Home Drug IndexClinical Monograph

Furosemide Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

Subclass

Loop diuretic

Speciality

Nephrology

Schedule (India)

Schedule H

Routes

Oral, Intravenous, Intramuscular

Formulations

Tablets: 20 mg, 40 mg
Oral solution: 10 mg/mL (limited to select hospital settings)
Injection: 10 mg/mL (2 mL ampoule = 20 mg; 4 mL ampoule = 40 mg)

Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Congestive Heart Failure (CHF) — Volume Overload / Pulmonary Congestion

Parameter	Oral	Intravenous
Starting dose	20–40 mg once daily	20–40 mg slow IV push (over 1–2 min)
Titration	Increase by 20–40 mg every 6–8 hours based on response	Repeat dose in 2 hours if inadequate response
Usual maintenance	40–80 mg/day (single or divided doses)	Convert to oral once stable
Maximum dose	600 mg/day (divided doses)	200 mg/bolus; higher only under specialist care

Clinical Notes:

Monitor daily weight, fluid balance, serum electrolytes, BP
Consider potassium supplementation or combine with spironolactone if hypokalaemia develops

2. Acute Pulmonary Oedema

Step	Action
Starting dose	IV 40 mg bolus (slow push over 1–2 min)
Titration	May repeat 40–80 mg IV in 1–2 hours if response inadequate
If already on oral loop diuretic	Give IV dose equivalent to patient's total daily oral dose
Maximum dose	200 mg per bolus; higher doses require ECG and electrolyte monitoring

Clinical Notes:

Administer with oxygen and positioning
Rapid infusion increases ototoxicity risk

3. Chronic Kidney Disease with Volume Overload

Parameter	Recommendation
Starting dose	40–80 mg oral once or twice daily
Titration	Increase to 80–160 mg twice daily based on clinical response
Usual maintenance	80–320 mg/day in divided doses
Maximum dose	600 mg/day oral (divided)

Clinical Notes:

Higher doses often required due to reduced tubular secretion in low GFR
Consider adding thiazide-type diuretic for sequential nephron blockade in resistant oedema

4. Hypertension (Volume-dependent or Resistant)

Parameter	Recommendation
Starting dose	20 mg once or twice daily
Titration	Increase to 40 mg twice daily if needed
Usual maintenance	20–80 mg/day
Maximum dose	80 mg/day (as adjunct therapy)

Clinical Notes:

Not first-line antihypertensive
Reserve for patients with concurrent fluid overload or CKD

Secondary Indications — Adults Only (Off-label)

Indication	Dose	Duration	Notes
Acute Hypercalcaemia— OFF-LABEL	20–40 mg IV every 2–4 hours	Until calcium normalises	Administer with IV saline; specialist supervision essential; monitor calcium and fluid balance. Based on Indian nephrology practice.
Ascites in Cirrhosis (spironolactone-resistant) — OFF-LABEL	20–40 mg oral daily; titrate as needed	Long-term maintenance	Combine with spironolactone (40:100 mg ratio preferred). Monitor for encephalopathy and electrolyte disturbance. Based on Indian hepatology protocols.

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Congestive Heart Failure (CHF) — Volume Overload / Pulmonary Congestion

Parameter	Oral	Intravenous
Starting dose	20–40 mg once daily	20–40 mg slow IV push (over 1–2 min)
Titration	Increase by 20–40 mg every 6–8 hours based on response	Repeat dose in 2 hours if inadequate response
Usual maintenance	40–80 mg/day (single or divided doses)	Convert to oral once stable
Maximum dose	600 mg/day (divided doses)	200 mg/bolus; higher only under specialist care

Clinical Notes:

Monitor daily weight, fluid balance, serum electrolytes, BP
Consider potassium supplementation or combine with spironolactone if hypokalaemia develops

2. Acute Pulmonary Oedema

Step	Action
Starting dose	IV 40 mg bolus (slow push over 1–2 min)
Titration	May repeat 40–80 mg IV in 1–2 hours if response inadequate
If already on oral loop diuretic	Give IV dose equivalent to patient's total daily oral dose
Maximum dose	200 mg per bolus; higher doses require ECG and electrolyte monitoring

Clinical Notes:

Administer with oxygen and positioning
Rapid infusion increases ototoxicity risk

3. Chronic Kidney Disease with Volume Overload

Parameter	Recommendation
Starting dose	40–80 mg oral once or twice daily
Titration	Increase to 80–160 mg twice daily based on clinical response
Usual maintenance	80–320 mg/day in divided doses
Maximum dose	600 mg/day oral (divided)

Clinical Notes:

Higher doses often required due to reduced tubular secretion in low GFR
Consider adding thiazide-type diuretic for sequential nephron blockade in resistant oedema

