Furosemide (Page 3 of 4)

Geriatric Use

Controlled clinical studies of Furosemide tablets did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for the elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection and it may be useful to monitor renal function.(See PRECAUTIONS: General and DOSAGE AND ADMINISTRATION.)

ADVERSE REACTIONS

Adverse reactions are categorized below by organ system and listed by decreasing severity.

Gastrointestinal System Reactions

  1. hepatic encephalopathy in patients with hepato-cellular insufficiency
  2. pancreatitis
  3. jaundice (intrahepatic cholestatic jaundice)
  4. increased liver enzymes
  5. anorexia
  6. oral and gastric irritation
  7. cramping
  8. diarrhea
  9. constipation
  10. nausea
  11. vomiting

Systemic Hypersensitivity Reactions

  1. Severe anaphylactic or anaphylactoid reactions (e.g. with shock)
  2. systemic vasculitis
  3. interstitial nephritis
  4. necrotizing angiitis

Central Nervous System Reactions

  1. tinnitus and hearing loss
  2. paresthesias
  3. vertigo
  4. dizziness
  5. headache
  6. blurred vision
  7. xanthopsia

Hematologic Reactions

  1. aplastic anemia
  2. thrombocytopenia
  3. agranulocytosis
  4. hemolytic anemia
  5. leukopenia
  6. anemia
  7. eosinophilia

Dermatologic-Hypersensitivity Reactions

  1. toxic epidermal necrolysis
  2. Stevens-Johnson Syndrome
  3. erythema multiforme
  4. drug rash with eosinophilia and systemic symptoms
  5. acute generalized exanthematous pustulosis
  6. exfoliative dermatitis
  7. bullous pemphigoid
  8. purpura
  9. photosensitivity
  10. rash
  11. pruritis
  12. urticaria

Cardiovascular Reaction

  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. fever

Whenever adverse reactions are moderate or severe, Furosemide tablets dosage should be reduced or therapy withdrawn.

CALL YOUR DOCTOR FOR MEDICAL ADVICE ABOUT SIDE EFFECTS. YOU MAY REPORT SIDE EFFECTS TO THE FDA AT 1-800-FDA-1088 OR LEADING PHARMA, LLC AT 1-844-740-7500.

OVERDOSAGE

The principal signs and symptoms of overdose with Furosemide are dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, and are extensions of its diuretic action.

The acute toxicity of Furosemide has been determined in mice, rats and dogs. In all three, the oral LD 50 exceeded 1000 mg/kg body weight, while the intravenous LD 50 ranged from 300 to 680 mg/kg. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats.

The concentration of Furosemide tablets in biological fluids associated with toxicity or death is not known.

Treatment of overdosage is supportive and consists of replacement of excessive fluid and electrolyte losses. Serum electrolytes, carbon dioxide level and blood pressure should be determined frequently. Adequate drainage must be assured in patients with urinary bladder outlet obstruction (such as prostatic hypertrophy).

Hemodialysis does not accelerate furosemide elimination.

DOSAGE AND ADMINISTRATION

Edema

Therapy should be individualized according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that response.

Adults

The usual initial dose of Furosemide tablets is 20 to 80 mg given as a single dose. Ordinarily a prompt diuresis ensues. If needed, the same dose can be administered 6 to 8 hours later or the dose may be increased. The dose may be raised by 20 or 40 mg and given not sooner than 6 to 8 hours after the previous dose until the desired diuretic effect has been obtained. The individually determined single dose should then be given once or twice daily (eg, at 8 am and 2 pm). The dose of Furosemide tablets may be carefully titrated up to 600 mg/day in patients with clinically severe edematous states.

Edema may be most efficiently and safely mobilized by giving Furosemide tablets on 2 to 4 consecutive days each week.

When doses exceeding 80 mg/day are given for prolonged periods, careful clinical observation and laboratory monitoring are particularly advisable. (See PRECAUTIONS: Laboratory Tests.)

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

The usual initial dose of oral Furosemide tablets in pediatric patients is 2 mg/kg body weight, given as a single dose. If the diuretic response is not satisfactory after the initial dose, dosage may be increased by 1 or 2 mg/kg no sooner than 6 to 8 hours after the previous dose. Doses greater than 6 mg/kg body weight are not recommended. For maintenance therapy in pediatric patients, the dose should be adjusted to the minimum effective level.

Hypertension

Therapy should be individualized according to the patient’s response to gain maximal therapeutic response and to determine the minimal dose needed to maintain the therapeutic response.

Adults

The usual initial dose of Furosemide tablets for hypertension is 80 mg, usually divided into 40 mg twice a day. Dosage should then be adjusted according to response. If response is not satisfactory, add other antihypertensive agents.

Changes in blood pressure must be carefully monitored when Furosemide tablets are used with other antihypertensive drugs, especially during initial therapy. To prevent excessive drop in blood pressure, the dosage of other agents should be reduced by at least 50% when Furosemide tablets are added to the regimen. As the blood pressure falls under the potentiating effect of Furosemide tablets, a further reduction in dosage or even discontinuation of other antihypertensive drugs may be necessary.

Geriatric patients

In general, dose selection and dose adjustment for the elderly patient should be cautious, usually starting at the low end of the dosing range (see PRECAUTIONS: Geriatric Use).

HOW SUPPLIED

Furosemide tablets 20 mg are supplied as white to off-white, round, flat face beveled edge, compressed tablets, debossed “EP” and “116” on one side and plain on the other side in bottles of 100 (NDC 69315-116-01), and 1000 (NDC 69315-116-10).

Furosemide tables 40 mg are supplied as white to off-white, round, flat face beveled edge, bisected compressed tablets, debossed “EP” above bisect and “117” below bisect on one side, and “40” on the other side in bottles of 100 (NDC 69315-117-01) and 1000 (NDC 69315-117-10).

Furosemide tablets 80 mg are supplied as white to off-white, round, flat face beveled edge, bisected compressed tablets, debossed “EP” above bisect and “118” below bisect on one side, and “80” on the other side in bottles of 100 (NDC 69315-118-01) and 500 (NDC 69315-118-05).

Note: Dispense in well-closed, light-resistant containers. Exposure to light might cause a slight discoloration. Discolored tablets should not be dispensed.

Meets USP Dissolution Test 2

Store at 20° -25° C (68° -77° F) [ See USP Controlled Room Temperature].

Protect from light.

Manufactured by:
Leading Pharma, LLC
Fairfield, NJ 07004

Rev. 09 10/22

Package Package: 17224-178-21

Label
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