This platform is currently totally free and created by doctors. 🩺
Menu
SpecialtiesDrug IndexGuidelinesClassificationsPricing
Login
HomeDrug IndexClinical Monograph

Furosemide Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

Navigation

Subclass
Loop diuretic
Speciality
Nephrology
Schedule (India)
Schedule H
Routes
Oral, Intravenous, Intramuscular
Formulations
  • Tablets: 20 mg, 40 mg
  • Oral solution: 10 mg/mL (limited to select hospital settings)
  • Injection: 10 mg/mL (2 mL ampoule = 20 mg; 4 mL ampoule = 40 mg)
Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Congestive Heart Failure (CHF) — Volume Overload / Pulmonary Congestion
Parameter Oral Intravenous
Starting dose
 20–40 mg once daily 20–40 mg slow IV push (over 1–2 min)
Titration
 Increase by 20–40 mg every 6–8 hours based on response Repeat dose in 2 hours if inadequate response
Usual maintenance
 40–80 mg/day (single or divided doses) Convert to oral once stable
Maximum dose
 600 mg/day (divided doses) 200 mg/bolus; higher only under specialist care
Clinical Notes:
  • Monitor daily weight, fluid balance, serum electrolytes, BP
  • Consider potassium supplementation or combine with spironolactone if hypokalaemia develops
2. Acute Pulmonary Oedema
Step Action
Starting dose
 IV 40 mg bolus (slow push over 1–2 min)
Titration
 May repeat 40–80 mg IV in 1–2 hours if response inadequate
If already on oral loop diuretic
 Give IV dose equivalent to patient's total daily oral dose
Maximum dose
 200 mg per bolus; higher doses require ECG and electrolyte monitoring
Clinical Notes:
  • Administer with oxygen and positioning
  • Rapid infusion increases ototoxicity risk
3. Chronic Kidney Disease with Volume Overload
Parameter Recommendation
Starting dose
 40–80 mg oral once or twice daily
Titration
 Increase to 80–160 mg twice daily based on clinical response
Usual maintenance
 80–320 mg/day in divided doses
Maximum dose
 600 mg/day oral (divided)
Clinical Notes:
  • Higher doses often required due to reduced tubular secretion in low GFR
  • Consider adding thiazide-type diuretic for sequential nephron blockade in resistant oedema
4. Hypertension (Volume-dependent or Resistant)
Parameter Recommendation
Starting dose
 20 mg once or twice daily
Titration
 Increase to 40 mg twice daily if needed
Usual maintenance
 20–80 mg/day
Maximum dose
 80 mg/day (as adjunct therapy)
Clinical Notes:
  • Not first-line antihypertensive
  • Reserve for patients with concurrent fluid overload or CKD

Secondary Indications — Adults Only (Off-label)

Indication Dose Duration Notes
Acute Hypercalcaemia— OFF-LABEL
 20–40 mg IV every 2–4 hours Until calcium normalises Administer with IV saline; specialist supervision essential; monitor calcium and fluid balance. Based on Indian nephrology practice.
Ascites in Cirrhosis (spironolactone-resistant) — OFF-LABEL
 20–40 mg oral daily; titrate as needed Long-term maintenance Combine with spironolactone (40:100 mg ratio preferred). Monitor for encephalopathy and electrolyte disturbance. Based on Indian hepatology protocols.

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Congestive Heart Failure (CHF) — Volume Overload / Pulmonary Congestion
Parameter Oral Intravenous
Starting dose
 20–40 mg once daily 20–40 mg slow IV push (over 1–2 min)
Titration
 Increase by 20–40 mg every 6–8 hours based on response Repeat dose in 2 hours if inadequate response
Usual maintenance
 40–80 mg/day (single or divided doses) Convert to oral once stable
Maximum dose
 600 mg/day (divided doses) 200 mg/bolus; higher only under specialist care
Clinical Notes:
  • Monitor daily weight, fluid balance, serum electrolytes, BP
  • Consider potassium supplementation or combine with spironolactone if hypokalaemia develops
2. Acute Pulmonary Oedema
Step Action
Starting dose
 IV 40 mg bolus (slow push over 1–2 min)
Titration
 May repeat 40–80 mg IV in 1–2 hours if response inadequate
If already on oral loop diuretic
 Give IV dose equivalent to patient's total daily oral dose
Maximum dose
 200 mg per bolus; higher doses require ECG and electrolyte monitoring
Clinical Notes:
  • Administer with oxygen and positioning
  • Rapid infusion increases ototoxicity risk
3. Chronic Kidney Disease with Volume Overload
Parameter Recommendation
Starting dose
 40–80 mg oral once or twice daily
Titration
 Increase to 80–160 mg twice daily based on clinical response
Usual maintenance
 80–320 mg/day in divided doses
Maximum dose
 600 mg/day oral (divided)
Clinical Notes:
  • Higher doses often required due to reduced tubular secretion in low GFR
  • Consider adding thiazide-type diuretic for sequential nephron blockade in resistant oedema
4. Hypertension (Volume-dependent or Resistant)
Parameter Recommendation
Starting dose
 20 mg once or twice daily
Titration
 Increase to 40 mg twice daily if needed
Usual maintenance
 20–80 mg/day
Maximum dose
 80 mg/day (as adjunct therapy)
Clinical Notes:
  • Not first-line antihypertensive
  • Reserve for patients with concurrent fluid overload or CKD