4. Hypertension (Volume-dependent or Resistant)

Parameter	Recommendation
Starting dose	20 mg once or twice daily
Titration	Increase to 40 mg twice daily if needed
Usual maintenance	20–80 mg/day
Maximum dose	80 mg/day (as adjunct therapy)

Clinical Notes:

Not first-line antihypertensive
Reserve for patients with concurrent fluid overload or CKD

Secondary Indications — Adults Only (Off-label)

Indication	Dose	Duration	Notes
Acute Hypercalcaemia— OFF-LABEL	20–40 mg IV every 2–4 hours	Until calcium normalises	Administer with IV saline; specialist supervision essential; monitor calcium and fluid balance. Based on Indian nephrology practice.
Ascites in Cirrhosis (spironolactone-resistant) — OFF-LABEL	20–40 mg oral daily; titrate as needed	Long-term maintenance	Combine with spironolactone (40:100 mg ratio preferred). Monitor for encephalopathy and electrolyte disturbance. Based on Indian hepatology protocols.

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications

1. Oedema (Cardiac / Renal / Hepatic Causes)

Age Group	Route	Starting Dose	Frequency	Maximum Single Dose
Neonates (term)	IV or Oral	0.5–1 mg/kg	Every 12–24 hours	2 mg/kg
Infants (1 month – 1 year)	IV or Oral	1–2 mg/kg	Every 6–12 hours	4 mg/kg
Children (1–12 years)	IV or Oral	1–2 mg/kg	Every 6–8 hours	6 mg/kg (max 40 mg/dose)
Adolescents (>12 years)	IV or Oral	20–40 mg	Once or twice daily	80 mg/dose

Safety Monitoring:

Serum electrolytes (K⁺, Na⁺, Ca²⁺, Mg²⁺)
Fluid balance, daily weight
Audiometry if repeated high-dose IV use

Cautions:

Avoid in premature neonates unless essential — increased ototoxicity and nephrocalcinosis risk

2. Acute Kidney Injury (Oliguric Phase) — Nephrologist Only

Parameter	Recommendation
Starting dose	1–2 mg/kg IV
Titration	May increase to 4 mg/kg if no response
Maximum dose	6 mg/kg/dose (specialist discretion)

Clinical Notes:

Response-based dosing; not for routine use
Close monitoring of urine output and electrolytes mandatory

Secondary Indications — Paediatric (Off-label)

Indication	Dose	Duration	Notes
Bronchopulmonary Dysplasia (BPD) — OFF-LABEL	1 mg/kg/dose oral or IV, once or twice daily	Short-term (days to weeks)	Specialist (neonatologist) only. Limited to NICU settings. Risk of electrolyte imbalance. Based on tertiary NICU protocols in India.

Age Restriction: Not recommended below 4 weeks of age except under specialist supervision.

Renal Adjustments

Renal Status	Recommendation
Mild–Moderate impairment (eGFR 15–60)	No dose reduction; may need higher doses due to reduced efficacy
Severe impairment (eGFR <15)	Higher doses often required; monitor volume and electrolytes closely
Dialysis patients	Can be used for residual diuresis; not removed by haemodialysis

Note: Avoid dehydration. Combine with thiazide for synergy in resistant cases.

Hepatic adjustment

Contraindications

Anuria unresponsive to fluid challenge
Severe hypovolaemia or dehydration
Known hypersensitivity to furosemide or sulfonamides
Severe uncorrected hypokalaemia or hyponatraemia
Hepatic coma or pre-coma (unless under specialist supervision)

Cautions

Gout or hyperuricaemia (may precipitate acute attack)
Diabetes mellitus (may worsen glycaemic control)
Prostatic hypertrophy / bladder outlet obstruction
Pre-existing hearing impairment
Concurrent nephrotoxic or ototoxic drug use
Elderly patients (increased risk of falls, hypotension)
Severe electrolyte disturbances

Pregnancy

Parameter	Information
Risk category	Use only if benefit clearly outweighs risk
Concerns	May reduce placental perfusion; risk of oligohydramnios, fetal electrolyte imbalance
Preferred alternatives	Methyldopa, labetalol for hypertension in pregnancy
When to use	Only if volume overload poses immediate maternal risk
Monitoring	Fetal growth (serial USG), maternal electrolytes, BP

Lactation

Parameter	Information
Compatibility	Generally compatible with breastfeeding
Milk levels	Low; minimal infant exposure expected
Concerns	High doses may reduce milk production
Monitoring in infant	Weight gain, feeding adequacy, hydration status
Preferred alternatives	None specifically preferred; continue if clinically indicated

Elderly

Parameter	Recommendation
Starting dose	20 mg once daily (lower end of range)
Titration	Slow; increase cautiously based on response
Special risks	Orthostatic hypotension, falls, hyponatraemia, dehydration, acute kidney injury
Monitoring	BP (including postural), renal function, electrolytes at baseline and periodically

