Dose & administration
1-2 mg/kg/dose. Intravenous injection or oral administration, intermittently or on a regular basis once or twice per 24 hours.
Can be given as intravenous infusion from 0.1-0.2 mg/kg/h. If oliguria persists, the infusion rate may be increased to 0.4 mg/kg/h.
Lower and less frequent doses should be considered to preterm infants
Need to increase diuresis. May be used in various conditions complicated by fluid retention and/or low urine output.
Contraindications and special considerations
Use cautiously in extremely preterm infants, in infants with renal impairment, in infants with severe jaundice and in infants with hyponatremia and/or hypokalemia.
Furosemide injection solution has an alcalotic pH of ~9 and should not be mixed with acidic solutions with pH<5.5, as furosemide may precipitate.
Electrolyte disturbances including hypochloremic alkalosis
Risk of bone demineralization
Skin reactions including Stevens-Johnson syndrome
Furosemide acts on the loop of Henley with a rapid onset. The chloride site of the Na/K/Cl-channel is blocked and sodium reabsorption is inhibited, leading to diuresis. Chloride site blockade leads to increased excretion of potassium and chloride, and reduced absorption of calcium and magnesium. Repeated administration leads to pharmacologic tolerance.
Gastric pH, delayed gastric emptying and slower intestinal transit time influence absorption of diuretics in infants.
Renal and hepatic pathways eliminate furosemide. In neonates, non-renal clearance is limited, but non-renal clearance increases during childhood. Half times in newborn infants varies but extends over 8-24 hours. Preterm infants have longer half times than term infants, and clearance improves with postnatal age.
Furosemide displaces other drugs bound to albumin, and critically ill infants may risk increased levels of free bilirubin.
Segar. Neonatal Diuretic Therapy: Furosemide, Thiazides, and Spironolactone. Clin Perinatol 2012;39:209–220. PMID 22341547.
Pacifici.Clinical pharmacology of furosemide in neonates: a Review. Pharmaceuticals (Basel). 2013 Sep 5;6(9):1094-129. PMID 24276421.
Pacifici. Clinical Pharmacology of the Loop Diuretics Furosemide and Bumetanide in Neonates and Infants. Pediatr Drugs 2012;14:233-246. PMID 22702741.
van der Vorst. Diuretics in Pediatrics. Pediatr Drugs 2006;8:245-264. PMID 16898855.
Document version history
Created 2016-05-15 / Stefan Johansson
Revised 2016-05-25 / Stefan Johansson