Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Furosemide may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for The name of your medicine is Frusol 40mg/5ml Oral Solution (called Frusol in this leaflet). It contains furosemide. This belongs to a group of medicines called diuretics, or water tablets. Furosemide can be used to remove the levels of excess water in the body caused by heart, lung, kidney, liver or blood vessel problems.
e Frusol Do not take Frusol and tell your doctor if: you are allergic (hypersensitive) to furosemide, sulphonamides or any other ingredients in this liquid (listed in Section 6). The signs of an allergic reaction include a rash, itching or shortness of breath you have symptoms of weakness, difficulty in breathing and light-headedness. This could be a sign of having too little water in the body you are dehydrated you are not passing water (urine) at all or only a small amount each day you have kidney failure or liver problems, including cirrhosis or liver encephalopathy (confusion, altered levels of consciousness and coma as a result of liver failure) you have a severe change in blood salts, such as high potassium or calcium levels or low sodium or magnesium levels. You may notice signs of this such as muscle cramps, weakness and tiredness. You must not take other medicines or supplements that contain potassium you have low blood pressure. The signs of this include dizziness, feeling less alert than usual, fainting and general weakness you have an illness called 'Addison's disease'. This is when your adrenal glands are not working properly. It can cause weakness, tiredness, weight loss and low blood pressure you are taking digoxin, used to treat heart problems you are breast-feeding. Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Frusol. Warnings and precautions Talk to your doctor before taking Frusol, if: you have difficulty in passing water (urine), particularly if you have an enlarged prostate gland you have gout you have low levels of protein in the blood. The signs of this may include swelling, feeling sick (nausea) or being sick (vomiting), diarrhoea and stomach pain you have liver congestion (slowed blood flow through the vessels) or other liver problems you have kidney problems you have brain disorders affecting your nervous system, or a condition called porphyria. This is a disorder that can cause skin blisters, pain in and around the stomach area (abdomen) you have diabetes you are going to give this medicine to a baby that was born too early you have an abnormal heart rhythm or have a history of heart problems you are elderly (above 65), especially if you are taking risperidone for dementia you are pregnant if you are elderly, if you are taking any other medication that can cause a drop in blood pressure or if you have any medical conditions that can cause a drop in blood pressure. If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Frusol. Having operations and tests whilst on Frusol Tell your doctor, dentist or nurse you are taking this medicine if you are going to have an anaesthetic you are going to have an X-ray examination that involves taking medicines before the procedure. While you are taking this medicine, your doctor may give you regular blood tests. Your doctor will do this to monitor levels of salts, minerals and glucose in your blood and to check that your kidneys are working properly. Other medicines and Frusol Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because furosemide, the main ingredient of this medicine, can affect the way some other medicines work. Also some medicines can affect the way furosemide works. Your doctor may need to change your dose and/or to take other precautions if you are taking one of the following medicines: Aliskiren – used to treat high blood pressure Tell your doctor if you are taking any of these medicines: medicines used to treat high blood pressure known as ACE-inhibitors or Angiotensin-II receptor antagonists, such as captopril and losartan or hydralazine medicines used to treat high blood pressure or prostate problems known as alpha-blockers, such as prazosin medicines used to treat high blood pressure and other medicines used to remove water from the body known as diuretics, such as amiloride, spironolactone, acetazolamide and metolazone medicines used to treat unusual heart beats, such as amiodarone, disopyramide, flecainide, lidocaine, sotalol and mexiletine medicines used to treat angina that you spray or dissolve under your tongue such as glyceryl trinitrate or isosorbide dinitrate warfarin, used to prevent atrial fibrillation, unwanted clotting and stroke medicines used to treat high cholesterol, such as clofibrate, colestyramine or colestipol moxisylyte used to treat Raynaud's syndrome medicines used to treat pain and inflammation known as NSAIDs, such as indometacin or salicylates such as aspirin medicines used to treat inflammation known as corticosteroids, such as prednisolone and dexamethasone medicines used to treat infections caused by bacteria, such as tetracyclines (including tetracycline, oxytetracycline, minocycline, doxycycline, lymecycline) vancomycin, gentamicin, trimethoprim, cephaloridine, ceftriaxone and colistin medicines used to treat infections caused by fungus, such as amphotericin medicines used to treat infections caused by a virus, such as nelfinavir, ritonavir and saquinavir drugs used after transplants, such as tacrolimus, ciclosporin, aldesleukin medicines used for depression, such as reboxetine, amitriptyline and phenelzine medicines used for mental problems called 'psychoses', such as risperidone (see section 'Do not take Frusol'), amisulpride, sertindole, pimozide and chlorpromazine. Avoid