Furosemide Injection

Furosemide injection is used in adults and children who cannot take oral medications or in emergency situations to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart failure, pulmonary edema (excess fluid in the lungs), kidney, and liver disease. Furosemide injection (Furoscix) is also used to treat edema caused by certain types of chronic heart failure in adults who cannot take oral medications. 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.

Furosemide injection comes as a solution (liquid) to be injected intramuscularly (into a muscle) or intravenously (into a vein) by a doctor or nurse in a medical office or hospital. Furosemide injection (Furoscix) comes in an on-body delivery system (on-body injector with a prefilled cartridge) to be injected subcutaneously (just under the skin) at home.

If furosemide injection is given intramuscularly or intravenously to treat edema caused by various medical problems, it is usually given as a single dose or it may be given once or twice a day. Your dosing schedule will depend on your condition and on how you respond to treatment.

If furosemide injection (Furoscix) is given to treat adults with edema caused by certain types of heart failure, it is usually given in an on-body delivery system to be injected subcutaneously (just under the skin) over 5 hours. During this time, you will need to limit your activity and limit bending. You should notice an increased need to urinate starting about 1 hour after the subcutaneous injection begins. This may last up to 8 hours, Make sure that you have access to a bathroom for up to 8 hours after beginning the subcutaneous injection using the on-body injector. Use furosemide injection for subcutaneous injection exactly as directed. Do not use more or less of this medication or use it more often or for a longer period of time than prescribed by your doctor.

Your doctor may decide to allow you or a caregiver to perform the subcutaneous injections using the on-body delivery system at home. Your healthcare provider will show you how to prepare and perform the injections at home. Ask your pharmacist or doctor for a copy of the manufacturer's instructions for use information for the patient. Be sure to ask your doctor or pharmacist if you have any questions about how to inject the medication.

Check the cartridge to be sure that the expiration date printed on the cartridge has not passed. Look closely at the liquid in the cartridge. The liquid should be clear to slightly yellow and should not be cloudy or discolored. Do not drop the on-body injector or cartridge or allow the injector to get wet. After you apply the on-body injector, do not shower, bathe, swim, or do activities that will make you sweat when you are wearing the on-body injector. Call your pharmacist if there are any problems with the package or the cartridge and do not inject the medication.

You can apply the on-body injector on the abdomen (stomach) on either side of your navel in a flat, hairless area above the belt line and below the rib cage. Choose a different spot each time you apply the on-body injector. Do not apply the on-body injector in an area directly under a belt or waistband. Be sure that the skin in the area where you plan to apply the on-body injector is clean, dry, and healthy. Do not apply the on-body injector to skin that is red, irritated, or not intact. Also do not apply the on-body injector to skin that you have recently treated with creams, lotions, oils, or other skin products. Dispose of used on-body delivery systems in a puncture-resistant container. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using furosemide injection,

• tell your doctor and pharmacist if you are allergic to furosemide, sulfonamide medications, any other medications, or any of the ingredients in furosemide injection. Also, if you are using the furosemide on-body injector, tell your doctor if you are allergic to any adhesives. Ask your pharmacist or check the patient information for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have kidney disease, liver cirrhosis (a disease which causes scarring of liver tissue), or ascites (build-up of fluid in the stomach area). Your doctor may not want you to use furosemide injection.

• tell your doctor if you have or have ever had any condition that stops your bladder from emptying completely, an electrolyte imbalance in your blood, including low levels of potassium in your blood, hypertension, diabetes, gout, systemic lupus erythematosus (SLE; a chronic inflammatory condition), or liver disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using furosemide injection, call your doctor.

• if you are having surgery, tell the doctor that you are using furosemide injection.

• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Furosemide may make your skin sensitive to sunlight.

• you should know that furosemide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking furosemide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. Alcohol can add to these side effects.

• if you are using the furosemide on-body injector, tell your doctor if you will be having a magnetic resonance imaging exam (MRI; a medical test that uses powerful magnets to take pictures of the inside of the body).

If your doctor prescribes a low-salt or low-sodium diet, or to eat or drink increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice) in your diet, follow these instructions carefully.

• Furosemide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • frequent urination

  • blurred vision

  • headache

  • constipation

  • diarrhea

  • injection site pain

• Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

  • ringing in the ears

  • loss of hearing

  • ongoing pain that begins in the stomach area, but may spread to the back

  • rash, hives, itching, or difficulty breathing or swallowing

  • blisters or peeling skin

  • yellowing of the skin or eyes

  • light-colored stools

  • dark urine

  • pain in the upper right part of the stomach

• Furosemide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

• If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep the on-body delivery system in the carton it came in, tightly closed, and out of reach of children. Store it at room temperature and protect from light. Do not refrigerate or freeze.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• extreme thirst

• dry mouth

• dizziness

• confusion

• extreme tiredness

• vomiting

• stomach cramps

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to furosemide.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.