furosemide injection, USP VIAL Drug Interactions

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7 DRUG INTERACTIONS

7.1 Effects of Furosemide on Other Drugs

Drug/Substance Class or NameDrug Interaction EffectRecommendations

Aminoglycoside antibiotics

Furosemide may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function [see Warnings and Precautions (5.3)].

Avoid combination except in life-threatening situations.

Ethacrynic acid

Possibility of ototoxicity [see Warnings and Precautions (5.3)].

Avoid concomitant use with ethacrynic acid.

Salicylates

May experience salicylate toxicity at lower doses because of competitive renal excretory sites.

Monitor for symptoms of salicylate toxicity.

Cisplatin

There is a risk of ototoxic effects if cisplatin and furosemide are given concomitantly [see Warnings and Precautions (5.3)].

Cisplatin and nephrotoxic drugs

Nephrotoxicity

Administer furosemide at lower doses and with postitive fluid balance when used to achieve forced diuresis during cisplatin treatment. Monitor renal function.

Paralytic agents

Furosemide has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine.

Monitor for skeletal muscle effect.

Lithium

Furosemide reduces lithium's renal clearance and add a high-risk of lithium toxicity.

Avoid concomitant use with lithium.

Angiotensin converting enzyme inhibitors or angiotensin II receptor blockers

May lead to severe hypotension and deterioration in renal function, including renal failure.

Monitor for changes in blood pressure and renal function and interrupt or reduce the dosage of furosemide, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers if needed.

Antihypertensive drugs

Furosemide may add to or potentiate the therapeutic effect of other antihypertensive drugs.

Monitor for changes in blood pressure and adjust the dose of other antihypertensive drugs if needed.

Adrenergic blocking drugs or peripheral adrenergic blocking drugs

Potentiation occurs.

Monitor for changes in blood pressure and adjust the dose of adrenergic blocking drugs if needed.

Norepinephrine

Furosemide may decrease arterial responsiveness (vasoconstricting effect) to norepinephrine.

Monitor blood pressure (or mean arterial pressure).

Chloral hydrate

In isolated cases, intravenous administration of furosemide within 24 hours of taking chloral hydrate may lead to flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia.

Concomitant use with chloral hydrate is not recommended.

Methotrexate and other drugs undergoing renal tubular secretion

Furosemide may decrease renal elimination of other drugs that undergo tubular secretion. High-dose treatment of furosemide may result in elevated serum levels of these drugs and may potentiate their toxicity.

Monitor serum levels of drugs undergoing renal tubular secretion and adjust the dose if needed.

Cephalosporin

Furosemide can increase the risk of cephalosporin-induced nephrotoxicity even in the setting of minor or transient renal impairment.

Monitor for changes in renal function.

Cyclosporine

Increased risk of gouty arthritis secondary to furosemide-induced hyperuricemia and cyclosporine impairment of renal urate excretion.

Monitor serum urate levels.

Thyroid hormones

High-doses (> 80 mg) of furosemide may inhibit the binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by an overall decrease in total thyroid hormone levels.

Monitor the total thyroid hormone levels.

7.2 Effects of Other Drugs on Furosemide

Drug/Substance Class or NameDrug Interaction EffectRecommendations

Phenytoin

Interferes directly with renal action of furosemide.

Monitor diuretic effects of furosemide and adjust the dose of furosemide if needed.

Methotrexate and other drugs undergoing renal tubular secretion

May reduce the effect of furosemide. High-dose treatment of methotrexate and these other drugs may result in elevated serum levels of furosemide and may potentiate the toxicity of furosemide.

Monitor for enhanced toxicity of furosemide.

Indomethacin

Coadministration of indomethacin may reduce the natriuretic and antihypertensive effects of furosemide in some patients by inhibiting prostaglandin synthesis. Indomethacin may also affect plasma renin levels, aldosterone excretion, and renin profile evaluation.

Patients receiving both indomethacin and furosemide should be observed closely to determine if the desired diuretic and/or antihypertensive effect of furosemide is achieved.