using pimozide at the same time as furosemide lithium, used to treat extreme mood swings medicines used to help you sleep, such as chloral hydrate and triclofos atomoxetine used to treat Attention Deficit Hyperactivity Disorder (ADHD) medicines used to treat epilepsy, such as carbamazepine, phenobarbital and phenytoin medicines used to treat Parkinson's disease such as levodopa medicines used to treat diabetes, including insulin medicines to treat asthma, such as salmeterol, salbutamol and theophylline. These medicines also treat chronic obstructive pulmonary disease medicines used to treat blocked noses, such as ephedrine and xylometazoline medicines used to treat cancer such as cisplatin, methotrexate and aminoglutethimide medicines to relax muscles such as baclofen and tizanidine laxatives that help you go to the toilet alprostadil, used to treat male impotence oestrogen and drospirenone, used as contraceptives or in hormone replacement therapy (HRT) probenecid, used to treat gout potassium salts used to treat low potassium in the blood sucralfate, used to treat stomach ulcers. Do not take sucralfate within two hours of taking Frusol. This is because the sucralfate can stop the Frusol from working properly antihistamines, used to treat allergies such as cetirizine medicines or food containing liquorice. If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Frusol. Frusol with food, drink and alcohol You should avoid drinking alcohol while taking Frusol as this may lower your blood pressure further. Pregnancy and breast-feeding If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. You should not take this medicine if you are breast-feeding. Driving and using machines While taking this medicine you may feel less alert than normal. If this happens, do not drive a car or use any tools or machines. Frusol contains ethanol (10%v/v), liquid maltitol and propylene glycol: ethanol (Alcohol) – This medicine contains 79.5 mg of alcohol (ethanol) in each ml. The amount in 5ml of this medicine is equivalent to less than 10 ml beer or 4 ml wine. The amount of alcohol in this medicine is not likely to have an effect in adults and adolescents, and its effects in children are not likely to be noticeable. It may have some effects in younger children, for example feeling sleepy. The alcohol in this medicine may alter the effects of other medicines. Talk to your doctor or pharmacist if you are taking other medicines. If you are pregnant or breast-feeding, talk to your doctor or pharmacist before taking this medicine. If you are addicted to alcohol, talk to your doctor or pharmacist before taking this medicine. liquid maltitol (E 965) – If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. F1MD1RBJ5 V3
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JOB INFORMATION
Keyline Ref:
Frusol 40mg/5ml Oral Solution
Dimensions: 150 x 500mm
EAN Code: N/A
Folded Size: 150mm x 33mm
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propylene glycol (E1520) – This medicine contains 0.35 mg propylene glycol in each 5ml. If your baby is less than 4 weeks old, talk to your doctor or pharmacist before giving them this medicine, in particular if the baby is given other medicines that contain propylene glycol or alcohol. This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially 'sodium-free'.
3. How to take Frusol Always take this medicine exactly as your doctor or pharmacist has told you. Look on the label and check with your doctor or pharmacist if you are not sure. Taking this medicine this medicine contains 40mg of furosemide in each 5ml take this medicine by mouth this medicine can also be administered via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes: 1. ensure the tube is clear before taking the medicine 2. flush the tube with a minimum of 5mL of water 3. administer the medicine gently and slowly into the tube, with a suitable measuring device 4. flush the tube again with a minimum of 5mL of water. A 10mL flush volume should be used for large bore size tubes (18 Fr). it is best to take your dose in the morning plan your doses so that they do not affect your personal activities and sleep ask your doctor or pharmacist to help you plan the best time to take this medicine. Adults The usual dose for adults is: 40mg each day take the dose prescribed by your doctor. Use in children The usual dose for children is: 1mg to 3mg for each kilogram of the child's body weight the correct dose will be worked out by the doctor children should not take more than 40mg each day. Older People If you are an older person, your doctor may start you on a lower dose and gradually raise this dose. If you take more Frusol than you should If you take more of the medicine than you should, talk to a doctor or go to a hospital straight away. Take the medicine pack with you so the doctor knows what you have taken. If you forget to take Frusol If you forget a dose, take it as soon as you remember it. However, if it is nearly time for the next dose, skip the missed dose Do not take a double dose (two doses at the same time) to make up for a forgotten dose. