Furosemide (Lasix) | Davis's Drug Guide - Nursing Central

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Davis's Drug Guide

General

**BEERS Drug**

Pronunciation: fur-oh-se-mide

furosemide

Trade Name(s)

Furoscix
Lasix

Ther. Class.

diuretics

Pharm. Class.

loop diuretics

Indications

PO IM IV Edema due to HF, hepatic impairment, or renal disease.
SUBQ Edema due to chronic HF.
PO Hypertension.

Action

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium.
Effectiveness persists in impaired renal function.

Therapeutic Effect(s):

Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).
Decreased BP.

Pharmacokinetics

Absorption: 60–67% absorbed after oral administration (↓ in acute HF and in renal failure); also absorbed from IM sites; IV administration results in complete availability; 99.6% absorbed after SUBQ administration.

Distribution: Unknown.

Protein Binding: 91–99%.

Metabolism and Excretion: Minimally metabolized by liver, some nonhepatic metabolism, some renal excretion as unchanged drug.

Half-life: 30–120 min (↑ in renal impairment).

TIME/ACTION PROFILE (diuretic effect)

ROUTE	ONSET	PEAK	DURATION
PO	30–60 min	1–2 hr	6–8 hr
IM	10–30 min	unknown	4–8 hr
IV	5 min	30 min	2 hr
SUBQ	unknown	unknown	8 hr

Contraindication/Precautions

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with thiazides and sulfonamides may occur;
Hepatic coma;
Anuria;
Hepatic cirrhosis (SUBQ only);
Alcohol intolerance (some liquid products may contain alcohol).

Use Cautiously in:

Severe hepatic impairment (may precipitate hepatic coma; concurrent use with potassium-sparing diuretics may be necessary);
Electrolyte depletion;
Diabetes mellitus;
Hypoproteinemia (↑ risk of ototoxicity);
Severe renal impairment (↑ risk of ototoxicity);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: ↑ risk for renal calculi and patent ductus arteriosis in premature neonates;
Geri: Appears on Beers list. May worsen or cause hyponatremia in older adults. Use with caution in older adults and monitor sodium concentrations closely when initiating therapy or ↑ the dose.

Adverse Reactions/Side Effects

CV: hypotension

Derm: ERYTHEMA MULTIFORME, photosensitivity, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN), urticaria

EENT: blurred vision, hearing loss, tinnitus

Endo: hyperglycemia

F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

GI: ↑ liver enzymes, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, pancreatitis, vomiting

GU: excessive urination, nephrocalcinosis, renal impairment

Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, hemolytic anemia, leukopenia, thrombocytopenia

Metabolic: hypercholesterolemia, hypertriglyceridemia, hyperuricemia

MS: muscle cramps

Neuro: dizziness, headache, paresthesia, vertigo

Misc: fever

* CAPITALS indicate life-threatening.Underline indicate most frequent.

Interactions

Drug-Drug

↑ risk of hypotension with antihypertensives, nitrates, or acute ingestion of alcohol.
↑ risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids.
Hypokalemia may ↑ risk of digoxin toxicity and risk of arrhythmia in patients taking QT interval prolonging drugs.
May ↑ risk of lithium toxicity.
May ↑ risk of ototoxicity with aminoglycosides or cisplatin.
May ↑ risk of nephrotoxicity with cisplatin.
NSAIDs may ↓ effects of furosemide.
May ↑ risk of methotrexate toxicity.
Sucralfate, cholestyramine, or colestipol may ↓ absorption and effects.
May ↑ risk of salicylate toxicity (with use of high-dose salicylate therapy).
Concurrent use with cyclosporine may ↑ risk of gouty arthritis.

Route/Dosage

Edema

PO (Adults): 20–80 mg/day as a single dose initially; may repeat in 6–8 hr; may ↑ dose by 20–40 mg every 6–8 hr until desired response. Maintenance doses may be given once or twice daily (doses up to 2.5 g/day have been used in patients with HF or renal disease). Hypertension: 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response; Hypercalcemia: 120 mg/day in 1–3 doses.

PO (Children >1 mo): 2 mg/kg as a single dose; may ↑ by 1–2 mg/kg every 6–8 hr (maximum dose = 6 mg/kg).

