Furosemide with Germanium Interaction Details
Brand Names Associated with Furosemide
- Furosemide
- Lasix®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
Increased risk of diuretic resistance
Interaction Summary
Germanium has been noted to be nephrotoxic with increased concentrations of lipofuscin granules in the cells of the thick ascending limb of the loop of Henle. A case report suggests that the germanium content of a ginseng and germanium combination product led to hypertension and decreased diuretic (furosemide) effectiveness . Theoretically, other loop diuretics may be similarly affected.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Patients should be advised to discontinue use of germanium and germanium-supplemented ginseng products while taking loop diuretics. Long-term use of germanium is not recommended as it has been associated with chronic renal failure.
Mechanism Of Interaction
Germanium may damage cells of the thick ascending limb of the loop of Henle, diminishing the cells' responsiveness to loop diuretics
Literature Reports
A) A 63 year-old man with membranous glomerulonephritis treated with furosemide and cyclosporine was hospitalized with unremitting hypertension and edema. Ten days prior to hospitalization the patient had commenced taking 10 to 12 tablets daily of Uncle Hsu's Korean ginseng, which contained germanium as well as ginseng. On admission, blood pressure was 186/100 mmHg and serum creatinine was 115 micromoles/liter (1.3 milligram/deciliter). The patient responded to 240 milligrams (mg) of furosemide administered intravenously (IV) every eight hours (during which time he was not taking the ginseng product). He was discharged home on furosemide orally 80 mg twice daily but elected to resume intake of the germanium-supplemented ginseng product. Within 14 days, the patient experienced worsening edema and hypertension necessitating an increase in his furosemide dose to 240 mg twice daily. On readmission to the hospital, the ginseng product was discontinued and the patient was given furosemide 240 mg IV every eight hours. Within 48 hours of discontinuation of the ginseng product, diuresis ensued and blood pressure control was established at 128/78 mmHg. The investigators observed a strong temporal relationship between discontinuation of the ginseng product and diuresis .
Furosemide Overview
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Furosemide is used alone or in combination with other medications to treat high blood pressure. Furosemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Furosemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.