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them. If you have any of the following side effects while taking your medicine tell your doctor immediately or go to hospital straight away: severe allergic reaction which may include a skin rash, itching, dermatitis, peeling skin, sensitivity to sunlight or sun lamps or fever, swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing inflammation of blood vessels (vasculitis, which may cause rash, fever and joint or muscle pains) or kidney inflammation, this may change the number of times you pass urine or you may see blood in your urine. You may have a fever, feel drowsy, or notice swelling e.g. of the ankles blood clot (causing pain, swelling or tenderness in the legs). If you get any of the following side effects, see your doctor as soon as possible: Very common: may affect more than 1 in 10 people dehydration altered balance of fluid or chemicals in the body (e.g. sodium, potassium, chlorine, calcium and magnesium) causing a dry mouth, weakness, tiredness or drowsiness, restlessness, fits, muscle pain fatigue or cramps, low pressure causing loss of concentration and slowed reactions, difficulty passing water, fast or irregular heart rate and feeling and being sick. Common: may affect up to 1 in 10 people low blood volume (hypovolaemia) increased creatinine and blood urea (seen in blood tests). Uncommon: may affect up to 1 in 100 people anaemia causing tiredness, breathlessness, unusual bleeding or bruising changes in the body seen in tests such as levels of cholesterol, glucose, uric acid gout changes in vision including blurred or yellow vision light-headedness, sensations of pressure in the head, headache, drowsiness, weakness, changes in vision, dry mouth, dizziness when standing. irregular heartbeat muscle cramps or weakness changes in the amount or need to urinate tiredness dry mouth, thirst feeling or being sick changes in bowel movements including diarrhoea and constipation deafness (sometimes irreversible). Rare: may affect up to 1 in 1,000 people changes in blood cells such as amount of white blood cells, reduction of platelets causing a rash fever, sweating, tiredness, and weight loss. Your doctor will perform regular blood tests to ensure no changes have occurred psychiatric disorder NOC causing delusions, hallucinations, disorganized speech feeling `pins and needles' or tingling sensation confusion headache `ringing' in the ears, loss of hearing usually reversible symptoms of shock such as changes in heart rate, breathlessness, cool clammy skin inflammation of the pancreas causing pains in your abdomen or back and nausea changes in the liver causing yellowing of the skin or whites of the eyes skin rashes tiredness, generally feeling unwell fever acute kidney failure kidney damage (interstitial nephritis). Very rare: may affect up to 1 in 10,000 people involuntary movements of the muscle inflammation or failure of the kidney which may cause back pain or changes in the amount or need to urinate. Not known: frequency cannot be estimated from the available data worsening of conditions where there is already balances of fluid or chemicals in the body acute generalised exanthematous pustulosis (AGEP) (acute febrile drug eruption) dizziness, fainting and loss of consciousness (caused by symptomatic hypotension) decreased levels of potassium in the body. This medicine may raise cholesterol and lipid (fat) levels in the blood. If this medicine is used in babies born too soon (prematurely), this medicine can cause: persistence of a blood channel that normally closes at or around birth. This may cause heart failure, failure to grow, shortness of breath and rapid pulse kidney stones and/or calcium deposits in the body. Tell your doctor if you get any of these side effects: feeling sick (nausea) or being sick (vomiting) generally feeling unwell. If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme www.mhra.gov.uk/Yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Frusol Keep this medicine out of the sight and reach of children. Do not store above 25°C. After you open the bottle, this medicine expires after 3 months. Take this medicine back to the pharmacy three months after you first open it. Do not use this medicine after the expiry date which is stated on the label and carton (exp: month, year). The expiry date refers to the last day of that month. Do not use Frusol if you notice that the appearance or smell of your medicine has changed. Talk to your pharmacist. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information What Frusol 40mg/5ml Oral Solution contains The active substance is furosemide. The other ingredients are ethanol, sodium hydroxide, cherry flavour (containing ethanol and propylene glycol (E1520)), liquid maltitol (E965), disodium hydrogen phosphate (E339), citric acid monohydrate (E330), and purified water. What Frusol 40mg/5ml Oral Solution looks like and contents of the pack A clear colourless to straw coloured liquid that smells like cherry. It comes in a brown glass bottle holding 150ml of solution. Marketing Authorisation Holder and Manufacturer Rosemont Pharmaceuticals Ltd, Yorkdale Industrial Park, Braithwaite Street, Leeds, LS11 9XE, UK. This leaflet was last revised in February 2024 F1MD1RBJ5 V3
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Keyline Ref:
Frusol 40mg/5ml Oral Solution
Dimensions: 150 x 500mm
EAN Code: N/A
Folded Size: 150mm x 33mm
No. of Colours: 1
Tabbed:
Page Number: 2 of 2
Strength:
ARTWORK VERSION:
3
Date:
29.01.2024 Operator:
EVA
PRINT VERSION:
APPROVALS
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Product Name:
40mg_5ml Pack Size: 150ml Bottle Size: 150ml Design Icon: N/A
Date:
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Operator:
Print Colours: Black
New Item Code: Previous Item Code: Supplier Code: Change Control No.:
F1MD1RBJ5 F1MD1RBJ4 N/A CR-00982
Pharmacode:
UKL413
No
81
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propylene glycol (E1520) – This medicine contains 0.35 mg propylene glycol in each 5ml. If your baby is less than 4 weeks old, talk to your doctor or pharmacist before giving them this medicine, in particular if the baby is given other medicines that contain propylene glycol or alcohol. This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially 'sodium-free'.
