Hypersensitivity furosemide

Table 1 A rapid oral desensitization protocol for patients with furosemide hypersensitivity...

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

Thrombocytopenia Because there have been rare spontaneous reports of thrombocytopenia with bumetanide, observe regularly for possible occurrence. Hypersensitivity reactions Patients with known sulfonamide sensitivity may show allergic reactions to furosemide, torsemide, or bumetanide. Bumetanide use following instances of allergic reactions to furosemide suggests a lack of cross-sensitivity. Refer to Management of Acute Hypersensitivity Reactions. 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Hypersensitivity, sulphite allergy, excessive hypotension with disopyramide. Incompatible with dextrose and frusemide (furosemide). 

A review of furosemide-induced skin reactions included a description of a unique case of an 88-year-old man who developed an eruption that clinically and histologically simulated Sweet s syndrome (acute febrile neutrophilic vasculitis) after 6 weeks (15). Atypical features and rapid resolution suggested a drug eruption rather than true Sweet s syndrome. However, a similar mechanism may have been implicated a hypersensitivity reaction involving immune complexes. 

Lin RY. Unusual autoimmune manifestations in furosemide-associated hypersensitivity angiitis. NY State J Med 1988 88(8) 439-40. 

Neither patient had a previous history of drug hypersensitivity. Both patients had previously tolerated furosemide, another sulfonamide derivative. The temporal correlation with torasemide administration suggested a causal relation, but the mechanism was unclear. 

Like all sulfonamides, sulfasalazine is contraindicated in patients with known hypersensitivity to other drags containing sulfur (thiazides, furosemide, or oral sulfonylureas), in patients with known hypersensitivity to salicylates, in patients with severe renal or hepatic dysfunction, or porphyria, during pregnancy, and during lactation, and in infants and children under age 2. Sulfasalazine is also contraindicated in patients with intestinal or urinary tract obstructions because of the risk of local GI irritation and of crystalluria. 

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