Side Effects of furosemide: A Synthesis of Findings from 13 Studies

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Original Abstract of the Article

Main Research Findings

Furosemide is a diuretic drug used to treat various diseases such as heart failure, kidney dysfunction, and hypertension. Furosemide works by inhibiting sodium and water reabsorption in the kidneys, increasing urine output, and eliminating excess fluid from the body. However, it is also known that furosemide can cause various side effects.

Research has reported side effects of furosemide including kidney dysfunction, electrolyte abnormalities, tinnitus, and hearing loss. 13 shows that furosemide can increase the risk of kidney dysfunction when administered continuously to patients with heart failure. 5 reports that furosemide has the effect of preventing renal side effects of indomethacin therapy in premature infants. 3 reports that furosemide does not prevent the renal side effects of indomethacin in preterm infants. Also, 4 suggests that furosemide may cause tinnitus and hearing loss.

Many of the side effects of furosemide are thought to be caused by an imbalance in electrolytes. 9 reports a case of milk-alkali syndrome, characterized by hypercalcemia, metabolic alkalosis, and kidney dysfunction, caused by loop diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities.

Reasons for Side Effects

The side effects of furosemide are caused by its inhibition of sodium and water reabsorption in the kidneys. When sodium and water reabsorption is inhibited, urine output increases and excess fluid is eliminated from the body. Therefore, the electrolyte balance in the body may be disrupted, leading to various side effects.

Common Side Effects

Kidney dysfunction

Furosemide can cause kidney dysfunction because it inhibits sodium and water reabsorption in the kidneys. 13 shows that furosemide can increase the risk of kidney dysfunction when administered continuously to patients with heart failure. 7 reports a case of kidney dysfunction caused by vitamin D3 intoxication, suggesting that furosemide and other diuretics may also contribute to kidney burden.

Electrolyte abnormalities

Furosemide can cause electrolyte abnormalities because it inhibits the reabsorption of electrolytes such as sodium, potassium, and calcium in the kidneys. 9 reports a case of milk-alkali syndrome, characterized by hypercalcemia, metabolic alkalosis, and kidney dysfunction, caused by loop diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities.

Tinnitus and hearing loss

Furosemide can affect the hair cells of the inner ear, potentially causing tinnitus and hearing loss. 4 suggests that furosemide may cause tinnitus and hearing loss. 12 suggests that aminoglycoside antibiotics, including furosemide, may cause hearing loss by inhibiting the MET channels of hair cells in the inner ear.

Side Effect Management

Kidney dysfunction

To prevent kidney dysfunction, it is important to adjust the dosage of furosemide. If kidney function is impaired, it is necessary to reduce the dosage as instructed by a physician. 13 suggests that intermittent administration of furosemide may be less risky for kidney dysfunction than continuous administration in patients with heart failure.

Electrolyte abnormalities

To prevent electrolyte abnormalities, it is important to regularly check electrolyte balance through blood tests. If electrolyte abnormalities are detected, it is necessary to supplement electrolytes as instructed by a physician. 9 reports a case of milk-alkali syndrome, characterized by hypercalcemia, metabolic alkalosis, and kidney dysfunction, caused by loop diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities.

Tinnitus and hearing loss

Tinnitus and hearing loss may improve if the dosage of furosemide is reduced. If you are concerned about tinnitus or hearing loss, consult with your doctor. 12 suggests that aminoglycoside antibiotics, including furosemide, may cause hearing loss by inhibiting the MET channels of hair cells in the inner ear.

Comparison between Studies

Common points of studies

Multiple studies have reported kidney dysfunction, electrolyte abnormalities, tinnitus, and hearing loss as side effects of furosemide.

Differences between studies

The risk of side effects may vary depending on the administration method of furosemide. 13 suggests that intermittent administration of furosemide may be less risky for kidney dysfunction than continuous administration in patients with heart failure. On the other hand, 2 reports that continuous administration of furosemide in horses leads to higher diuretic efficacy, less fluctuation in fluids and electrolytes, and suppression of renin-angiotensin-aldosterone system (RAAS) activation. Furthermore, 5 and 3 show conflicting results regarding the preventive effect of furosemide on renal side effects of indomethacin in preterm infants.

Precautions for Real-life Application

Furosemide is an effective drug used to treat various diseases, but it is important to consider the risk of side effects. If you are taking furosemide, it is important to follow your doctor's instructions and get regular blood tests. If you experience symptoms such as tinnitus or hearing loss, consult your doctor immediately.

Limitations of Current Research

Research on the side effects of furosemide is still insufficient. Particularly, further research is needed on the side effects of long-term furosemide administration.

Future Research Directions

It is necessary to develop new therapeutic methods to reduce the side effects of furosemide. Moreover, further research is needed on the long-term impact of long-term furosemide administration on side effects.

Conclusion

Furosemide is an effective drug used to treat various diseases such as heart failure, kidney dysfunction, and hypertension. However, furosemide can cause side effects such as kidney dysfunction, electrolyte abnormalities, tinnitus, and hearing loss. If you are taking furosemide, it is important to follow your doctor's instructions and get regular blood tests. If you experience symptoms such as tinnitus or hearing loss, consult your doctor immediately.

Literature analysis of 13 papers
Positive Content
10
Neutral Content
0
Negative Content
3
Article Type
3
0
1
2
10
1.

Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.