Frusol Always take this medicine exactly as your doctor or pharmacist has told you. Look on the label and check with your doctor or pharmacist if you are not sure. Taking this medicine this medicine contains 40mg of furosemide in each 5ml take this medicine by mouth this medicine can also be administered via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes: 1. ensure the tube is clear before taking the medicine 2. flush the tube with a minimum of 5mL of water 3. administer the medicine gently and slowly into the tube, with a suitable measuring device 4. flush the tube again with a minimum of 5mL of water. A 10mL flush volume should be used for large bore size tubes (18 Fr). it is best to take your dose in the morning plan your doses so that they do not affect your personal activities and sleep ask your doctor or pharmacist to help you plan the best time to take this medicine. Adults The usual dose for adults is: 40mg each day take the dose prescribed by your doctor. Use in children The usual dose for children is: 1mg to 3mg for each kilogram of the child's body weight the correct dose will be worked out by the doctor children should not take more than 40mg each day. Older People If you are an older person, your doctor may start you on a lower dose and gradually raise this dose. If you take more Frusol than you should If you take more of the medicine than you should, talk to a doctor or go to a hospital straight away. Take the medicine pack with you so the doctor knows what you have taken. If you forget to take Frusol If you forget a dose, take it as soon as you remember it. However, if it is nearly time for the next dose, skip the missed dose Do not take a double dose (two doses at the same time) to make up for a forgotten dose. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everybody gets them. If you have any of the following side effects while taking your medicine tell your doctor immediately or go to hospital straight away: severe allergic reaction which may include a skin rash, itching, dermatitis, peeling skin, sensitivity to sunlight or sun lamps or fever, swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing inflammation of blood vessels (vasculitis, which may cause rash, fever and joint or muscle pains) or kidney inflammation, this may change the number of times you pass urine or you may see blood in your urine. You may have a fever, feel drowsy, or notice swelling e.g. of the ankles blood clot (causing pain, swelling or tenderness in the legs). If you get any of the following side effects, see your doctor as soon as possible: Very common: may affect more than 1 in 10 people dehydration altered balance of fluid or chemicals in the body (e.g. sodium, potassium, chlorine, calcium and magnesium) causing a dry mouth, weakness, tiredness or drowsiness, restlessness, fits, muscle pain fatigue or cramps, low pressure causing loss of concentration and slowed reactions, difficulty passing water, fast or irregular heart rate and feeling and being sick. Common: may affect up to 1 in 10 people low blood volume (hypovolaemia) increased creatinine and blood urea (seen in blood tests). Uncommon: may affect up to 1 in 100 people anaemia causing tiredness, breathlessness, unusual bleeding or bruising changes in the body seen in tests such as levels of cholesterol, glucose, uric acid gout changes in vision including blurred or yellow vision light-headedness, sensations of pressure in the head, headache, drowsiness, weakness, changes in vision, dry mouth, dizziness when standing. irregular heartbeat muscle cramps or weakness changes in the amount or need to urinate tiredness dry mouth, thirst feeling or being sick changes in bowel movements including diarrhoea and constipation deafness (sometimes irreversible). Rare: may affect up to 1 in 1,000 people changes in blood cells such as amount of white blood cells, reduction of platelets causing a rash fever, sweating, tiredness, and weight loss. Your doctor will perform regular blood tests to ensure no changes have occurred psychiatric disorder NOC causing delusions, hallucinations, disorganized speech feeling `pins and needles' or tingling sensation confusion headache `ringing' in the ears, loss of hearing usually reversible symptoms of shock such as changes in heart rate, breathlessness, cool clammy skin inflammation of the pancreas causing pains in your abdomen or back and nausea changes in the liver causing yellowing of the skin or whites of the eyes skin rashes tiredness, generally feeling unwell fever acute kidney failure kidney damage (interstitial nephritis). Very rare: may affect up to 1 in 10,000 people involuntary movements of the muscle inflammation or failure of the kidney which may cause back pain or changes in the amount or need to urinate. Not known: frequency cannot be estimated from the available data worsening of conditions where there is already balances of fluid or chemicals in the body acute generalised exanthematous pustulosis (AGEP) (acute febrile drug eruption) dizziness, fainting and loss of consciousness (caused by symptomatic hypotension) decreased levels of potassium in the body. This medicine may raise cholesterol and lipid (fat) levels in the blood. If this medicine is used in babies born too soon (prematurely), this medicine can cause: persistence of a blood channel that normally closes at or around birth. This may cause heart failure, failure to grow, shortness of breath and rapid pulse kidney stones and/or calcium deposits in the body. Tell your doctor if you get any of these side effects: feeling sick (nausea) or being sick (vomiting) generally feeling unwell. If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme www.mhra.gov.uk/Yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
Frusol Keep this medicine out of the sight and reach of children. Do not store above 25°C. After you open the bottle, this medicine expires after 3 months. Take this medicine back to the pharmacy three months after you first open it. Do not use this medicine after the expiry date which is stated on the label and carton (exp: month, year). The expiry date refers to the last day of that month. Do not use Frusol if you notice that the appearance or smell of your medicine has changed. Talk to your pharmacist. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
What Frusol 40mg/5ml Oral Solution contains The active substance is furosemide. The other ingredients are ethanol, sodium hydroxide, cherry flavour (containing ethanol and propylene glycol (E1520)), liquid maltitol (E965), disodium hydrogen phosphate (E339), citric acid monohydrate (E330), and purified water. What Frusol 40mg/5ml Oral Solution looks like and contents of the pack A clear colourless to straw coloured liquid that smells like cherry. It comes in a brown glass bottle holding 150ml of solution. Marketing Authorisation Holder and Manufacturer Rosemont Pharmaceuticals Ltd, Yorkdale Industrial Park, Braithwaite Street, Leeds, LS11 9XE, UK. This leaflet was last revised in February 2024 F1MD1RBJ5 V3
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Keyline Ref:
Frusol 40mg/5ml Oral Solution
Dimensions: 150 x 500mm
EAN Code: N/A
Folded Size: 150mm x 33mm
No. of Colours: 1
Tabbed:
Page Number: 2 of 2
Strength:
ARTWORK VERSION:
3
Date:
29.01.2024 Operator:
EVA
PRINT VERSION:
APPROVALS
JOB SPECIFICATION
Product Name:
40mg_5ml Pack Size: 150ml Bottle Size: 150ml Design Icon: N/A
Date:
COLOURS
Operator:
Print Colours: Black
New Item Code: Previous Item Code: Supplier Code: Change Control No.:
F1MD1RBJ5 F1MD1RBJ4 N/A CR-00982
Pharmacode:
UKL413
No
81
MAIN BODY TEXT Font Type:
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Frusol 40mg/5ml Oral Solution comes as oral solution containing 40mg / 5ml. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Frusol 40mg/5ml Oral Solution is furosemide.
