Take Lasimax exactly as dircted by your doctor.

The usual adult oral dose in edema associated with congestive heart faillure(CHF), liver cirrhosis and renal disease, including nephrotic syndrome is initially 40 mg daily; the dose may be increased by 20-40 mg not exceeding 600mg/day. In hypertension, the adult dose is generally 20-40 mg twice a day.

Tell your doctor  if you are taking, have recently taken, or might take any other medicines, including medicines obtained without a prescription. Especially:

ACE Inhibitors: Enhanced hypotensive effect when given with diuretics. A marked fall in blood pressure and deterioration in renal function may be seen when ACE inhibitors are added to furosemide therapy. The dose of furosemide should be reduced for at least three days, or the drug stopped, before initiating the ACE inhibitor or increasing the dose of an ACE inhibitor.

Alpha-blockers: Enhanced hypotensive effect when diuretics are given with alpha-blockers, also increased risk of first dose hypotension with post-synaptic alpha-blockers such as prazosin.

Antipsychotics: Hypokalaemia caused by diuretics increase the risk of ventricular arrhythmias with amisulpiride or sertindole. An enhanced hypotensive effect may be seen when diuretics are given with phenothiazines. Hypokalaemia caused by diuretics increases risk of ventricular arrhythmias with pimozide (avoid concomitant use).

Antidepressants: Possible increase of hypokalaemia when loop diuretics are given with reboxetine. There is an enhanced hypotensive effect when diuretics are given with MAOIs. There is an increased risk of postural hypotension when diuretics are given with tricyclic antidepressants.

Anti-arrhythmics: Hypokalaemia caused by loop diuretics increases cardiac toxicity with amiodarone, disopyramide, flecainide, and antagonises the action of lidocaine and mexiletine.

Analgesics: Diuretics can increase the risk of nephrotoxicity of NSAIDs, also antagonism of diuretic effect. Antagonism of diuretic effect (especially with indomethacin and ketorolac). Salicylic toxicity may be increased by furosemide.

Angiotensin –II Receptor Antagonists: Enhanced hypotensive effect when diuretics given with angiotensin-II receptor antagonists.

Antibacterials: Avoid the use of diuretics in lymecycline treatment. There is an increased risk of ototoxicity when loop diuretics are given with aminoglycosides, polymyxins or vancomycin. Since this may lead to irreversible damage, these drugs must only be used with furosemide if there are compelling medical reasons. Impairment of renal function may develop in patients receiving concurrent treatment with furosemide and high doses of certain cephalosporins.

Antiepileptics: There is an increased risk of hyponatraemia when diuretics are given with carbemazepine. The effects of furosemide are antagonised by phenytoin.

Antifungals: There is an increased risk of hypokalaemia when loop diuretics are given with amphotericin.

Antivirals: Plasma concentration of diuretics may be increased by nelfinavir, ritonavir or saquinavir.

Atomoxetine: Hypokalaemia caused by diuretics increases the risk of ventricular arrhythmias with atomoxetine.

Barbiturates: Plasma concentrations of diuretics may be decreased. There may be an increased risk of osteomalacia when diuretics are taken in combination with Phenobarbital.

Beta-blockers: There is an enhanced hypotensive effect when diuretics are given with beta- blockers. Hypokalaemia caused by loop diuretics increases the risk of ventricular arrhythmias with sotalol.

Cardiac glycosides: Hypokalaemia caused by loop diuretics increases cardiac toxicity with cardiac glycosides.

Ciclosporin: there is an increased risk of nephrotoxicity and possibly hypermagnesaemia when diuretics are given with ciclosporin.

Cisplatin: There is a risk of increased ototoxic effects if cisplatin and furosemide are given concomitantly. In addition, nephrotoxicity of cisplatin may be enhanced if furosemide is not given in low doses (e.g. 40mg in patients with normal renal function) and with positive fluid balance when used to achieve forced diuresis during cisplatin treatment.

Corticosteroids: The diuretic effect of diuretics is antagonized by corticosteroids. There is an increased risk of hypokalaemia when loop diuretics are given with corticosteroids.

Other Diuretics: There is an increased risk of hypokalaemia when loop diuretics are given with acetazolamide. Profound diuresis is possible when metolazone is given with furosemide. There is an increased risk of hypokalaemia when loop diuretics are given with thiazides and related diuretics.

Lithium: Loop diuretics reduce the excretion of lithium, which may lead to increased plasma concentrations and a risk of toxicity. Therefore, it is recommended that lithium levels are carefully monitored and where necessary the lithium dosage is adjusted in patients receiving this combination.

Potassium salts: There is an increased risk of hyperkalaemia when given with potassium salts.

Sucralfate: Furosemide and sucralfate must not be taken within 2 hours of each other as sucralfate decreases the absorption of furosemide from the intestine and so reduces its effect.

Sympathomimetics, Beta2: There is an increased risk of hypokalameia when loop diuretics are given with high doses of beta2 synpathomimetics.

If you have any of the following side effects while taking this medicine tell your doctor immediately or go to the 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
• Blistering or peeling of the skin around the lips, eyes, mouth, nose and genitals, flu-like symptoms and fever could be signs of a condition called Stevens-Johnson syndrome
• Inflammation of blood vessels (vasculitis, which may cause rash, fever and joint or muscle pains)
• 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

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 blood pressure causing loss of concentration and slowed reactions, difficulty passing water, fast or irregular heart rate and feeling and being sick are some of the common side effects. Talk with you doctor if you experience any of these effects.

Furosemide is contraindicated in the following circumstances:

• Hypersensitivity to furosemide, any of its excipients, sulphonamides, sulphonamide derivatives/amiloride

• Anuria and impaired renal function)and renal failure

• Electrolyte disturbances (severe hyponatraemia: severe hypokalaemia, hypovolaemia), dehydration and/or hypotension 

• Concomitant potassium supplements or potassium sparing diuretics

• Pre-coma/coma associated with hepatic cirrhosis or encephalopathy

Inform your doctor  before taking Furosemide if you:

• have low blood volume (hypovolaemia) or are at risk of developing low blood pressure

• have low levels of protein in the blood (hypoproteinaemia) as a result of kidney damage • have liver congestion (slowed blood flow through the vessels) or other liver problems

• have kidney problems

• have or may have diabetes. If you are taking insulin, your doctor may need to adjust your insulin dosage

• take other medicines which can cause the drop of blood pressure or you have other medical conditions that are risks for the drop of blood pressure

• have prostate trouble or difficulty passing urine

• have or have had gout

• have an abnormal blood condition