Author: SheaBeverley, SwindenMichael V, GhogomuElizabeth Tanjong, OrtizZulma, KatchamartWanruchada, RaderTamara, BombardierClaire, WellsGeorge A, TugwellPeter

Reduces GI side effects
Reduces hepatic dysfunction

Folic acid or folinic acid supplementation while receiving methotrexate (MTX) therapy for rheumatoid arthritis (RA) reduced the incidence of gastrointestinal side effects by 26%, abnormal serum transaminase elevation by 76.9%, and discontinuation of MTX treatment for any reason by 60.8%.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

2.

Furosemide continuous rate infusion in the horse: evaluation of enhanced efficacy and reduced side effects.

Author: JohanssonAnna M, GardnerSarah Y, LevineJay F, PapichMark G, LaFeversD Heath, FuquayLaura R, ReaganVirginia H, AtkinsClarke E

Diuretic efficacy
Fluid and electrolyte balance

Continuous rate infusion (CRI) of furosemide was compared to intermittent administration (IA) in horses. CRI produced a more uniform urine flow, decreased fluctuations in plasma volume, and suppressed renal concentrating ability. It also resulted in greater potassium, calcium, and chloride excretion. CRI is recommended when profound diuresis is needed acutely in horses.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Furosemide does not prevent indomethacin-induced renal side effects in preterm infants.

Author: RomagnoliC, ZeccaE, PapacciP, De CarolisM P, GianniniR, GalliniF, TortoroloG

Renal side effects

Furosemide did not prevent indomethacin-induced renal failure in preterm infants, but it did not negatively influence the therapeutic effectiveness of indomethacin.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Furosemide prevents the renal side effects of indomethacin therapy in premature infants with patent ductus arteriosus.

Author: YehT F, WilksA, SinghJ, BetkerurM, LilienL, PildesR S

Patent ductus arteriosus closure

Furosemide, a diuretic, was shown to prevent the renal side effects of indomethacin therapy in premature infants with patent ductus arteriosus without affecting the efficacy of indomethacin in closing the ductus.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

6.

An interesting observation: prolonged green urine can be a combined effect of decreased liver and renal function in a patient with heart failure-a case report.

Author: ÇöllüoğluTuğçe, AksuMelahat Hicran, ÖnalanOrhan, AkınYeşim

Green urine discoloration

The administration of propofol and methylene blue (MB) can cause prolonged green urine discoloration, especially in patients with heart failure (HF) and renal and liver dysfunction.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

7.

[A rare cause of kidney injury: vitamin D3 intoxication].

Author: HutkaiDávid, BodorMiklós

Vitamin D treatment
Kidney damage
Vitamin D intoxication

This case report highlights the dangers of excessive vitamin D supplementation and discusses the diagnosis, differential diagnosis, and treatment of vitamin D intoxication. A 57-year-old female patient presented with hypercalcemia and acute tubular necrosis due to vitamin D intoxication. The case emphasizes the importance of monitoring vitamin D levels and the need for accurate diagnosis and prompt treatment in cases of intoxication.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Hungarian

8.

Case report: Alternative approach for management of refractory volume overload in heart failure: usefulness of venous leg compression.

Author: Collado MaciánCarlos, Pujol PocullDavid, DominguezFernando, López-AzorJuan Carlos, Garcia-PaviaPablo, NuñezJulio, Cobo MarcosMarta

HF congestion management
Diuretic resistance

Refractory congestion in heart failure (HF) is a significant challenge. Diuretics are commonly used to achieve euvolemia, but some patients experience fluid overload despite high doses. This highlights the need for new strategies to overcome diuretic resistance.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

10.

An unusual case of checkpoint-inhibitor-induced pleuropericarditis.

Author: SuarezZoilo K, FinkeAna C, HospedalesEmilio, PerezErnesto, SharifzadehArya, FosterJennifer, FerrisAllison

Promotes T-cell function
Anorexia
Cardiotoxicity
Fatigue
Pruritus

This study discusses the adverse events associated with pembrolizumab, an immune checkpoint inhibitor. Cardiotoxicity is a rare but potential adverse event, occurring in 1% of cases.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

Identification of a series of hair-cell MET channel blockers that protect against aminoglycoside-induced ototoxicity.

Author: KenyonEmma J, KirkwoodNerissa K, KitcherSiân R, GoodyearRichard J, DerudasMarco, CantillonDaire M, BaxendaleSarah, de la Vega de LeónAntonio, MahieuVirginia N, OsgoodRichard T, WilsonCharlotte Donald, BullJames C, WaddellSimon J, WhitfieldTanya T, WardSimon E, KrosCorné J, RichardsonGuy P

Otoprotectant

A screen of 10,240 compounds identified 8 that protected outer hair cells (OHCs) from the ototoxic effects of aminoglycoside antibiotics in vitro. These compounds blocked the mechano-electrical transducer (MET) channel, a route of aminoglycoside entry into hair cells. One of the strongest blockers, UoS-7692, protected against multiple aminoglycosides and preserved hearing in a mouse model of ototoxicity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Continuous versus intermittent use of furosemide in patients with heart failure and moderate chronic renal dysfunction.

Author: ZhengZhigui, JiangXinxin, ChenJianguo, HeDongyuan, XieXiaohui, LuYunan

ADHF treatment

This study compared the efficacy and safety of continuous infusion (CI) versus bolus injection (BI) of intravenous furosemide in patients with acute decompensated heart failure (ADHF) and chronic renal dysfunction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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