Medicines with the same active substance, strength and form include: Furosemide 40 mg/5 ml Oral Solution. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for Frusol 40mg/5ml Oral Solution, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Furosemide is indicated in all conditions requiring prompt diuresis, including cardiac, pulmonary, hepatic and renal oedema, peripheral oedema due to mechanical obstruction or venous insufficiency and hypertension.
It is also indicated for the maintenance therapy of mild oedema of any origin.
Posology
Adults
The usual initial daily dose is 40mg. This may be adjusted until an effective dose is achieved.
Paediatric population
1 to 3mg/Kg body weight daily up to a maximum total dose of 40mg/day.
Elderly
In the elderly, Furosemide is generally eliminated more slowly. Dosage should be titrated until the required response is achieved.
Method of administration
For oral use.
Suitable for administration via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes. For further instructions see section 6.6.
The medication should be administered in the morning to avoid nocturnal diuresis.
Contra-indicated conditions
See also
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 or sulphonamides, sulphonamide derivatives.
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Hypovolaemia and dehydration (with or without accompanying hypotension)
Section 4.4
Severe hypokalaemia: severe hyponatraemia
Section 4.4
Comatose or pre-comatose states associated with hepatic cirrhosis or encephalopathy
Section 4.4
Anuria or renal failure with anuria not responding to furosemide, renal failure as a result of poisoning by nephrotoxic or hepatotoxic agents
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Impaired renal function with a creatinine clearance below 30ml/min per 1.73 m2 body surface area
Section 4.4
Addison's disease
Section 4.4
Digitalis intoxication
Section 4.5
Concomitant potassium supplements or potassium sparing diuretics
Section 4.5
Breast-feeding women
Section 4.6
Conditions requiring correction before furosemide is started (see also section 4.3)
• Hypotension
• Hypovolaemia
• Severe electrolyte disturbances – particularly hypokalaemia, hyponatraemia and acid-base disturbances
Furosemide is not recommended
• In patients at high risk for radiocontrast nephropathy - it should not be used for diuresis as part of the preventative measures against radiocontrast-induced nephropathy.
• In elderly patients with dementia taking risperidone - Increased mortality (see below and section 4.5)
Particular caution and/or dose reduction required:
• elderly patients (lower initial dose as particularly susceptible to side-effects - see section 4.2).
• difficulty with micturition including prostatic hypertrophy (increased risk of urinary retention: consider lower dose). Closely monitor patients with partial occlusion of the urinary tract
• in moderate liver congestion dosage adjustment may be needed
• diabetes mellitus (latent diabetes may become overt: insulin requirements in established diabetes may increase: stop furosemide before a glucose tolerance test)
• pregnancy (see section 4.6)
• gout (furosemide may raise uric acid levels/precipitate gout)
• impaired hepatic function – hepatic failure and alcoholic cirrhosis particularly predispose to hypokalaemia and hypomagnesaemia (see section 4.3 and below – monitoring required)
• impaired renal function and hepato-renal syndrome (see section 4.3 and below – monitoring required)
• adrenal disease (see section 4.3 – contraindication in Addison's disease)
• hypoproteinemia e.g. nephrotic syndrome (effect of furosemide may be impaired and its ototoxicity potentiated - cautious dose titration required).
• acute hypercalcaemia (dehydration results from vomiting and diuresis - correct before giving furosemide). Treatment of hypercalcaemia with a high dose of furosemide results in fluid and electrolyte depletion - meticulous fluid replacement and correction of electrolyte required
• premature infants – possible development of nephrocalcinosis/ nephrolithiasis (see below – monitoring of renal function required)
• some diuretics have been considered unsafe in acute porphyria
• symptomatic hypotension leading to dizziness, fainting or loss of consciousness can occur in patients treated with furosemide, particularly in the elderly, patients on other medications which can cause hypotension and patients with other medical conditions that are risks for hypotension.