Major drug interactions

Drug	Interaction	Management
Aminoglycosides(gentamicin, amikacin)	Additive ototoxicity and nephrotoxicity, especially with IV furosemide	Avoid combination if possible; if essential, monitor hearing and renal function
Digoxin	Hypokalaemia increases digoxin toxicity risk	Monitor potassium; supplement or add K⁺-sparing diuretic
Lithium	Reduced lithium clearance; increased toxicity risk	Monitor lithium levels closely; dose adjustment may be needed
NSAIDs	Reduce diuretic efficacy; increase AKI risk	Avoid routine use; use paracetamol as alternative analgesic

Moderate drug interactions

Drug	Interaction	Management
Corticosteroids	Additive hypokalaemia	Monitor potassium; consider supplementation
Antidiabetic agents	May blunt hypoglycaemic effect	Monitor blood glucose; adjust antidiabetic dose if needed
ACE inhibitors / ARBs	Additive hypotension, especially first dose	Start at low dose; monitor BP
Proton pump inhibitors	Combined risk of hypomagnesaemia	Monitor magnesium in long-term use
Antipsychotics(haloperidol, risperidone)	Electrolyte imbalance may prolong QTc	Monitor ECG and electrolytes
Antiepileptics(phenytoin)	May reduce furosemide absorption	Monitor diuretic response

Common Adverse effects

Hypokalaemia
Hyponatraemia
Postural hypotension
Hyperuricaemia
Dizziness, fatigue
Dehydration
Hyperglycaemia
Increased urinary frequency

Serious Adverse effects

Effect	Notes
Ototoxicity	Risk increased with rapid IV infusion, high doses, renal impairment, or concurrent aminoglycosides; may be irreversible
Severe electrolyte disturbance	Hypokalaemia, hyponatraemia, hypomagnesaemia — can cause arrhythmias
Stevens-Johnson Syndrome / TEN	Rare; discontinue immediately if rash develops
Acute pancreatitis	Rare; consider if unexplained abdominal pain occurs
Photosensitivity	Advise sun protection
Blood dyscrasias	Agranulocytosis, thrombocytopenia (rare)

Monitoring requirements

Timing	Parameters
Baseline	Serum electrolytes (K⁺, Na⁺, Mg²⁺), renal function (creatinine, urea), BP, uric acid
After initiation / dose change	Electrolytes and renal function within 1 week
Long-term	Electrolytes, renal function, uric acid every 1–3 months
CHF / oedema management	Daily weight, fluid balance assessment
High-dose IV or concurrent digoxin	ECG monitoring
Paediatric (repeated IV doses)	Audiometry

Brands in India

Lasix (Sanofi)
Frusemide (generic — multiple manufacturers)
Frusenex (Macleods)
Frusol (Micro Labs)
Furoped (Ipca)
Dytor (combination with torsemide — note: different loop diuretic; FDC with spironolactone also available)

Price range (INR)

Formulation	Approximate Price
Tablet 40 mg	₹1–3 per tablet
Injection 20 mg (2 mL)	₹4–8 per ampoule
Injection 40 mg (4 mL)	₹6–12 per ampoule

Note: Listed under NLEM 2022; prices regulated by NPPA. Government supply rates may be lower.

Clinical pearls

IV administration: Always give slow IV push (over 1–2 minutes); rapid injection increases ototoxicity risk.
Potassium management: Routinely monitor potassium; consider adding spironolactone or potassium chloride supplementation if persistent hypokalaemia.
Diuretic resistance: In resistant oedema, combine with thiazide (metolazone or hydrochlorothiazide) for sequential nephron blockade — requires close monitoring.
Avoid NSAIDs: These blunt the diuretic effect and increase AKI risk; use paracetamol for analgesia.
Metabolic effects: May worsen diabetes control and precipitate gout — monitor glucose and uric acid accordingly.
IV to oral conversion: Oral bioavailability is approximately 50%; when converting from IV to oral, consider doubling the dose or using more frequent dosing.

Version

RxIndia v1.1 — 05 Jan 2025

Reference

CDSCO approved prescribing information
Indian Pharmacopoeia / National Formulary of India
NLEM 2022
API Textbook of Medicine
AIIMS Drug Formulary
Indian Society of Nephrology Guidelines
Indian Academy of Pediatrics (IAP) treatment protocols
Harrison's Principles of Internal Medicine
Goodman & Gilman's The Pharmacological Basis of Therapeutics
Tertiary NICU protocols (for paediatric off-label use)

⚖️

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

Content Feedback

Is this information helpful?

Help us improve our clinical database for the medical community.

RxIndia

Loading clinical data...