours after the previous dose, until the desired diuretic effect has been obtained. Doses greater than 6 mg/kg body weight are not recommended.

Literature reports suggest that the maximum dose for premature infants should not exceed 1 mg/kg/day. WARNINGS: Pediatric Use: In premature neonates with respiratory distress syndrome, diuretic treatment with furosemide in the first few weeks of life may increase the risk of persistent patent ductus arteriosus (PDA), possibly through a prostaglandin-E-mediated process.

Literature reports indicate that premature infants with post-conceptual age (gestational plus postnatal) less than 31 weeks receiving doses exceeding 1 mg/kg/24 hours may develop plasma levels which could be associated with potential toxic effects including ototoxicity.

Hearing loss in neonates has been associated with the use of furosemide injection

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Furosemide injection should be inspected visually for particulate matter and discoloration before administration. Do not use if solution is discolored.

HOW SUPPLIED
1275 - Carpuject® with Luer Lock - 10 mg/mL - 2 mL
Box of 10

Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Do not freeze.

Protect CARPUJECT from light. Do not remove cartridges from package until time of use.

Do not use the injection if it is discolored or contains a precipitate.

©Hospira 2004
EN-0529
HOSPIRA, INC., LAKE FOREST, IL 60045 USA


Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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