Avoidance with other medicines (see also section 4.5 for other interactions)
• concurrent NSAIDs should be avoided – if not possible diuretic effect of furosemide may be attenuated
• ACE-inhibitors & Angiotensin II receptor antagonists – severe hypotension may occur – dose of furosemide should be reduced/stopped (3 days) before starting or increasing the dose of these
• concurrent risperidone in elderly patients with dementia has resulted in increased mortality – no mechanism for and no consistent pattern of deaths identified (see section 4.5)
Laboratory and other monitoring requirements:
• Serum sodium
Particularly in the elderly or in patients liable to electrolyte deficiency
• Serum potassium
The possibility of hypokalaemia should be taken into account, in particular in patients with cirrhosis of the liver, those receiving concomitant treatment with corticosteroids, those with an unbalanced diet and those who abuse laxatives. Regular monitoring of the potassium, and if necessary treatment with a potassium supplement, is recommended in all cases, but is essential at higher doses and in patients with impaired renal function. It is especially important in the event of concomitant treatment with digoxin, as potassium deficiency can trigger or exacerbate the symptoms of digitalis intoxication (see section 4.5). A potassium-rich diet is recommended during long-term use.
Frequent checks of the serum potassium are necessary in patients with impaired renal function and creatinine clearance below 60ml/min per 1.73m2 body surface area as well as in cases where furosemide is taken in combination with certain other drugs which may lead to an increase in potassium levels (see section 4.5 & refer to section 4.8 for details of electrolyte and metabolic abnormalities)
• Renal function
Frequent BUN in first few months of treatment, periodically thereafter. Long-term/high-dose BUN should regularly be measured. Marked diuresis can cause reversible impairment of kidney function in patients with renal dysfunction. Adequate fluid intake is necessary in such patients. Serum creatinine and urea levels tend to rise during treatment. If used in premature infants there is a risk of nephrocalcinosis/nephrolithiasis so renal function must be monitored and renal ultrasonography performed
• Glucose
Adverse effect on carbohydrate metabolism - exacerbation of existing carbohydrate intolerance or diabetes mellitus. Regular monitoring of blood glucose levels is desirable.
• Other electrolytes
Patients with hepatic failure/alcoholic cirrhosis are particularly at risk of hypomagnesemia (as well as hypokalaemia). During long-term therapy (especially at high doses) magnesium, calcium, chloride, bicarbonate and uric acid should be regularly measured.
• Lipids
Serum cholesterol and triglycerides may rise but usually return to normal within 6 months of starting furosemide.
Clinical monitoring requirements (see also section 4.8):
Regular monitoring for
• blood dyscrasias. If these occur, stop furosemide immediately
• liver damage
• idiosyncratic reactions
Excipient Warnings
This product contains:
• Ethanol (Alcohol) – This medicine contains 79.5 mg of alcohol (ethanol) in each ml. The amount in 5ml of this medicine is equivalent to less than 10 ml beer or 4 ml wine. The amount of alcohol in this medicine is not likely to have an effect in adults and adolescents, and its effects in children are not likely to be noticeable. It may have some effects in younger children, for example feeling sleepy. The alcohol in this medicine may alter the effects of other medicines. Talk to your doctor or pharmacist if you are taking other medicines. If you are pregnant or breast-feeding, talk to your doctor or pharmacist before taking this medicine. If you are addicted to alcohol, talk to your doctor or pharmacist before taking this medicine.
• Liquid Maltitol (E 965) – Patients with rare hereditary problem of fructose intolerance should not take this medicine.
• Propylene Glycol (E1520) – This medicine contains 0.35 mg propylene glycol in each 5ml. If your baby is less than 4 weeks old, talk to your doctor or pharmacist before giving them this medicine, in particular if the baby is given other medicines that contain propylene glycol or alcohol.
• This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially 'sodium-free'.
Antihypertensives – enhanced hypotensive effect possible with all types. Concurrent use with ACE inhibitors or Angiotensin II receptor antagonists can result in marked falls in blood pressure, furosemide should be stopped or the dose reduced before starting an ACE-inhibitor or Angiotensin II receptor antagonists (see section 4.4). Increased risk of first dose hypotension with post-synaptic alpha-blockers (eg prazosin). Furosemide may interact with ACE inhibitors causing impaired renal function.
Aliskiren - reduces the plasma concentration of furosemide given orally. Reduced effect of furosemide might be observed in patients treated with both aliskiren and oral furosemide, and it is recommended to monitor for reduced diuretic effect and adjust the dose accordingly.
Antipsychotics – furosemide-induced hypokalaemia increases the risk of cardiac toxicity. Avoid concurrent use with pimozide. Increased risk of ventricular arrhythmias with pimozide (avoid concurrent use), amisulpride or sertindole. Enhanced hypotensive effect with phenothiazines.