PO (Neonates): 1–4 mg/kg/dose 1–2 times/day.

IM IV (Adults): 20–40 mg; may repeat in 1–2 hr and ↑ by 20 mg every 1–2 hr until response is obtained; maintenance dose may be given every 6–12 hr; Continuous infusion: Bolus 0.1 mg/kg followed by 0.1 mg/kg/hr; double every 2 hr to a maximum of 0.4 mg/kg/hr.

IM IV (Children): 1–2 mg/kg/dose every 6–12 hr; Continuous infusion: 0.05 mg/kg/hr; titrate to clinical effect.

IM IV (Neonates): 1–2 mg/kg/dose every 12–24 hr.

SUBQ (Adults): 30 mg over the 1st hr; then 12.5 mg per hr over the next 4 hr with the single-use on-body Infusor. Replace with oral diuretic therapy as soon as possible.

Hypertension

PO (Adults): 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response.

Availability (generic available)

Tablets: 20 mg, 40 mg, 80 mg, 500 mg Canadian Trade name

Oral solution (10 mg/mL–orange flavor, 8 mg/mL–pineapple-peach flavor): 8 mg/mL, 10 mg/mL

Solution for intravenous/intramuscular injection: 10 mg/mL

Solution for SUBQ injection (Furoscix) (prefilled cartridges): 80 mg/10 mL

Assessment

Assess fluid status. Monitor daily weight, intake and output, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care provider if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
Monitor BP and HR before administration and throughout therapy.
Assess for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with renal impairment or those taking other ototoxic drugs.

Assess for rash frequently with signs and symptoms of SJS, TEN, or erythema multiforme during therapy (fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophila). Discontinue immediately and provide supportive care; may be life-threatening. May recur once treatment is stopped.

Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; ↑ risk of digoxin toxicity because of the potassium-depleting effect of the diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.
Assess for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with renal impairment or those taking other ototoxic drugs.

Geri: Diuretic use is associated with ↑ risk for falls in older adults. Assess risk and implement fall prevention strategies.

Assess for allergy to sulfonamides.

Lab Test Considerations:

Monitor electrolytes before and regularly during therapy. May ↓ sodium, potassium, calcium, and magnesium concentrations.

Monitor renal and hepatic function, serum glucose, and uric acid levels before and periodically during therapy. May ↑ BUN, serum glucose, creatinine, and uric acid levels.

Implementation

Do not confuse Lasix with Wakix.
PO May be taken with food or milk to minimize GI irritation. Tablets may be crushed, if needed.
- Do not administer discolored solution or tablets.

Black Box: If given in excessive amounts, furosemide can lead to significant diuresis with water and electrolyte depletion. Careful medical supervision is required and dose regimen must be adjusted to the individual patient's needs.

Administer medication in the morning to prevent disruption of sleep cycle. If administering twice daily, give last dose no later than 5 pm to minimize disruption of sleep cycle.
- IV route is preferred over IM for parenteral administration.
PO May be taken with food or milk to minimize GI irritation. Tablets may be crushed, if needed.
- Do not administer discolored solution or tablets.

SUBQ The single-use on-body infusor with prefilled cartridge is preprogrammed to deliver 30 mg over 1st hr followed by 12.5 mg/hr for the subsequent 4 hr. Inspect fluid in prefilled cartridge; solution is clear to slightly yellow; do not administer if discolored or cloudy. Load prefilled cartridge and close. Peel adhesive liner on the infusor and apply to clean, dry skin of the abdomen between top of beltline and bottom of rib cage (>2½ inches from beltline or bottom of rib cage) that is not tender, bruised, red or indurated. Start injection by firmly pressing and releasing the start button. Do not remove until the injection is complete (signaled by the solid green status light, beeping sound, and white plunger rod filling the cartridge window). Rotate the site of each SUBQ administration. Patient must limit activity during administration. The infusor cannot be immersed fluids such as water, sweat, blood, etc. to prevent malfunction. Keep infusor >12 inches away from electronic devices or wireless accessories (TV remote, Bluetooth devices). Infusor must be removed prior to MRI. SUBQ route is not for chronic use; replace with oral diuretics as soon as practical.

