Furosemide

Chemical name

5-(Аминосульфонил)-4-хл��р-2[(2-фуранилметил)]ам��нобензойная acid

Gross

C12-H11-Cl-N2-O5-S

Characteristics

The white crystalline powder, insoluble in water.

Of drugs

The drugs-dioreticescoe, natriyureticescoe. Applied throughout the thicker bottom segment knee hinges Genle and blocks reabsorbqiyu 15-20% profiltrovavshih sodium ions. Secretiruetsa clearance in renal proximal channel. Increases down bicarbonate, phosphate, calcium, magnesium and potassium, raises the pH of urine. And secondary effects resulting from the release of vnutripochechnykh mediators and the redeployment vnutripocherngo flow. Quickly and adequately absorbed in any way imposing. Bioavailability when administered is usually between 60-70%. Linking plasma protein-91-97%. T_1/2 0.5-1 hours The liver is biotransformation education inactive metabolites (mainly-glukuronida). Excreted 88% of kidneys and 12% from Jelchew.diureticeski effect is a significant manifestation, and the duration depends on the dose. After weeks of destination it is a 15-30 minutes, reaches its maximum after 1-2 hours and lasts 6-8 hours The on / in the injections is in five minutes, peak, in 30 minutes, the length-2 hours During the excretion of sodium ions increases, but after a speed breeding of sodium ions fall below the base level (the phenomenon of "ricocheta" or impact). The phenomenon is due to a sharp run ренин-ангиотензиново��о et al. �нтинатрийуретически�� neirogumoralnah links regulation in response to the massive diurez. Does аргинин-вазопрессино��ую and the sympathetic system, reduces the level предсердного натрийуретического factor in the plasma is вазоконстрикцию. Because of the phenomenon of "ricocheta" in the employment once a day may not have a significant impact on the daily excretion of sodium ions. Effective in heart failure (both acute and chronic), improves functional class of heart failure, as reduces filling the left chamber. Decreases peripheral oedema, stagnation in the lungs, lung vascular resistance, the pressure jamming pulmonary capillaries in the pulmonary artery and the right предсердии. Saves efficiency at low speed clubockova filtering is used for the treatment of hypertension in patients with renal insufficiency.

Indications

Chronic heart failure, swelling of the lungs, hypertonic kriz, otern-astiticeski syndrome with cirrhosis of the liver, kidney failure, principally syndrome expressed gipernatriemia, gipercalziemia and gipermagniemia.

Contraindications

Гиперчувствительност ь (incl. to сульфонамидам), hepatic coma, severe violations электролитного balance гипокалиемия expressed lack of liver and kidney олигурия for more than 24 hours, анурия, gout, гиперурикемия, diabetes or violation of tolerance to carbohydrates, декомпенсированный митральный or аортальный stenoses, the rise in pressure in the jugular vein over 10 mm Hg, gipertrofica cardiomyopathy with obstruction output tract left chamber, hypotension, myocardial infarction, red systemic lupus, pancreatitis, the metabolic alkaloz.

Side-Effects

Gipotenzia, incl. постуральная, collapsed тромбоэмболия, throm (mostly elderly), гипокалиемия, гипомагниемия, гипонатриемия violation tolerance to глюкозе, гиперурикемия, gout, increased cholesterol levels claimed (in high doses), the КЩС (гипохлоремический алкалоз) гиперкальциурия, violations of the liver, внутрипеченочный холестаз, pancreatitis, diarrhea, constipation, nausea, vomiting, anorexia, the defeat inner ear, hearing loss, the fog, спутанность consciousness, nervousness, headache, dizziness, парестезии, weakness, muscle spasm, causes bladder, chills, fever, ana f337 emia, aplastic anaemia, лейкопения, system васкулит, интерстициальный jade, гематурия, некротизирующий ангиит, эксфолиативный dermatitis, erythema мультиформная, impotence, photosensitization, urticaria, skin itch.

Specific guidance

For breeding should be used izotonicescie solutions of sodium chloride or glucose in a pH of at least 5.5.

Patient interaction

Aminoglikozida, etakrinova acid and cisplatin increased ototoksicnosti (especially in the damaged kidney). Do danger of kidney amidst амфотерицина B. In appointing high doses salicilatov increased risk of salicilizma (competition renal excretion), cardiac glycosides - gipokaliemii and related witness, corticosteroid-elektrolitnogo imbalance. Decreases miorelaksirutuyu activity tubokurarina, potenziruet suktinilholina effect. Reduces Kidney klirens (and increases the likelihood of intoxication) lithium. Influenced furosemida increasing effect ACE inhibitors and antigipertenziveh funds racumin, diazoksida, theofillina declines - protivodiabeticakih preparations norarenalina. Sukralfat and indometacin (through inhibition of the synthesis of GHG levels of renin plasma and aldosterone excretion) reduces efficiency. Probenecid increases the concentration in serum (blocking excretion).

Overdosing

Symptoms : hypotension, a decline Open, and гипокалиемия гипохлоремический алкалоз.Лечение : maintaining vital functions.

Precautions

If асцита without peripheral oedema being recommended doses, providing an additional диурез up to a maximum of 700-900 ml per day in order to avoid the development олигурии, азотемии and violations электролитного exchange. To avoid the phenomenon of "ricocheta" in the treatment of hypertension appoint at least two times a day. It should be borne in mind that the long-term prescription of can lead to weakness, fatigue, reduce AD and heart discards, and excessive diurez with myocardial infarct with stagnant in terms of small blood can contribute to the development cardiogennogo shock. A suspension of (for a few days) before the appointment of ACE inhibitors. During the first months of treatment to control actions, the level of electrolytes (especially potassium), CO_2, creatinine, urea nitrogen, uric acid, periodic determination activity liver enzymes, the level of calcium and magnesium content of glucose in the blood and urine (diabetes). If oligurii within 24 hours furosemide should be abolished. It should not be used in conjunction with the drivers of vehicles and people skills relate to the high concentration of attention.

Dosing and Administration

Inside, in a daily dose of 20-60 mg; If required, it may increase the dose of 20-40 mg every 6 to 8 hours (high doses share at the reception 2-3). V / m or / in-one, 20-40 mg (if necessary, the dose of 20 mg every two hours). Audio in / in the introduction are slowly for 1-2 minutes. In high doses (80-240 mg or more) on a / in the drip, with a speed of more than 4 mg / min. The maximum daily dose of 600 mg.

Literature

1. Glezer GA Major groups modern drugs. Petleve dioretiki / / Ter. archive-1992-N-6 S. 101-104.2. Glezer GA Dioretiki-Metro : Interbuk, 1993 - 351 pp.

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