Brand Names:

• Bumex
• Demadex
• Edecrin
• Edecrin Sodium
• Furocot
• Furomide M.D.
• Lasix

Dosage Forms:

• Tablet
• Powder for Solution
• Solution
• Injectable

Uses of This Medicine:

Loop diuretics are given to help reduce the amount of water in the body. They work by acting on the kidneys to increase the flow of urine.

Furosemide and torsemide are also used to treat high blood pressure (hypertension) in those patients who are not helped by other medicines or in those patients who have kidney problems.

Loop diuretics may also be used for other conditions as determined by your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, loop diuretics are used in certain patients with the following medical conditions:

• Hypercalcemia (too much calcium in the blood)
• Diagnostic aid for kidney disease

Before Using This Medicine:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Although there is no specific information comparing the use of loop diuretics in children with use in any other age group, these medicines are not expected to cause different side effects in children than they do in adults.

Older adults

Dizziness, lightheadedness, or signs of too much potassium loss may be more likely to occur in the elderly, who are more sensitive to the effects of this medicine. Elderly patients may also be more likely to develop blood clots.

Pregnancy

Studies have not been done in pregnant women. However, studies in animals have shown this medicine to cause harmful effects. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. Diuretics should not be taken during pregnancy unless recommended by your doctor.

Breast-feeding

These medicines have not been reported to cause problems in nursing babies. Furosemide passes into breast milk; it is not known whether bumetanide, ethacrynic acid, or torsemide passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking a diuretic and who wish to breast-feed should discuss this with their doctor.

Other medicines

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Arsenic Trioxide
• Bepridil
• Digitoxin
• Dofetilide
• Droperidol
• Ethacrynic Acid
• Furosemide
• Ketanserin
• Levomethadyl
• Lithium
• Sotalol

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Anuric (inability to urinate) Torsemide should NOT be used if you have this condition.

• Diabetes mellitus (sugar diabetes) Loop diuretics may increase the amount of sugar in the blood

• Gout or
• Hearing problems or
• Pancreatitis (inflammation of the pancreas) Loop diuretics may make these conditions worse

• Heart attack, recent Use of loop diuretics after a recent heart attack may increase the chance of side effects

• Liver disease Higher blood levels of the loop diuretic may occur, which may increase the chance of side effects

• Lupus erythematosus (history of) Ethacrynic acid and furosemide may make this condition worse

Proper Use of This Medicine:

This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:

• If you are to take a single dose a day, take it in the morning after breakfast.
• If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.

However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking the oral liquid form of furosemide:

• This medicine is to be taken by mouth even if it comes in a dropper bottle. If this medicine does not come in a dropper bottle, use a specially marked measuring spoon or other device to measure each dose accurately, since the average household teaspoon may not hold the right amount of liquid.

For patients taking this medicine for high blood pressure:

• In addition to the use of the medicine your doctor has prescribed, appropriate treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which factors are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

If this medicine upsets your stomach, it may be taken with meals or milk. If stomach upset (nausea, vomiting, or stomach pain) continues or gets worse, or if you suddenly get severe diarrhea, check with your doctor.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For bumetanide:
  • To lower the amount of water in the body:
    • For oral dosage form (tablets):
      • Adults-0.5 to 2 milligrams (mg) once a day. Your doctor may increase your dose if needed.
      • Children-Dose must be determined by your doctor.
    • For injection dosage form:
      • Adults 0.5 to 1 mg injected into a muscle or a vein every two to three hours as needed.
      • Children Dose must be determined by your doctor.

• For ethacrynic acid:
  • To lower the amount of water in the body:
    • For oral dosage form (oral solution or tablets):
      • Adults-50 to 200 milligrams (mg) a day. This may be taken as a single dose or divided into smaller doses.
      • Children At first, 25 mg a day. Your doctor may increase your dose as needed.
    • For injection dosage form:
      • Adults 50 mg injected into a vein every two to six hours as needed.
      • Children Dose is based on body weight and must be determined by your doctor. The usual dose is 1 mg per kilogram (kg) (0.45 mg per pound) of body weight injected into a vein.