IV Administration

IV Push: Dilution: Administer undiluted. Concentration: 10 mg/mL.
Rate: Administer slowly at 20 mg/min. Pedi: Administer at a max rate of 0.5–1 mg/kg/min (for doses <120 mg), with infusion not exceeding 10 min.
Intermittent Infusion: Dilution: Dilute larger doses in 50 mL of D5W, D10W, D20W, D5/0.9% NaCl, D5/LR, 0.9% NaCl, 3% NaCl, 1/6 M sodium lactate, or LR. Infusion stable for 24 hr at room temperature. Do not refrigerate. Protect from light. Concentration: 1 mg/mL.
Rate: Do not exceed 4 mg/min (for doses >120 mg) in adults to prevent ototoxicity. Pedi: Do not exceed 1 mg/kg/min with infusion not exceeding 10 min. Use an infusion pump to ensure accurate dose.
Y-Site Compatibility:
- acyclovir
- allopurinol
- MORE...
  - alprostadil
  - amifostine
  - amikacin
  - aminocaproic acid
  - aminophylline
  - amphotericin B lipid complex
  - amphotericin B liposomal
  - anidulafungin
  - argatroban
  - arsenic trioxide
  - ascorbic acid
  - atropine
  - azathioprine
  - aztreonam
  - bivalirudin
  - bleomycin
  - bumetanide
  - calcium chloride
  - calcium gluconate
  - cangrelor
  - carboplatin
  - carmustine
  - cefazolin
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  - cefotaxime
  - cefotetan
  - cefoxitin
  - ceftaroline
  - ceftazidime
  - ceftazidime/avibactam
  - ceftolozane/tazobactam
  - ceftriaxone
  - cefuroxime
  - chloramphenicol
  - cisplatin
  - cladribine
  - clindamycin
  - cyanocobalamin
  - cyclophosphamide
  - cyclosporine
  - cytarabine
  - dactinomycin
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  - fentanyl
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  - fluorouracil
  - folic acid
  - foscarnet
  - fosphenytoin
  - ganciclovir
  - granisetron
  - heparin
  - hetastarch
  - hydrocortisone
  - ibuprofen lysine
  - ifosfamide
  - imipenem/cilastatin
  - indomethacin
  - ketorolac
  - LR
  - leucovorin calcium
  - lidocaine
  - linezolid
  - lorazepam
  - mannitol
  - melphalan
  - meropenem
  - meropenem/vaborbactam
  - mesna
  - methotrexate
  - methylprednisolone
  - metoprolol
  - metronidazole
  - micafungin
  - mitomycin
  - multivitamins
  - nafcillin
  - naloxone
  - nitroprusside
  - octreotide
  - oxacillin
  - oxaliplatin
  - oxytocin
  - paclitaxel
  - palonosetron
  - pamidronate
  - pemetrexed
  - penicillin G
  - pentobarbital
  - phenobarbital
  - phytonadione
  - piperacillin/tazobactam
  - plazomicin
  - potassium acetate
  - potassium chloride
  - procainamide
  - propofol
  - propranolol
  - remdesivir
  - sargramostim
  - sodium acetate
  - sodium bicarbonate
  - succinylcholine
  - sufentanil
  - sulbactam/durlobactam
  - tedizolid
  - theophylline
  - thiotepa
  - tigecycline
  - tirofiban
  - tobramycin
  - topotecan
  - voriconazole
  - zoledronic acid
Y-Site Incompatibility:
- alemtuzumab
- MORE...
  - atracurium
  - benztropine
  - blinatumomab
  - butorphanol
  - caspofungin
  - ciprofloxacin
  - dantrolene
  - daunorubicin
  - dexrazoxane
  - diazepam
  - diazoxide
  - diltiazem
  - dimenhydrinate
  - diphenhydramine
  - doxycycline
  - droperidol
  - epirubicin
  - eptifibatide
  - eravacycline
  - filgrastim
  - gemcitabine
  - gemtuzumab ozogamicin
  - glycopyrrolate
  - haloperidol
  - idarubicin
  - irinotecan
  - isavuconazonium
  - ketamine
  - levofloxacin
  - milrinone
  - mitoxantrone
  - moxifloxacin
  - mycophenolate
  - nalbuphine
  - nicardipine
  - ondansetron
  - papaverine
  - pentamidine
  - phenytoin
  - posaconazole
  - potassium phosphates
  - prochlorperazine
  - protamine
  - pyridoxine
  - rituximab
  - rocuronium
  - telavancin
  - thiamine
  - trastuzumab
  - trimethoprim/sulfamethoxazole
  - vancomycin
  - vecuronium
  - verapamil
  - vinblastine
  - vinorelbine

Patient/Family Teaching

Explain purpose and side effects of furosemide. Instruct to take as directed. Take missed doses as soon as possible; do not double doses. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.