In placebo-controlled trials in elderly patients with dementia, a higher incidence of mortality was observed in patients treated with furosemide plus risperidone. No consistent pattern for cause of death was observed but caution should be exercised and the risks and benefits of this combination considered prior to the decision to use.
Anti-arrhythmics (including amiodarone, disopyramide, flecainide and sotalol) - risk of cardiac toxicity (because of furosemide-induced hypokalaemia). The effects of lidocaine, tocainide or mexiletine may be antagonised by furosemide.
Cardiac glycosides – hypokalaemia and electrolyte disturbances (including hypomagnesemia) increase the risk of cardiac toxicity.
Drugs that prolong Q-T interval – increased risk of toxicity with furosemide induced electrolyte disturbances.
Vasodilators – enhanced hypotensive effect with moxisylyte (thymoxamine) or hydralazine.
Other diuretics – profound diuresis possible when furosemide given with metolazone. Increased risk of hypokalaemia with thiazides. Contraindicated with potassium sparing diuretics (e.g. amiloride spironolactone) - increased risk of hyperkalaemia (see section 4.3).
Renin inhibitors – aliskiren reduces plasma concentrations of furosemide.
Nitrates – enhanced hypotensive effect.
Lithium - furosemide reduces lithium excretion with increased plasma lithium concentrations (risk of cardio- and/or neuro-toxicity). Avoid concomitant administration unless plasma levels are monitored.
Chelating agents – sucralfate may decrease the gastro-intestinal absorption of furosemide – the 2 drugs should be taken at least 2 hours apart.
Lipid regulating drugs – Bile acid sequestrants (eg colestyramine: colestipol) – reduced absorption of furosemide – administer 2 to 3 hours apart.
NSAIDs – increased risk of nephrotoxicity (especially with pre-existing hypovolaemia/dehydration. Indometacin and ketorolac may antagonise the effects of furosemide (avoid if possible see section 4.4). In patients with dehydration or hypovolaemia, NSAIDs may cause acute renal insufficiency.
Salicylates – effects may be potentiated by furosemide. Salicylic toxicity may be increased by furosemide.
Antibiotics – increased risk of ototoxicity with aminoglycosides, polymixins or vancomycin - only use concurrently if compelling reasons. Increased risk of nephrotoxicity with aminoglycosides or cefaloridine. Furosemide can decrease vancomycin serum levels after cardiac surgery. Increased risk of hyponatraemia with trimethoprim. Concurrent use with tetracyclines may increase the risk of rising BUN (see section 4.4 – monitoring).
Antiviral – plasma concentrations of diuretics may be increased by nelfinavir, ritonavir or saquinavir.
Antidepressants – enhanced hypotensive effect with MAOIs. Increased risk of postural hypotension with TCAs (tricyclic antidepressants). Increased risk of hypokalaemia with reboxetine.
Antidiabetics – hypoglycaemic effects antagonised by furosemide.
Insulin - requirements may be increased (see section 4.4).
Antiepileptics – increased risk of hyponatraemia with carbamazepine. Diuretic effect reduced by phenytoin.
Antihistamines – hypokalaemia with increased risk of cardiac toxicity.
Antifungals – increased risk of hypokalaemia and nephrotoxicity with amphotericin.
Anxiolytics and hypnotics – enhanced hypotensive effect. Chloral hydrate or triclofos may displace thyroid hormone from binding site.
CNS stimulants (drugs used for ADHD) – hypokalaemia increases the risk of ventricular arrhythmias.
Corticosteroids – diuretic effect antagonised (sodium retention) and increased risk of hypokalaemia.
Cytotoxics – increased risk of nephrotoxicity and ototoxicity with platinum compounds/cisplatin.
Anti-metabolites – effects of furosemide may be reduced by methotrexate and furosemide may reduce renal clearance of methotrexate
Potassium salts – contraindicated - increased risk of hyperkalaemia (see section 4.3)
Dopaminergics – enhanced hypotensive effect with levodopa.
Immunomodulators – enhanced hypotensive effect with aldesleukin. Increased risk of hyperkalaemia with ciclosprin and tacrolimus. Increased risk of gouty arthritis with ciclosporin
Muscle relaxants – enhanced hypotensive effect with baclofen or tizanidine. Increased effect of curare-like muscle relaxants
Oestrogens – diuretic effect antagonised
Progestogens (drospirenone) – increased risk of hyperkalaemia and diuretic effect antagonised.
Prostaglandins – enhanced hypotensive effect with alprostadil
Sympathomimetics – increased risk of hypokalaemia with high doses of beta2 sympathomimetics
Theophylline – enhanced hypotensive effect
Probenecid –effects of furosemide may be reduced by probenecid and furosemide may reduce renal clearance of probenecid.
Anaesthetic agents – general anaesthetic agents may enhance the hypotensive effects of furosemide. The effects of curare may be enhanced by furosemide.
Warfarin and clofibrate – compete with furosemide in binding to serum albumin – possibly significant if this is low (eg nephrotic syndrome).
