Description and indication for use
Frusemide is a potent diuretic with a rapid
onset of action. The onset after IV
administration is within 5 to 20 minutes with peak diuresis between 1 to 3
hours. Duration of action is between 4
to 6 hours.
It can be used to treat acute episodes of
fluid overload as sometimes seen in infants with chronic lung disease or
associated with oliguria. Can be used to
treat other fluid/electrolyte disturbances.
We do not routinely give Frusemide in
association with top-up transfusions in infants receiving transfusions.
Please
note:
Frusemide may cause deafness.
This is more likely to occur when there are high peak concentrations of
the drug, as occurs with bolus intravenous administration, or very large oral
doses. See, for example, Laryngoscope 1985; 95(9 Pt 2 Suppl 38): 1-4, J
Otolaryngology 1982; 11:127-133, Klinische Wochenschrift 1970; 48:1052-1056.
Dose
IV & O:
0.5 to 2 mg/kg/dose (higher doses may
occasionally be used).
|
VLBW
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Daily
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Term
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|
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Week 1
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daily
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Week 2 and over
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12 hourly
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Continuous 24 hour IV infusion:
0.1 – 1 mg/kg/hr.
Dose may be increased in resistant cases
and in renal impairment.
Anuric/oliguric renal failure may require
doses of 3 mg/kg or higher to establish urine output.
Reconstitution/Dilution
Ampoule = 20 mg in 2 mL.
IV:
Withdraw required dose further dilute so
that the dose can be administered over the appropriate time frame.
IV administration is recommended.
Give IM when no IV access is available.
IM:
No dilution is necessary.
IV
Infusion
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DRUG
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HOW TO MAKE UP
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DOSE EQUIVALENT
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DOSE RANGE
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Frusemide
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10 mg/kg in 50 mL
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1 mL/hr = 0.2 mg/kg/hour
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0.1 to 1 mg/kg/hour
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50 mg/kg in 50 mL
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1 mL/hr = 1 mg/kg/hour
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Route and method of administration
IV:
Never give Frusemide as a bolus
intravenously.
Administer intravenous doses at a maximum
rate of 0.05 mg/kg/min – for example, a 1.0 mg/kg dose should be infused over
at least 20 minutes.
Whenever possible, give high doses by
continuous intravenous infusion (because of drug incompatibilities, this will
often require another IV cannula to be inserted).
If being given in association with top-up
transfusion, dose should be given half
way through transfusion.
Side effects
Hypokalaemia.
Electrolyte and fluid disturbances.
Hypercalciuiria and development of renal
calculi (long term therapy).
Hyperglycaemia, glycosuria.
Dehydration, hypovolaemia, hypotension.
Thrombophlebitis at injection site.
Hypochloraemic metabolic alkalosis.
Chronic therapy may cause nephrocalcinosis
and osteopenia with potential for rickets and fractures.
Risk of ototoxicity is increased with renal
impairment, high doses, rapid IV administration and use of other ototoxic drugs.
Compatible Solutions
Sodium Chloride 0.9%.
Glucose 5%.
Incompatibilities
Administer alone, or contact pharmacy for
further information if required.
Check compatibilities with other
intravenous fluids when mixing is unavoidable.
For example, Frusemide is not
compatible with Amphotericin (in saline), Ampicillin, Amrinone, Atracurium,
Benztropine, Chlorpromazine, Cimetidine, Cotrimoxazole, Diazepam, Dobutamine, Esmolol,
Fentanyl, Gentamicin (in Glucose) Isoprenaline, Magnesium, Metaraminol, Midazolam,
Noradrenaline, Ondansetron, Phentolamine, Phenytoin, Prochlorperazine, Promethazine,
Protamine, Vancomycin or Verapamil.
Special precautions
CAUTION in patients with renal failure.
CAUTION in patients with acidosis, low serum albumin, hyperbilirubinaemia
or jaundice.
If used long term, monitor potassium and
consider potassium supplementation or the addition of a potassium-sparing
diuretic.
Administration of oral Frusemide – divide
doses as much as possible throughout the day (i.e. 2 – 3 small doses instead of
a single, large daily dose).