Furosemide
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Furosemide
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| Systematic (IUPAC) name | |
| 5-(aminosulfonyl)-4-chloro-2- [(2-furanylmethyl)amino]benzoic acid |
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| Identifiers | |
| CAS number | |
| ATC code | C03 |
| PubChem | |
| DrugBank | |
| Chemical data | |
| Formula | C12H11ClN2O5S |
| Mol. mass | 330.745 g/mol |
| Pharmacokinetic data | |
| Bioavailability | 43-69% |
| Metabolism | hepatic and renal glucuronidation |
| Half life | up to 100 minutes |
| Excretion | renal 66%, biliary 33% |
| Therapeutic considerations | |
| Pregnancy cat. | |
| Legal status |
℞ Prescription only |
| Routes | Oral, IV, IM |
Furosemide (INN) or frusemide (former BAN) is a loop diuretic used in the treatment of congestive heart failure and oedema. It is most commonly marketed by Sanofi-Aventis under the brand name Lasix. It has also been used to prevent thoroughbred race horses from bleeding through the nose during races.
Along with some other diuretics, furosemide is also included on the World Anti-Doping Agency's banned drug list due to its alleged use as a masking agent for other drugs.
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[edit] Mechanism of action
Like other loop diuretics, furosemide acts by inhibiting the Na-K-2Cl symporter in the thick ascending loop of Henle. It also has inhibitory activity on carbonic anhydrase. it also abolishes the corticomedullary osmotic gradient and blocks negative as well as positive free water clearence.
Additionally, furosemide is a noncompetitive subtype-specific blocker of GABA-A receptors (Korpi et al, 1995, Tia et al, 1996, Wafford et al, 1996). Furosemide has been reported to reversibly antagonize GABA-evoked currents of alpha6 beta2 gamma2 receptors at microM concentrations, but not alpha1 beta2 gamma2 receptors (Korpi et al, 1995; Wafford et al, 1996). During development, the alpha6 beta2 gamma2 receptor increases in expression in cerebellar granule neurons, corresponding to increased sensitivity to furosemide (Tia et al, 1995).
[edit] Clinical use in humans
Furosemide, as a loop diuretic, is principally used in the following indications (Aventis, 1998):
- Oedema associated with heart failure, hepatic cirrhosis, renal impairment, nephrotic syndrome
- Hypertension
- Adjunct in cerebral/pulmonary oedema where rapid diuresis is required (IV injection)
It is also sometimes used in the management of severe hypercalcemia in combination with adequate rehydration (Rossi, 2004).
Although disputed,[1] it is considered ototoxic: "usually with large parenteral doses and rapid administration and in renal impairment"[2]
[edit] Use in horses
Apparently, sometime in the early 1970s, furosemide's ability to prevent or at least greatly reduce the incidence of bleeding by horses during races was discovered accidentally. Pursuant to the racing rules of most states, horses that bleed from the nostrils three times are permanently barred from racing (for their own protection). Clinical trials followed, and by decade's end, racing commissions in some states began legalizing its use on race horses. On September 1, 1995, New York became the last state in the United States to approve such use, after years of refusing to consider doing so. Some states allow its use for all racehorses; some allow it only for confirmed "bleeders." Its use for this purpose is still prohibited in many other countries, however.
[edit] Drug Interactions
Furosemide has potential interactions with the following medications:[1]
- Aminoglycoside antibiotics such as Garamycin
- Aspirin and other salicylates
- Other diuretics (e.g. Ethacrynic acid)
- Indomethacin
- Lithium
- Synergistic effects with other antihypertensives (e.g. Doxazosin)
- Sucralfate
[edit] Brand names
Some of the brand names under which furosemide is marketed include: Aisemide®, Beronald®, Desdemin®, Discoid®, Diural®, Diurapid®, Dryptal®, Durafurid®, Errolon®, Eutensin®, Frusetic®, Frusid®, Fulsix®, Fuluvamide®, Furesis®, Furo-Puren®, Furosedon®, Hydro-rapid®, Impugan®, Katlex®, Lasilix®, Lasix®, Lodix®, Lowpston®, Macasirool®, Mirfat®, Nicorol®, Odemase®, Oedemex®, Profemin®, Rosemide®, Rusyde®, Salix®, Trofurit®, Urex®
Founded around 1964.
[edit] References
- ^ Rais-Bahrami K, Majd M, Veszelovszky E, Short B (2004). "Use of furosemide and hearing loss in neonatal intensive care survivors.". Am J Perinatol 21 (6): 329-32. PMID 15311369.
- ^ BNF 45 March 2003
[edit] Further reading
- Aventis Pharma (1998). Lasix Approved Product Information. Lane Cove: Aventis Pharma Pty Ltd.
- Rossi S (Ed.) (2004). Australian Medicines Handbook 2004. Adelaide: Australian Medicines Handbook. ISBN 0-9578521-4-2.
- Korpi ER, Kuner T, Seeburg PH, Lüddens H (1995) Selective antagonist for the cerebellar granule cell-specific gamma-aminobutyric acid type A receptor. Mol Pharmacol 47:283-289.
- Tia S, Wang JF, Kotchabhakdi N, Vicini S (1996) Developmental changes of inhibitory synaptic currents in cerebellar granule neuronsrole of GABAA receptor -6 subunit. J Neurosci 16:3630-3640.
- Wafford KA, Thompson SA, Thomas D, Sikela J, Wilcox AS, Whiting PJ (1996) Functional characterization of human gamma-aminobutyric acid (a) receptors containing the alpha-4 subunit. Mol Pharmacol 50:670-678.
[edit] External links
- Lasix and horse bleeding
- "Diuretics and other masking agents" (PDF) – Part S5 of the World Anti-Doping Agency's 2005 Prohibited List. International Standard.
- Links to external chemical sources
| Antihypertensives (C02) and diuretics (C03) | |
|---|---|
| Antiadrenergic agents (including alpha) | Clonidine, Doxazosin, Guanethidine, Guanfacine, Lofexidine,Mecamylamine, Methyldopa, Moxonidine, Prazosin, Rescinnamine, Reserpine |
| Vasodilators | Diazoxide, Hydralazine, Minoxidil, Nitroprusside, Phentolamine |
| Other antihypertensives | Bosentan, Ketanserin |
| Low ceiling diuretics | Bendroflumethiazide, Chlorothiazide, Chlortalidone, Hydrochlorothiazide, Indapamide, Quinethazone, Mersalyl, Metolazone, Theobromine, Cicletanine |
| High ceiling diuretics | Bumetanide, Furosemide, Torasemide |
| Potassium-sparing diuretics | Amiloride, Eplerenone, Spironolactone, Triamterene |
