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14-September-2008 18:02:39 - Furosemide Furosemide Systematic IUPAC name 5-aminosulfonyl-4-chloro-2- 2-furanylmethylaminobenzoic acid Identifiers CAS number 54-31-9 ATC code C03CA01 PubChem 162482 DrugBank APRD00608 Chemical data Formula C12H11ClN2O5S Mol. mass 330.745 g/mol SMILES eMolecules PubChem Pharmacokinetic data Bioavailability 43-69% Metabolism hepatic and renal glucuronidation Half life up to 100 minutes Excretion renal 66%, biliary 33% Therapeutic considerations Pregnancy cat. CAU CUS Legal status â„ž Prescription only Routes Oral, IV, IM Furosemide INN or frusemide former BAN is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Sanofi-Aventis under the brand name Lasix. It has also been used to prevent thoroughbred and standardbred race horses from bleeding through the nose during races. Along with some other diuretics, furosemide is also included on the World Anti-Doping Agency's banned drug list due to its alleged use as a masking agent for other drugs. Contents 1 Mechanism of action 2 Clinical use in humans 3 Use in horses 3.1 Precautions, side-effects, and administration 4 Drug Interactions 5 Brand names 6 References 7 Further reading 8 External links Mechanism of action Main article: Loop diuretic The name of lasix is derived from lasts six hours -- referring to its duration of action. Like other loop diuretics, furosemide acts by inhibiting the Na-K-2Cl symporter in the thick ascending limb of the loop of Henle. The action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone, it also abolishes the corticomedullary osmotic gradient and blocks negative as well as positive free water clearance. Additionally, furosemide is a noncompetitive subtype-specific blocker of GABA-A receptors 123. Furosemide has been reported to reversibly antagonize GABA-evoked currents of alpha6 beta2 gamma2 receptors at microM concentrations, but not alpha1 beta2 gamma2 receptors 13. During development, the alpha6 beta2 gamma2 receptor increases in expression in cerebellar granule neurons, corresponding to increased sensitivity to furosemide2. Clinical use in humans Furosemide, as a loop diuretic, is principally used in the following indications Aventis, 1998: Edema associated with heart failure, hepatic cirrhosis, renal impairment, nephrotic syndrome Hypertension Adjunct in cerebral/pulmonary edema where rapid diuresis is required IV injection It is also sometimes used in the management of severe hypercalcemia in combination with adequate rehydration 4. Although disputed,5 it is considered ototoxic: usually with large parenteral doses and rapid administration and in renal impairment6 The tendency, as per all loop diuretics, to cause low potassium levels hypokalaemia has given rise to combination products, either with potassium itself e.g. Lasix-K or with the potassium sparing diuretic of amiloride Co-amilofruse. Use in horses The diuretic-effects are put to use most commonly in horses to prevent bleeding during a race. Sometime in the early 1970s, furosemide's ability to prevent, or at least greatly reduce, the incidence of bleeding EIPH by horses during races was discovered accidentally. Pursuant to the racing rules of most states, horses that bleed from the nostrils three times are permanently barred from racing for their own protection. Clinical trials followed, and by decade's end, racing commissions in some states began legalizing its use on race horses. On September 1, 1995, New York became the last state in the United States to approve such use, after years of refusing to consider doing so. Some states allow its use for all racehorses; some allow it only for confirmed bleeders. However, its use for this purpose is still prohibited in many other countries, and veterinarians dispute its use for this problem. Furosemide is also used in horses for pulmonary edema, congestive heart failure in combination with other drugs, and allergic reactions. Despite the fact that it increases circulation to the kidneys, it does not help kidney function, and is not recommended for kidney disease. Precautions, side-effects, and administration Furosemide is injected either intramuscularly IM or intravenously IV, usually 0.5-1.0 mg/lb 2x/day, although less before a horse is raced. As with many diuretics, it can cause dehydration and electrolyte imbalance, including loss of potassium, calcium, sodium, and magnesium. It is especially important to prevent potassium loss, as it can cause serious problems. The drug should therefore not be used in horses that are dehydrated or experiencing kidney failure. It should be used with caution in horses with liver problems or electrolyte abnormalities. Overdose may lead to dehydration, change in drinking patterns and urination, seizures, GI problems, kidney damage, lethargy, collapse, and coma. Furosemide should be used with caution when combined with corticosteriods as this increases the risk of electrolyte imbalance, aminoglycoside antibiotics increases risk of kidney or ear damage, and trimethoprim sulfa causes decreased platelet count. It may also cause interactions with anesthesics, so its use should be related to the veterinarian if the animal is going into surgery, and it decreases the kidney's ability to excrete aspirin, so dosages will need to be adjusted if combined with that drug Furosemide may cause Digoxin toxicity due to hypokalemia. The drug is best not used during pregnancy or in a lactating mare, as it has been shown to be passed through the placenta and milk in studies with other species. It should not