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Drug Interactions

7 DRUG INTERACTIONS

7.1 Effects of Furosemide on Other Drugs

Drug/Substance Class or NameDrug Interaction EffectRecommendations

Aminoglycoside antibiotics

Furosemide may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function [see Warnings and Precautions (5.3)].

Avoid combination except in life-threatening situations.

Ethacrynic acid

Possibility of ototoxicity [see Warnings and Precautions (5.3)].

Avoid concomitant use with ethacrynic acid.

Salicylates

May experience salicylate toxicity at lower doses because of competitive renal excretory sites.

Monitor for symptoms of salicylate toxicity.

Cisplatin

There is a risk of ototoxic effects if cisplatin and furosemide are given concomitantly [see Warnings and Precautions (5.3)].

Cisplatin and nephrotoxic drugs

Nephrotoxicity

Administer furosemide at lower doses and with postitive fluid balance when used to achieve forced diuresis during cisplatin treatment. Monitor renal function.

Paralytic agents

Furosemide has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine.

Monitor for skeletal muscle effect.

Lithium

Furosemide reduces lithium's renal clearance and add a high-risk of lithium toxicity.

Avoid concomitant use with lithium.

Angiotensin converting enzyme inhibitors or angiotensin II receptor blockers

May lead to severe hypotension and deterioration in renal function, including renal failure.

Monitor for changes in blood pressure and renal function and interrupt or reduce the dosage of furosemide, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers if needed.

Antihypertensive drugs

Furosemide may add to or potentiate the therapeutic effect of other antihypertensive drugs.

Monitor for changes in blood pressure and adjust the dose of other antihypertensive drugs if needed.

Adrenergic blocking drugs or peripheral adrenergic blocking drugs

Potentiation occurs.

Monitor for changes in blood pressure and adjust the dose of adrenergic blocking drugs if needed.

Norepinephrine

Furosemide may decrease arterial responsiveness (vasoconstricting effect) to norepinephrine.

Monitor blood pressure (or mean arterial pressure).

Chloral hydrate

In isolated cases, intravenous administration of furosemide within 24 hours of taking chloral hydrate may lead to flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia.

Concomitant use with chloral hydrate is not recommended.

Methotrexate and other drugs undergoing renal tubular secretion

Furosemide may decrease renal elimination of other drugs that undergo tubular secretion. High-dose treatment of furosemide may result in elevated serum levels of these drugs and may potentiate their toxicity.

Monitor serum levels of drugs undergoing renal tubular secretion and adjust the dose if needed.

Cephalosporin

Furosemide can increase the risk of cephalosporin-induced nephrotoxicity even in the setting of minor or transient renal impairment.

Monitor for changes in renal function.

Cyclosporine

Increased risk of gouty arthritis secondary to furosemide-induced hyperuricemia and cyclosporine impairment of renal urate excretion.

Monitor serum urate levels.

Thyroid hormones

High-doses (> 80 mg) of furosemide may inhibit the binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by an overall decrease in total thyroid hormone levels.

Monitor the total thyroid hormone levels.

7.2 Effects of Other Drugs on Furosemide

Drug/Substance Class or NameDrug Interaction EffectRecommendations

Phenytoin

Interferes directly with renal action of furosemide.

Monitor diuretic effects of furosemide and adjust the dose of furosemide if needed.

Methotrexate and other drugs undergoing renal tubular secretion

May reduce the effect of furosemide. High-dose treatment of methotrexate and these other drugs may result in elevated serum levels of furosemide and may potentiate the toxicity of furosemide.

Monitor for enhanced toxicity of furosemide.

Indomethacin

Coadministration of indomethacin may reduce the natriuretic and antihypertensive effects of furosemide in some patients by inhibiting prostaglandin synthesis. Indomethacin may also affect plasma renin levels, aldosterone excretion, and renin profile evaluation.

Patients receiving both indomethacin and furosemide should be observed closely to determine if the desired diuretic and/or antihypertensive effect of furosemide is achieved.

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