Aminoglutethimide – concomitant use may increase the risk of hyponatraemia
Alcohol – enhanced hypotensive effect
Laxative abuse - increases the risk of potassium loss
Liquorice - excess intake may increase the risk of hypokalaemia.
Pregnancy
Frusol must not be given during pregnancy unless there are compelling medical reasons.
Breast-feeding
Furosemide may inhibit lactation and may pass into breast milk. Women must not breastfeed if they are treated with furosemide.
Mental alertness may be reduced and the ability to drive or operate machinery may be impaired.
Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); Frequency not known (cannot be estimated from the available data)
Blood and lymphatic system disorders:
Uncommon:
aplastic anaemia
Rare:
bone marrow depression (necessitates withdrawal of treatment), eosinophilia, leucopenia.
Very rare:
haemolytic anaemia, agranulocytosis, thrombocytopenia
Metabolism and nutritional disorders:
Very common:
dehydration, hyponatraemia, hypochloremic metabolic alkalosis, hypocalcaemia, hypomagnesemia (incidences of the last three are reduced by triamterene)
Common:
Hypovolaemia, hypochloraemia
Uncommon:
impaired glucose tolerance (by hypokalaemia) hyperuricaemia, gout, reduction of serum HDL-cholesterol, elevation of serum LDL-cholesterol, elevation of serum triglycerides, hyperglycaemia.
Very rare:
tetany
Frequency not known:
aggravated pre-existing metabolic alkalosis (in decompensated cirrhosis of the liver), fluid and electrolyte disturbances, excretion of potassium increased* In patients with diabetes mellitus this may lead to deterioration of metabolic control; latent diabetes mellitus may become manifest
Psychiatric disorder:
Rare:
psychiatric disorder NOC
Nervous system disorders:
Rare:
paraesthesia, confusion, headache
Not known:
dizziness, fainting and loss of consciousness (caused by symptomatic hypotension)
Eye disorders:
Uncommon:
visual disturbance, blurred vision, yellow vision.
Ear and labyrinth disorders:
Uncommon:
deafness (sometimes irreversible)
Rare:
tinnitus and reversible or irreversible loss of hearing (although usually transitory, particularly in patients with renal failure, hypoproteinaemia (e.g. in nephritic syndrome)
Cardiac disorders:
Uncommon:
orthostatic intolerance, cardiac arrhythmias, increased risk or persistence of patent ductus arteriosus in premature infants.
Vascular disorders:
Very common:
hypotension, (which, if pronounced may cause signs and symptoms such as impairment of concentration and reactions, light-headedness, sensations of pressure in the head, headache, drowsiness, weakness, disorders of vision, dry mouth, orthostatic intolerance).
Rare:
vasculitis, thrombosis, shock
Gastrointestinal disorders:
Uncommon:
dry mouth, thirst, nausea, bowel motility disturbances, vomiting, diarrhoea, constipation
Rare:
acute pancreatitis (in long-term diuretic treatment, including furosemide).
Hepatobiliary disorders:
Rare:
pure intrahepatic cholestasis (jaundice), hepatic function abnormal.
Frequency not known:
Hepatic encephalopathy in patients with hepatocellular insufficiency may occur.
Skin and subcutaneous tissue disorders:
Rare:
rash, pruritus, photosensitivity, toxic epidermal necrolysis.
Frequency not known:
urticaria, erythema multiforme, purpura, exfoliative dermatitis, itching, allergic reactions, such as skin rashes, various forms of dermatitis including urticaria, bullous lesions, acute generalised exanthematous pustulosis (AGEP). When these occur treatment should be withdrawn. Steven-Johnson's syndrome
Musculoskeletal and connective tissue disorders:
Uncommon:
muscle cramps, muscle weakness.
Renal and urinary disorders:
Very common:
nephrocalcinosis in infants
Uncommon:
reduced diuresis, urinary incontinence, urinary obstruction (in patients with hyperplasia of the prostate, bladder inability to empty, urethral stricture unspecified).
Rare:
interstitial nephritis, acute renal failure.
Congenital, familial and genetic disorders:
Rare:
patent ductus arteriosus
General disorders and administration site conditions:
Uncommon:
Fatigue
Rare:
malaise, fever, severe anaphylactoid or anaphylactic reactions (e.g. with shock).
Investigations:
Common:
creatinine increased, blood urea increased
Rare:
Transaminases increased, blood
*Potassium deficiency manifests itself in neuromuscular symptoms (muscular weakness, paralysis), intestinal symptoms (vomiting, constipation, meterorism), renal symptoms (polyuria) or cardiac symptoms. Severe potassium depletion can result in paralytic ileus or confusion, which can result in coma.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.
Symptoms
Overdosing may lead to dehydration and electrolyte depletion through excessive diuresis. Severe potassium loss may lead to serious cardiac arrhythmias.
Management
Treatment of overdose consists of fluid replacement and electrolyte imbalance correction.
Ask anything about Frusol 40mg/5ml Oral Solution. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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