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Furosemide oral high strength

Updated 2 Feb 2023 | Loop diuretics


High strength tablet formulation of furosemide

Drugs List

  • DIURESAL 500mg tablets
  • furosemide 500mg tablets
  • Therapeutic Indications


    Oliguria due to renal failure



    Chronic Renal Impairment
    Initial dose of 250 mg. Increasing in increments of 250 mg at 4 to 6 hourly intervals until effective diuresis is achieved. Usual maximum daily dose of 1.5 g may only be exceeded in exceptional cases, whereby 2 g in 24 hours may be given.


    (See Dosage; Adult)
    As furosemide is eliminated more slowly in elderly patients the dose should be titrated to the minimum effective dose.


    Children aged 12 years and over
    (See Dosage; Adult)


    Cardiac glycoside toxicity
    Children under 12 years
    Addison's disease
    Electrolyte imbalance
    Hepatic coma
    Long QT syndrome
    Pre-coma associated with hepatic cirrhosis
    Renal damage secondary to nephrotoxic agents
    Renal impairment secondary to hepatotoxic agents
    Severe hypokalaemia
    Severe hyponatraemia
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Predisposition to hypotension
    Adrenal disorder
    Benign prostatic hyperplasia
    Cardiac impairment
    Diabetes mellitus
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    Hepato-renal syndrome
    History of gout
    History of torsade de pointes
    Lactose intolerance
    Metabolic alkalosis
    Urinary obstruction

    Correct electrolyte disorders before treatment
    Correct hypotension before initiating treatment
    May decrease glucose tolerance in patients with diabetes mellitus
    Advise ability to drive/operate machinery may be affected by side effects
    Correct hypovolaemia prior to administration
    Contains lactose
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor blood / urinary glucose concentrations in diabetic patients
    Monitor blood / urinary glucose in patients suspected of latent diabetes
    Monitor creatinine, blood urea nitrogen (BUN) and urinary output
    Monitor fluid and electrolyte status
    Monitor for signs of blood dyscrasias eg fever, sore throat, malaise etc
    Monitor hepatic function
    Monitor patients at risk of gout
    Monitor serum potassium regularly
    Excess consumption of liquorice may increase the risk of hypokalaemia
    May precipitate gout
    Potassium supplements may be required
    Discontinue treatment before glucose tolerance test
    Discontinue if blood dyscrasia develops
    Discontinue if evidence of significant bone marrow depression
    Advise patient not to take NSAIDs unless advised by clinician

    Only for use in patients with a marked reduction in glomerular filtration. Otherwise risk of increased excessive fluid and electrolyte losses.

    Regular monitoring of serum potassium level is necessary in patients with impaired renal function and a creatinine clearance below 60 ml/minute/1.73 metre squared body surface area.

    Patients who are at a high risk for radio contrast nephropathy, furosemide is not recommended to be used for diuresis as part of the preventative measures against radio contrast-induced nephropathy.

    Serum cholesterol and triglyceride levels may increase during treatment but should return to normal within 6 months of discontinuation.

    Pregnancy and Lactation


    Use furosemide with caution in pregnancy.

    Furosemide has been given after the first trimester of pregnancy without causing foetal or newborn adverse effects. It should only be given during pregnancy if strictly indicated and for short-term treatment.

    Schaefer (2007) states that diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy. They should only be used for particular indications. Furosemide can be given when treatment of heart or renal failure requires a diuretic.

    A study between 1985 and 1992 showed that out of 350 neonates exposed to furosemide in the first trimester, 18 had major birth defects (such as cardiovascular defects and limb reduction defects) (Briggs, 2011).

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Furosemide is contraindicated in breastfeeding.

    Furosemide should be discontinued during furosemide treatment as the drug may inhibit lactation and is secreted into the breast milk.

    An alternative drug may be preferred especially whilst nursing a newborn or premature infant.

    Hale (2010) states that it unlikely that the amount of furosemide transferred into breast milk would produce any effects in a nursing infant.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Acute renal failure
    Aggravation of metabolic alkalosis
    Altered bowel habit
    Anaphylactic reaction
    Anaphylactoid reaction
    Aplastic anaemia
    Blood urea increased
    Blurred vision
    Bone marrow depression
    Changes in hepatic function
    Decrease in blood pressure
    Decrease in high density lipoprotein (HDL)
    Decrease in plasma calcium
    Decreased glucose tolerance
    Delayed reactions
    Dry mouth
    Erythema multiforme
    Exfoliative dermatitis
    Haemolytic anaemia
    Hearing loss (reversible)
    Hepatic encephalopathy
    Impaired concentration
    Increase in plasma triglyceride concentration
    Increase in serum cholesterol (transient)
    Increase in serum transaminases
    Increased thirst
    Interstitial nephritis
    Intrahepatic cholestasis
    Metabolic alkalosis
    Muscle cramps
    Muscle weakness
    Postural hypotension
    Precipitation of diabetes
    Psychiatric disorders
    Sensation of pressure
    Serum creatinine increased
    Severe bullous lesions
    Toxic epidermal necrolysis
    Urinary incontinence
    Urinary retention
    Visual disturbances
    Yellow vision


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2014

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 6 December 2014.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on 6 December 2014.

    Summary for Product Characteristics: Diuresal 500mg tablets. Ennogen Pharma Ltd. Revised May 2013.

    Summary for Product Characteristics: Furosemide tablets BP 500mg. Actavis UK Ltd. Revised May 2013.

    Summary for Product Characteristics: Furosemide 500mg tablets. Amdipharm Mercury Company Ltd. Revised January 2014.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Furosemide Last revised: 7 September, 2013
    Last accessed: 6 January, 2014

    The Drug Database for Acute Porphyria (NAPOS).
    Available at:
    Furosemide Last revised: 22 September, 2009
    Last accessed: 6 December, 2014

    The Welsh Medicines Information Centre (WMIC).
    Available at:
    Furosemide Last revised: September, 2013
    Last accessed: 6 December, 2014

    European porphyria network.
    Available at:
    Last accessed: 6 December, 2014

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