Secondary Indications — Adults Only (Off-label)

Indication Dose Duration Notes
Acute Hypercalcaemia— OFF-LABEL
 20–40 mg IV every 2–4 hours Until calcium normalises Administer with IV saline; specialist supervision essential; monitor calcium and fluid balance. Based on Indian nephrology practice.
Ascites in Cirrhosis (spironolactone-resistant) — OFF-LABEL
 20–40 mg oral daily; titrate as needed Long-term maintenance Combine with spironolactone (40:100 mg ratio preferred). Monitor for encephalopathy and electrolyte disturbance. Based on Indian hepatology protocols.
Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications
1. Oedema (Cardiac / Renal / Hepatic Causes)
Age Group Route Starting Dose Frequency Maximum Single Dose
Neonates (term) IV or Oral 0.5–1 mg/kg Every 12–24 hours 2 mg/kg
Infants (1 month – 1 year) IV or Oral 1–2 mg/kg Every 6–12 hours 4 mg/kg
Children (1–12 years) IV or Oral 1–2 mg/kg Every 6–8 hours 6 mg/kg (max 40 mg/dose)
Adolescents (>12 years) IV or Oral 20–40 mg Once or twice daily 80 mg/dose
Safety Monitoring:
  • Serum electrolytes (K⁺, Na⁺, Ca²⁺, Mg²⁺)
  • Fluid balance, daily weight
  • Audiometry if repeated high-dose IV use
Cautions:
  • Avoid in premature neonates unless essential — increased ototoxicity and nephrocalcinosis risk
2. Acute Kidney Injury (Oliguric Phase) — Nephrologist Only
Parameter Recommendation
Starting dose
 1–2 mg/kg IV
Titration
 May increase to 4 mg/kg if no response
Maximum dose
 6 mg/kg/dose (specialist discretion)
Clinical Notes:
  • Response-based dosing; not for routine use
  • Close monitoring of urine output and electrolytes mandatory

Secondary Indications — Paediatric (Off-label)

Indication Dose Duration Notes
Bronchopulmonary Dysplasia (BPD) — OFF-LABEL
 1 mg/kg/dose oral or IV, once or twice daily Short-term (days to weeks) Specialist (neonatologist) only. Limited to NICU settings. Risk of electrolyte imbalance. Based on tertiary NICU protocols in India.
Age Restriction: Not recommended below 4 weeks of age except under specialist supervision.
Renal Adjustments
Renal Status Recommendation
Mild–Moderate impairment (eGFR 15–60) No dose reduction; may need higher doses due to reduced efficacy
Severe impairment (eGFR <15) Higher doses often required; monitor volume and electrolytes closely
Dialysis patients Can be used for residual diuresis; not removed by haemodialysis
Note: Avoid dehydration. Combine with thiazide for synergy in resistant cases.
Hepatic adjustment
Contraindications
  • Anuria unresponsive to fluid challenge
  • Severe hypovolaemia or dehydration
  • Known hypersensitivity to furosemide or sulfonamides
  • Severe uncorrected hypokalaemia or hyponatraemia
  • Hepatic coma or pre-coma (unless under specialist supervision)
Cautions
  • Gout or hyperuricaemia (may precipitate acute attack)
  • Diabetes mellitus (may worsen glycaemic control)
  • Prostatic hypertrophy / bladder outlet obstruction
  • Pre-existing hearing impairment
  • Concurrent nephrotoxic or ototoxic drug use
  • Elderly patients (increased risk of falls, hypotension)
  • Severe electrolyte disturbances

