ycoside 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 furosemide per minute has been used) (see precautions , drug interactions). 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 (see warnings, above ).

hen furosemide is given for prolonged periods, careful clinical observation and laboratory monitoring are particularly advisable (see precautions : laboratory tests). if the physician elects to use high dose parenteral therapy, add the furosemide to either sodium chloride injection, usp, lactated ringer's injection, usp, or dextrose injection 5%, 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 the 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). if necessary, additional therapy (e.g., digitalis, oxygen) may be administered concomitantly. geriatric patients in general, dose selection for the elderly patient should be cautious, usually starting at the low end of the dosing range (see precautions , geriatric use). 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 pediatric patients 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 (see warnings , pediatric use). furosemide injection should be inspected visually for particulate matter and discoloration before administration. do not use if solution is discolored. to prevent needle-stick injuries, needles should not be recapped, purposely bent, or broken by hand.

drome (3) erythema multiforme (4) drug rash with eosinophila and systemic symptoms (5) acute generalized exanthematous pustulosis (6) exfoliative dermatitis (7) bullous pemphigoid (8) purpura (9) photosensitivity (10) rash (11) pruritus (12) urticaria cardiovascular reactions (1) orthostatic hypotension may occur and be aggravated by alcohol, barbiturates or narcotics (2) increase in cholesterol and triglyceride serum levels other reactions (1) hyperglycemia (2) glycosuria (3) hyperuricemia (4) muscle spasm (5) weakness (6) restlessness (7) urinary bladder spasm (8) thrombophlebitis (9) transient injection site pain following intramuscular injection (10) fever. whenever adverse reactions are moderate or severe, furosemide dosage should be reduced or therapy withdrawn.

ministration is within 5 minutes and somewhat later after intramuscular administration. the peak effect occurs within the first half hour. the duration of diuretic effect is approximately 2 hours. in fasted normal men, the mean bioavailability of furosemide from tablets and oral solution is 64% and 60%, respectively, of that from an intravenous injection of the drug. although furosemide is more rapidly absorbed from the oral solution (50 minutes) than from the tablet (87 minutes), peak plasma levels and area under the plasma concentration-time curves do not differ significantly. peak plasma concentrations increase with increasing dose but times-to-peak do not differ among doses. the terminal half-life of furosemide is approximately 2 hours. significantly more furosemide is excreted in urine following the intravenous injection than after the tablet or oral solution. there are no significant differences between the two oral formulations in the amount of unchanged drug excreted in urine. geriatric population furosemide binding to albumin may be reduced in elderly patients. furosemide is predominantly excreted unchanged in the urine. the renal clearance of furosemide after intravenous administration in older healthy male subjects (60 to 70 years of age) is statistically significantly smaller than in younger healthy male subjects (20 to 35 years of age). the initial diuretic effect of furosemide in older subjects is decreased relative to younger subjects (see precautions , geriatric use).