be used in horses with pituitary pars intermedia dysfunction Cushings. Furosemide is detectible in urine 36-72 hours following injection. Its use is prohibited by most equestrian organizations. Drug Interactions Furosemide has potential interactions with the following medications:1 Aminoglycoside antibiotics such as Gentamicin Aspirin and other salicylates Other diuretics e.g. ethacrynic acid, hydrochlorothiazide Indomethacin Lithium Synergistic effects with other antihypertensives e.g. Doxazosin Sucralfate Brand names Some of the brand names under which furosemide is marketed include: Aisemide, Beronald, Desdemin, Discoid, Diural, Diurapid, Dryptal, Durafurid, Errolon, Eutensin, Frusetic, Frusid, Fulsix, Fuluvamide, Furesis, Furix, Furo-Puren, Furosedon, Hydro-rapid, Impugan, Katlex, Lasilix, Lasix, Lodix, Lowpston, Macasirool, Mirfat, Nicorol, Odemase, Oedemex, Profemin, Rosemide, Rusyde, Salix, Trofurit, Urex, Frudix Founded around 1964. References ^ a b Korpi ER, Kuner T, Seeburg PH, Lüddens H 1995. Selective antagonist for the cerebellar granule cell-specific gamma-aminobutyric acid type A receptor. Mol. Pharmacol. 47 2: 283-9. PMID 7870036. ^ a b Tia S, Wang JF, Kotchabhakdi N, Vicini S 1996. Developmental changes of inhibitory synaptic currents in cerebellar granule neurons: role of GABAA receptor alpha 6 subunit. J. Neurosci. 16 11: 3630-40. PMID 8642407. ^ a b Wafford KA, Thompson SA, Thomas D, Sikela J, Wilcox AS, Whiting PJ 1996. Functional characterization of human gamma-aminobutyric acidA receptors containing the alpha 4 subunit. Mol. Pharmacol. 50 3: 670-8. PMID 8794909. ^ in Rossi S: Australian Medicines Handbook 2004, 5th. ISBN 0-9578521-4-2. ^ Rais-Bahrami K, Majd M, Veszelovszky E, Short B 2004. Use of furosemide and hearing loss in neonatal intensive care survivors. Am J Perinatol 21 6: 329-32. doi:10.1055/s-2004-831887. PMID 15311369. ^ BNF 45 March 2003 Further reading Aventis Pharma 1998. Lasix Approved Product Information. Lane Cove: Aventis Pharma Pty Ltd. Barbara Forney 2007. Understanding Equine Medications, Revised ion Horse Health Care Library. Eclipse Press. ISBN 1-58150-151-X. External links Lasix and horse bleeding Diuretics and other masking agents PDF - Part S5 of the World Anti-Doping Agency's 2005 Prohibited List. International Standard. v d e Membrane transport modulators Channel blocker Calcium Amlodipine Amrinone Anandamide Anipamil Azimilide Bencyclane Benidipine Bepridil Berbamine Bevantolol Canadine Carboxyamido-Triazole Cilnidipine Cinnarizine Clentiazem Conotoxins Darodipine Dauricine Devapamil Diltiazem Dimiapramine Dotarizine Efonidipine Emopamil Enpiperate Eperisone Falipamil Fantofarone Fasudil Felodipine Fenamic acid Fendiline Flunarizine Fosfedil Gabapentin Gallopamil Isradipine Lacidipine Lamotrigine Lercanidipine Lidoflazine Magnesium sulfate Manidipine Manoalide Mepirodipine Mibefradil Monatepil Naftopidil Nicardipine Nifedipine Niguldipine Niludipin Nilvadipine Nimodipine Nisoldipine Nitrendipine Norverapamil Ochratoxin A Octylonium Osthol Oxodipine Perhexiline Pinaverium Piperidine Pranidipine Prenylamine Risedronic acid Ryodipine Sesamodil Stepholidine Terodiline Tetrahydropalmatine Tetrandrine Tolfenamic acid Tranilast Verapamil Potassium 3,4-Diaminopyridine 4-Aminopyridine Dofetilide Linopirdine Maurotoxin Paxilline Tetraethylammonium Charybdotoxin Sodium Amiloride Encainide Pilsicainide Saxitoxin Tetrodotoxin Tocainide Symporter inhibitor Sodium chloride thiazide: Bendroflumethiazide Chlorothiazide Cyclopenthiazide Hydrochlorothiazide Hydroflumethiazide Methyclothiazide Polythiazide Trichlormethiazide other: Chlorthalidone Sodium potassium chloride Bumetanide Furosemide v d e Antihypertensives C02 and diuretics C03 Sympatholytic agents Centrally acting/antiadrenergics α2 agonist Clonidine, Guanfacine, Methyldopa imidazoline receptor agonist Moxonidine, Rilmenidine adrenergic uptake inhibitor Rescinnamine, Reserpine Ganglion-blocking/nicotinic antagonist Mecamylamine, Trimethaphan Peripherally acting/antiadrenergics α1 blockers: Prazosin Indoramin Trimazosin Doxazosin Urapidil Guanidine derivatives: Betanidine Guanethidine Guanoxan Debrisoquine Guanoclor Guanazodine Guanoxabenz Vasodilators Diazoxide hydrazinophthalazine Hydralazine, Dihydralazine, Endralazine, Cadralazine Minoxidil Nitroprusside Phentolamine Other antihypertensives serotonin antagonist Ketanserin endothelin receptor antagonist Bosentan, Ambrisentan, Sitaxsentan MAOI Pargyline THI Metirosine Diuretics Low ceiling Thiazides at DCT Bendroflumethiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide Polythiazide Trichlormethiazide Cyclopenthiazide Methyclothiazide Cyclothiazide Mebutizide Sulfonamides Quinethazone Clopamide Chlortalidone Mefruside Clofenamide Metolazone Meticrane Xipamide Indapamide Clorexolone Fenquizone CA inhibitor at PT Acetazolamide Osmotic Mannitol Urea Other Mersalyl Theobromine Cicletanine High ceiling/ Loop diuretic at AL Bumetanide Furosemide Torasemide Etacrynic acid Potassium-sparing at CD ESC blockers Amiloride, Triamterene, Benzamil aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone Retrieved from http://en..org/wiki/Furosemide Categories: Loop diuretics | Carbonic anhydrase inhibitors | Organochlorides | Amines | Carboxylic acids | Furans | Sulfonamides | Equine medications Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Français Hrvatski Italiano Magyar 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Svenska УкраїнÑ?ька This page was last modified on 1 August 2008, at 02
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