Pregnancy

Parameter Information
Risk category
 Use only if benefit clearly outweighs risk
Concerns
 May reduce placental perfusion; risk of oligohydramnios, fetal electrolyte imbalance
Preferred alternatives
 Methyldopa, labetalol for hypertension in pregnancy
When to use
 Only if volume overload poses immediate maternal risk
Monitoring
 Fetal growth (serial USG), maternal electrolytes, BP
Lactation
Parameter Information
Compatibility
 Generally compatible with breastfeeding
Milk levels
 Low; minimal infant exposure expected
Concerns
 High doses may reduce milk production
Monitoring in infant
 Weight gain, feeding adequacy, hydration status
Preferred alternatives
 None specifically preferred; continue if clinically indicated
Elderly
Parameter Recommendation
Starting dose
 20 mg once daily (lower end of range)
Titration
 Slow; increase cautiously based on response
Special risks
 Orthostatic hypotension, falls, hyponatraemia, dehydration, acute kidney injury
Monitoring
 BP (including postural), renal function, electrolytes at baseline and periodically
Major drug interactions
Drug Interaction Management
Aminoglycosides(gentamicin, amikacin)
 Additive ototoxicity and nephrotoxicity, especially with IV furosemide Avoid combination if possible; if essential, monitor hearing and renal function
Digoxin
 Hypokalaemia increases digoxin toxicity risk Monitor potassium; supplement or add K⁺-sparing diuretic
Lithium
 Reduced lithium clearance; increased toxicity risk Monitor lithium levels closely; dose adjustment may be needed
NSAIDs
 Reduce diuretic efficacy; increase AKI risk Avoid routine use; use paracetamol as alternative analgesic
Moderate drug interactions
Drug Interaction Management
Corticosteroids
 Additive hypokalaemia Monitor potassium; consider supplementation
Antidiabetic agents
 May blunt hypoglycaemic effect Monitor blood glucose; adjust antidiabetic dose if needed
ACE inhibitors / ARBs
 Additive hypotension, especially first dose Start at low dose; monitor BP
Proton pump inhibitors
 Combined risk of hypomagnesaemia Monitor magnesium in long-term use
Antipsychotics(haloperidol, risperidone)
 Electrolyte imbalance may prolong QTc Monitor ECG and electrolytes
Antiepileptics(phenytoin)
 May reduce furosemide absorption Monitor diuretic response
Common Adverse effects
  • Hypokalaemia
  • Hyponatraemia
  • Postural hypotension
  • Hyperuricaemia
  • Dizziness, fatigue
  • Dehydration
  • Hyperglycaemia
  • Increased urinary frequency
Serious Adverse effects
Effect Notes
Ototoxicity
 Risk increased with rapid IV infusion, high doses, renal impairment, or concurrent aminoglycosides; may be irreversible
Severe electrolyte disturbance
 Hypokalaemia, hyponatraemia, hypomagnesaemia — can cause arrhythmias
Stevens-Johnson Syndrome / TEN
 Rare; discontinue immediately if rash develops
Acute pancreatitis
 Rare; consider if unexplained abdominal pain occurs
Photosensitivity
 Advise sun protection
Blood dyscrasias
 Agranulocytosis, thrombocytopenia (rare)
Monitoring requirements
Timing Parameters
Baseline
 Serum electrolytes (K⁺, Na⁺, Mg²⁺), renal function (creatinine, urea), BP, uric acid
After initiation / dose change
 Electrolytes and renal function within 1 week
Long-term
 Electrolytes, renal function, uric acid every 1–3 months
CHF / oedema management
 Daily weight, fluid balance assessment
High-dose IV or concurrent digoxin
 ECG monitoring
Paediatric (repeated IV doses)
 Audiometry
Brands in India
  • Lasix (Sanofi)
  • Frusemide (generic — multiple manufacturers)
  • Frusenex (Macleods)
  • Frusol (Micro Labs)
  • Furoped (Ipca)
  • Dytor (combination with torsemide — note: different loop diuretic; FDC with spironolactone also available)
Price range (INR)
Formulation Approximate Price
Tablet 40 mg ₹1–3 per tablet
Injection 20 mg (2 mL) ₹4–8 per ampoule
Injection 40 mg (4 mL) ₹6–12 per ampoule
Note: Listed under NLEM 2022; prices regulated by NPPA. Government supply rates may be lower.
Clinical pearls
  1. IV administration: Always give slow IV push (over 1–2 minutes); rapid injection increases ototoxicity risk.
  2. Potassium management: Routinely monitor potassium; consider adding spironolactone or potassium chloride supplementation if persistent hypokalaemia.
  3. Diuretic resistance: In resistant oedema, combine with thiazide (metolazone or hydrochlorothiazide) for sequential nephron blockade — requires close monitoring.
  4. Avoid NSAIDs: These blunt the diuretic effect and increase AKI risk; use paracetamol for analgesia.
  5. Metabolic effects: May worsen diabetes control and precipitate gout — monitor glucose and uric acid accordingly.
  6. IV to oral conversion: Oral bioavailability is approximately 50%; when converting from IV to oral, consider doubling the dose or using more frequent dosing.

Version

RxIndia v1.1 — 05 Jan 2025
Reference
  • CDSCO approved prescribing information
  • Indian Pharmacopoeia / National Formulary of India
  • NLEM 2022
  • API Textbook of Medicine
  • AIIMS Drug Formulary
  • Indian Society of Nephrology Guidelines
  • Indian Academy of Pediatrics (IAP) treatment protocols
  • Harrison's Principles of Internal Medicine
  • Goodman & Gilman's The Pharmacological Basis of Therapeutics
  • Tertiary NICU protocols (for paediatric off-label use)
⚖️

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

Content Feedback

Is this information helpful?

Help us improve our clinical database for the medical community.

All feedback is reviewed by our clinical editorial team.