displayName: BOXED WARNING SECTION
FDA Article Code: 34066-1
Furosemide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose schedule must be adjusted to the individual patient’s needs. (See DOSAGE AND ADMINISTRATION.)
displayName: DESCRIPTION SECTION
FDA Article Code: 34089-3
Each mL of Oral Solution for oral administration contains:
Furosemide, USP……………………………….10 mg per mL
Furosemide is a diuretic which is an anthranilic acid derivative. Chemically, it is 4-chloro-N-furfuryl-5-sulfamoylanthranilic acid. Furosemide is a white to off-white, odorless, crystalline powder. It is practically insoluble in water, sparingly soluble in alcohol, freely soluble in dilute alkali solutions and insoluble in dilute acids. The CAS Registry Number is 54-31-9. The structural formula is as follows:
Furosemide Oral Solution, USP is available for oral administration containing 10 mg per mL. The oral solution contains the following inactive ingredients: Dehydrated alcohol, D&C Yellow No. 10, FD&C Yellow No. 6, glycerin, hydrochloric acid, natural and artificial orange juice flavor, purified water, sodium hydroxide and sorbitol solution. It may contain 10% hydrochloric acid solution or 10% sodium hydroxide solution for pH adjustment. The pH range is between 7.0 and 9.0.
displayName: CLINICAL PHARMACOLOGY SECTION
FDA Article Code: 34090-1
Investigations into the mode of action of furosemide have utilized micropuncture studies in rats, stop flow experiments in dogs and various clearance studies in both humans and experimental animals. It has been demonstrated that furosemide inhibits primarily the absorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle. The high degree of efficacy is largely due to the unique site of action. The action on the distal tubule is independent of any inhibitory effect on carbonic anhydrase and aldosterone.
Recent evidence suggests that furosemide glucuronide is the only or at least the major biotransformation product of furosemide in man. Furosemide is extensively bound to plasma proteins, mainly to albumin. Plasma concentrations ranging from 1 to 400 mcg/mL are 91 to 99% bound in healthy individuals. The unbound fraction averages 2.3 to 4.1% at therapeutic concentrations.
The onset of diuresis following oral administration is within 1 hour. The peak effect occurs within the first or second hour. The duration of diuretic effect is 6 to 8 hours.
In fasted normal men, the mean bioavailability of furosemide from Furosemide Tablets and Furosemide Oral Solution is 64% and 60%, respectively, of that from an intravenous injection of the drug. Although furosemide is somewhat more rapidly absorbed from the oral solution (50 minutes) than from the tablet (87 minutes), peak plasma levels and area under the plasma concentration-time curves do not differ significantly. Peak plasma concentrations increase with increasing dose but times-to-peak do not differ among doses. The terminal half-life of furosemide is approximately 2 hours.
Significantly more furosemide is excreted in urine following the IV injection than after the tablet or oral solution. There are no significant differences between the two oral formulations in the amount of unchanged drug excreted in urine.
displayName: CONTRAINDICATIONS SECTION
FDA Article Code: 34070-3
Furosemide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.
displayName: WARNINGS SECTION
FDA Article Code: 34071-1
In patients with hepatic cirrhosis and ascites, furosemide therapy is best initiated in the hospital. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved. Sudden alterations of fluid and electrolyte balance in patients with cirrhosis may precipitate hepatic coma; therefore, strict observation is necessary during the period of diuresis. Supplemental potassium chloride and, if required, an aldosterone antagonist are helpful in preventing hypokalemia and metabolic alkalosis.
If increasing azotemia and oliguria occur during treatment of severe progressive renal disease, furosemide should be discontinued.
Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported. Reports usually indicate that furosemide ototoxicity is associated with rapid injection, severe renal impairment, the use of higher than recommended doses, hypoproteinemia, or concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs. If the physician elects to use high dose parenteral therapy, controlled intravenous infusion is advisable (for adults, an infusion rate not exceeding 4 mg furosemide per minute has been used) (See
PRECAUTIONS: Drug Interactions
displayName: ADVERSE REACTIONS SECTION
FDA Article Code: 34084-4
Adverse reactions are categorized below by organ system and listed by decreasing severity.
Gastrointestinal System Reactions
Systemic Hypersensitivity Reactions
- hepatic encephalopathy in patients with hepatocellular insufficiency
- jaundice (intrahepatic cholestatic jaundice)
- increased liver enzymes
- oral and gastric irritation
Central Nervous System Reactions
- severe anaphylactic or anaphylactoid reactions (e.g. with shock)
- systemic vasculitis
- interstitial nephritis
- necrotizing angiitis
- tinnitus and hearing loss
- blurred vision
Dermatologic – Hypersensitivity Reactions
- aplastic anemia
- hemolytic anemia
- toxic epidermal necrolysis
- Stevens-Johnson Syndrome
- erythema multiforme
- drug rash with eosinophilia and systemic symptoms
- acute generalized exanthematous pustulosis
- exfoliative dermatitis
- bullous pemphigoid
- Orthostatic hypotension may occur and be aggravated by alcohol, barbiturates or narcotics.
- Increase in cholesterol and triglyceride serum levels
Whenever adverse reactions are moderate or severe, furosemide dosage should be reduced or therapy withdrawn.
- muscle spasm
- urinary bladder spasm
displayName: OVERDOSAGE SECTION
FDA Article Code: 34088-5
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 LD50 exceeded 1000 mg/kg body weight, while the intravenous LD50 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 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.
displayName: HOW SUPPLIED SECTION
FDA Article Code: 34069-5
Furosemide Oral Solution USP, 10 mg/mL is supplied as orange-flavored liquid in plastic bottles of 2 fl oz (60 mL) accompanied by a graduated dropper and plastic bottles of 4 fl oz (120 mL) accompanied by a graduated dispensing spoon.
2 fl oz (60 mL) NDC 60432-613-60
4 fl oz (120 mL) NDC 60432-613-04
PRINCIPAL DISPLAY PANEL Bottle Carton
displayName: PACKAGE LABEL.PRINCIPAL DISPLAY PANEL
FDA Article Code: 51945-4
Oral Solution USP
Each mL contains
10 mg furosemide
See Package Insert For Complete
PROTECT FROM LIGHT
NET: 2 fl oz (60 mL)