Furosemide NSAIDs

Amantadine, amiodarone, barbiturates, benzodiazepines, carbamazepine, chlorpromazine, fluoroquinolones, furosemide, NSAIDs, promethazine, psoralens, quinidine, simvastatin, sulfonamide antimicrobials, sulfonylureas, tetracyclines, and thiazides... 

Cephalosporins Cimetidine Furosemide NSAIDs Probenecid Ranitidine Tetracycline Various anticancer ... 

Allergic interstitial nephritis Penicillins, rifampin, sulfonamides, thiazides, cimetidine.phenytoin, allopurinol, furosemide, NSAIDS, ciprofloxacin, pantoprazole, omeprazole, atazanavir, bevacizumab Rash, fever, eosinophilia, eosinophiluria, pyuria... 

Nephrotoxins (N) orototoxins (0) (eg., amphotericin B (N), cisplatin (N/0), cyclosporine (N), furosemide (0), NSAIDs (N), radio contrast (N), vancomycin (N) Additive adverse effects Monitor aminoglycoside SDC and renal function... 

Uses Edema, HTN, CHF, h atic cirrhosis Action Loop diuretic -1- reabsorption of Na Cr in ascending loop of Henle distal tubule Dose 5-20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic -1- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions t Risk of ototox W/ aminoglycosides, cisplatin t effects W/ thiazides t effects OF anticoagulants, antih5rpCTtensives, Li, salicylates X effects IT/barbiturates, carbamaz ine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandehon EMS t Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

The loop diuretics are rapidly absorbed. They are eliminated by the kidney by glomerular filtration and tubular secretion. Absorption of oral torsemide is more rapid (1 hour) than that of furosemide (2-3 hours) and is nearly as complete as with intravenous administration. The duration of effect for furosemide is usually 2-3 hours and that of torsemide is 4-6 hours. Half-life depends on renal function. Since loop agents act on the luminal side of the tubule, their diuretic activity correlates with their secretion by the proximal tubule. Reduction in the secretion of loop diuretics may result from simultaneous administration of agents such as NSAIDs or probenecid, which compete for weak acid secretion in the proximal tubule. Metabolites of ethacrynic acid and furosemide have been identified, but it is not known if they have any diuretic activity. Torsemide has at least one active metabolite with a half-life considerably longer than that of the parent compound. 

Drugs that can precipitate lactic acidosis in patients taking metformin include ACE inhibitors, thiazide diuretics, NSAIDs, and drugs such as furosemide, nifedipine, cimetidine, amiloride, triamterene, trimethoprim, and digoxin, which are all secreted in the renal tubules, compete with metformin, and can contribute to increased plasma metformin concentrations (76). 

P-Lactam antibiotics Cephalosporins Cidofovir Furosemide Ganciclovir Methotrexate NSAIDs Probenecid Tetracycline Zidovudine KW-3902 ... 

Furosemide inhibits the absorption of indometacin (42), while the diuretic and hypotensive effects of most diuretics are blunted by indometacin and probably also other NSAIDs (43). Intravenous furosemide is commonly given to patients with acute heart failure to relieve pulmonary congestion. Symptomatic relief occurs before the onset of diuresis, and the beneficial effect is believed to result from a venodUator action of furosemide, which precedes its diuretic effect. This venodilator response is inhibited by indometacin, suggesting that it occurs through local prostaglandin release. 

Furosemide inhibits the absorption of meloxicam (44), an NSAID that is relatively selective for COX-2, sparing the physiologically important isoform that mediates vasodilator prostaglandins, which maintain renal function. 

A 62-year-old woman developed acute renal insufficiency after using topical ketoprofen for 5 days (11). She had several predisposing factors to NSAID-induced acute renal insufficiency, such as advanced age, chronic renal impairment due to polycystic kidney disease, and treatment with an ACE inhibitor and furosemide. 

In 600 elderly patients with documented congestive cardiac failure there was a possible or probable link between NSAIDs and heart failure in 27 cases (32). In some, the mechanism was apparently a reduction in the effect of furosemide. In others the NSAID may have caused an imbalance in circulatory homeostasis. Preexisting renal impairment was not observed in any of the 27 cases. This study suggests that in elderly people congestive heart failure may be a complication of NSAIDs. 

NSAiDs, giafenin, ASA, fenoprofen, naproxen, phenyibutazone, piroxacam, tolemetin, zomepirac, contrast media, suifonamides, thiazides, phenytoin, furosemide, aiiopurinoi, cimetidine, omeprazole, phenindione. ... 

Slc21a4) taurocholate, thyroid hormones Drugs AZT, MTX Drugs NSAIDs, furosemide, valproate... 

May decrease antihypertensive effects of ACE inhibitors and angiotensin II antagonists decrease of antihypertensive and diuretic effects of hydrochlorothiazide and furosemide concomitant use with other NSAIDs may increase Gl adverse effects. 

Clinically important, potentially hazardous interactions with amphotericin B, benzodiazepines, doripenem, ertapenem, fludoxacillin, furosemide, glibenclamide, ketoprofen, ketorolac, methotrexate, NSAIDs, pemetrexed, penicillamine, penicillin G, penicillin V, salicylates, sulfamethoxazole, sulfonamides, torasemide, torsemide... 

Drugs that are commonly associated with vasculitis are ACE inhibitors, amiodarone, ampicillin, cimetidine, coumadin, furosemide, hydantoins, hydralazine, NSAIDs, pyrazolons, quinidine, sulfonamides, thiazides, and thiouracils. 

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