Furosemide Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• High pH: Administer via a central venous access device or via large peripheral vein
• For Y-site compatibility see below

Available preparations

Furosemide 50mg per 5ml ampoule

Furosemide injection 20mg per 2ml ampoule

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9%

Methods of intravenous administration

Intermittent intravenous infusion (administer using an electronically controlled infusion device)

• May be given diluted in any volume of sodium chloride 0.9% (e.g. 50ml)(ref 1), however the rate of administration must not exceed 4mg per minute (i.e. 40mg in 10 minutes, 80mg in 20minutes, 120mg in 30minutes)
• If a 50ml infusion volume is used the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing
• Maximum rate of administration in severe renal impairment (serum creatinine greater than 440micromol/L) is 2.5mg per minute

Continuous intravenous infusion (administer using an electronically controlled infusion device)

• May be given diluted in any volume of sodium chloride 0.9% and administered as a continuous infusion, rate adjusted according to the dose required (maximum rate 4mg per minute)
• Can also be given undiluted (ref 1)
• Maximum rate of administration in severe renal impairment (serum creatinine greater than 440micromol/L) is 2.5mg per minute

Slow intravenous injection (doses of up to 50mg): Not advised. Rate makes this impractical.

• Administer at a maximum rate of 4mg per minute
• Maximum rate of administration in severe renal impairment (serum creatinine greater than 440micromol/L) is 2.5mg per minute.

Dose in adults

Usual dose

• A dose of 20 to 50mg may be given initially, increased if necessary in steps of 20mg, the increases not more often than every 2 hours. (according to BNF)
• The interval between doses is a clinical decision based on the patient status and response to treatment
• The maximum licensed dose by the IV route is 1500mg per day.

Renal impairment

• Maximum rate of infusion in severe renal impairment: 2.5mg/minute.

Monitoring

• Monitor serum potassium, sodium and serum creatinine levels
• Monitor blood glucose, blood pressure

Further information

• Furosemide may precipitate in solutions of low pH and therefore sodium chloride 0.9% is the ONLY suitable infusion fluid
• Rapid administration (greater than 4mg/min) and high doses may cause tinnitus and deafness (ref 1)
• To achieve optimum efficacy and suppress counter regulation, a continuous infusion is preferred to repeated bolus injections
• Formerly known as frusemide

Storage

• Store below 25^oC
• Do not refrigerate or freeze

References

20mg/2ml, 50mg/2ml Accord SPC December 2021

Lasix 20mg/2ml SPC August 2021

1: Injectable Medicines Administration Guide Medusa downloaded 10th Oct 2022

Therapeutic classification

Loop diuretic