Emphasize the importance of routine follow-up examinations. Periodic lab tests will be needed.
Hypertension: Advise patients on antihypertensive regimen to continue taking medication even if feeling better. Furosemide controls but does not cure hypertension.
Reinforce the need to continue additional therapies for hypertension (weight loss, exercise, restricted sodium intake, stress reduction, regular exercise, moderation of alcohol consumption, cessation of smoking).

Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any OTC medications concurrently with this therapy.
Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension.
Instruct patient to consult health care professional regarding a diet high in potassium (see food sources for specific nutrients).
Advise patient to contact health care professional if weight gain >3 lb in 1 day.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
Advise patients with diabetes to monitor blood glucose closely; may cause ↑ blood glucose levels.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Loop diuretics are not recommended for use during pregnancy, except when necessary for treating pulmonary edema in cardiac failure. Monitor fetal growth during pregnancy; ↑ risk for higher birth weights.

Geri: Caution older patients or their caregivers about ↑ risk for falls. Suggest strategies for fall prevention.

Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Loop diuretics are not recommended for use during pregnancy, except when necessary for treating pulmonary edema in cardiac failure. Monitor fetal growth during pregnancy; ↑ risk for higher birth weights.

Evaluation/Desired Outcomes

Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).
Decrease in BP.

Citation

Vallerand, April Hazard., et al. "Furosemide." Davis's Drug Guide, 19th ed., F.A. Davis Company, 2026. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemide. Vallerand AHA, Sanoski CAC, . Furosemide. Davis's Drug Guide. F.A. Davis Company; 2026. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemide. Accessed March 12, 2026.Vallerand, A. H., Sanoski, C. A., & , (2026). Furosemide. In Davis's Drug Guide (19th ed.). F.A. Davis Company. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemideVallerand AHA, Sanoski CAC, . Furosemide [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2026. [cited 2026 March 12]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemide.* Article titles in AMA citation format should be in sentence-caseCopyDownloadMLAAMAAPAVANCOUVERTY - ELEC T1 - furosemide ID - 51345 A1 - Sanoski,Cynthia A, AU - Vallerand,April Hazard, AU - ,, BT - Davis's Drug Guide UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemide PB - F.A. Davis Company ET - 19 DB - Nursing Central DP - Unbound Medicine ER - Try the app for free!

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Cross Links

-semide

acidosis

ascites

Audiometry, Hearing Loss Diseases and Disorders icon

Blood Transfusion Reaction Tabers Dictionary icon

cardiomyopathy Davis Lab and Diagnostic Tests icon

Chest X-Ray Tabers Dictionary icon

diuresis

diuretic

Encephalitis Tabers Dictionary icon

furosemide Tabers Dictionary icon

furosemide stress test Diseases and Disorders icon

Glomerulonephritis, Acute Diseases and Disorders icon

Hypercalcemia Diseases and Disorders icon

Hypernatremia Diseases and Disorders icon

Hyperphosphatemia Diseases and Disorders icon

Hypokalemia Diseases and Disorders icon

Kidney Injury, Acute Tabers Dictionary icon

Lasix

Osteoporosis Diseases and Disorders icon

Rheumatic Fever, Acute

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Tag » When Teaching A New Nurse How To Administer Furosemide

General

General

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Indications

Indications

Indications

Action

Action

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Pharmacokinetics

Pharmacokinetics

Pharmacokinetics

Contraindication/Precautions

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Contraindication/Precautions

Adverse Reactions/Side Effects

Adverse Reactions/Side Effects

Adverse Reactions/Side Effects

Interactions

Interactions

Interactions

Route/Dosage

Route/Dosage

Route/Dosage

Availability (generic available)

Availability (generic available)

Availability (generic available)

Assessment

Assessment

Assessment

Implementation

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