• For furosemide:
  • To lower the amount of water in the body:
    • For oral dosage form (oral solution or tablets):
      • Adults At first, 20 to 80 milligrams (mg) once a day. Then, your doctor may increase your dose as needed. Your doctor may tell you to take a dose once a day, two or three times a day, or every other day.
      • Children Dose is based on body weight and must be determined by your doctor. The usual dose is 2 mg per kilogram (kg) (0.91 mg per pound) of body weight for one dose. Then, your doctor may increase your dose every six to eight hours as needed.
    • For injection dosage form:
      • Adults At first, 20 to 40 mg injected into a muscle or a vein for one dose. Then, your doctor may increase your dose every two hours as needed. Once the medicine is working, the dose is injected into a muscle or a vein one or two times a day.
      • Children Dose is based on body weight and must be determined by your doctor. The usual dose is 1 mg per kg (0.45 mg per pound) of body weight injected into a muscle or a vein for one dose. Your doctor may increase your dose every two hours as needed.
  • For high blood pressure:
    • For oral dosage form (oral solution or tablets):
      • Adults 40 mg two times a day. Your doctor may increase your dose.
  • For very high blood pressure:
    • For injection dosage form:
      • Adults 40 to 200 mg injected into a vein.

• For torsemide:
  • For lowering the amount of water in the body:
    • For oral dosage form (tablets):
      • Adults Dose is usually 5 to 20 milligrams (mg) once a day. However, your doctor may increase your dose as needed.
      • Children Use and dose must be determined by your doctor.
    • For injection dosage form:
      • Adults Dose is usually 5 to 20 mg injected into a vein once a day. However, your doctor may increase your dose as needed.
      • Children Use and dose must be determined by your doctor.
  • For high blood pressure:
    • For oral dosage form (tablets):
      • Adults 5 to 10 mg once a day.
      • Children Use and dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.

This medicine may cause a loss of potassium from your body.

• To help prevent this, your doctor may want you to:
  • eat or drink foods that have a high potassium content (for example, orange or other citrus fruit juices), or
  • take a potassium supplement, or
  • take another medicine to help prevent the loss of the potassium in the first place.
    • It is very important to follow these directions. Also, it is important not to change your diet on your own. This is more important if you are already on a special diet (as for diabetes), or if you are taking a potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary and, in some cases, too much potassium could be harmful.

To prevent the loss of too much water and potassium, tell your doctor if you become sick, especially with severe or continuing nausea and vomiting or diarrhea.

Before having any kind of surgery (including dental surgery) or emergency treatment, make sure the medical doctor or dentist in charge knows that you are taking this medicine.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. This is more likely to occur in the morning. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.

The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time.

For diabetic patients:

• This medicine may affect blood sugar levels. While you are using this medicine, be especially careful in testing for sugar in your blood or urine.

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

For patients taking furosemide:

• Furosemide may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
  • Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible
  • Wear protective clothing, including a hat. Also, wear sunglasses.
  • Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
  • Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
  • Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

ECG abnormality with torsemide only

Rare

Black, tarry stools

blood in urine or stools

cough or hoarseness

fever or chills

joint pain

lower back or side pain

painful or difficult urination

pinpoint red spots on skin

ringing or buzzing in ears or any loss of hearing more common with ethacrynic acid

skin rash or hives

stomach pain (severe) with nausea and vomiting

unusual bleeding or bruising

yellow eyes or skin

yellow vision for furosemide only

Signs and symptoms of too much potassium loss

Dryness of mouth

increased thirst

irregular heartbeat

mood or mental changes

muscle cramps or pain

nausea or vomiting

unusual tiredness or weakness

weak pulse

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness or lightheadedness when getting up from a lying or sitting position

excessive urination with torsemide only

Less common

Acid or sour stomach with torsemide only

belching with torsemide only

blurred vision

chest pain with bumetanide and torsemide only

confusion with ethacrynic acid only

cough increase with torsemide only

diarrhea more common with ethacrynic acid

difficulty having a bowel movement (stool) with torsemide only

difficulty in moving with torsemide only

headache

heartburn with torsemide only

increased sensitivity of skin to sunlight with furosemide only

indigestion with torsemide only

lack or loss of strength with torsemide only

loss of appetite more common with ethacrynic acid

muscle aching or stiffness with torsemide only

nervousness with ethacrynic acid and torsemide only

premature ejaculation or difficulty in keeping an erection with bumetanide only

redness or pain at place of injection

runny nose with torsemide only

sneezing with torsemide only

sore throat with torsemide only

stomach cramps or pain

stomach discomfort or upset with torsemide only

stuffy nose with torsemide only

swollen joints with torsemide only

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.