What are the precautions for furosemide subcutaneous injection?

In clinical studies of furosemide subcutaneous injection (furosemide)-FUROSCIX in the treatment of congestion due to fluid overload in adult patients with chronic heart failure, warnings and precautions such as fluid, electrolyte and metabolic abnormalities, worsening of renal function, ototoxicity, acute urinary retention, and incomplete dosing have emerged. Discontinue and resume at reduced dose upon recovery, or permanently discontinue based on severity.

1. Fluid, electrolyte and metabolic abnormalities: Furosemide may cause fluid, electrolyte and metabolic abnormalities such as hypovolemia, hypokalemia, azotemia, hyponatremia, hypochloral alkalosis, hypomagnesemia, hypocalcemia, hyperglycemia or hyperuricemia, especially in patients receiving higher doses, patients with insufficient oral electrolyte intake and elderly patients. Excessive diuresis may lead to dehydration and volume depletion with circulatory collapse and may lead to vascular thrombosis and embolism, especially in elderly patients. Serum electrolytes, carbon dioxide, urea nitrogen, creatinine, glucose, and uric acid should be monitored frequently during treatment with furosemide subcutaneous injection.

2. Deterioration of renal function: Furosemide can cause dehydration and azotemia. If azotemia and increased oliguria develop during treatment of severe progressive renal disease, use of furosemide subcutaneous injection should be discontinued.

3. Ototoxicity: There are case reports of tinnitus, reversible or irreversible hearing damage and deafness caused by the use of furosemide subcutaneous injection. Reports generally indicate that furosemide ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses of the drug, hypoalbuminemia, or concomitant use of aminoglycoside antibiotics, isanic acid, or other ototoxic drugs. If the physician chooses to use high-dose parenteral therapy, a controlled intravenous infusion is recommended (In adults, the infusion rate should not exceed 4 mg of furosemide per minute).

4. Acute urinary retention: For patients with severe symptoms of urinary retention (due to bladder emptying disorder, prostatic hyperplasia, urethral stricture), the use of furosemide subcutaneous injection can cause acute urinary retention associated with increased urine production and retention. These patients require careful monitoring, especially during the initial stages of treatment.

5. Incomplete administration: Do not allow the internal syringe to get wet with water or any other fluid (blood or medicine). Contact of fluid with the circuit board can result in device errors and premature termination of the infusion. This in vivo infusion set is intended for use in environments where the patient may have their activities restricted during drug administration. Certain movements of the patient may result in disruption of device adhesion to the skin and premature termination of the infusion. Internal syringes for furosemide subcutaneous injection should only be used in patients who are able to detect and respond to alarms to ensure that the complete dose is administered.

In summary, although furosemide subcutaneous injection has important clinical value in the treatment of chronic heart failure, its side effects and potential risks cannot be ignored. During use, the patient's condition should be regularly monitored and appropriate adjustments should be made according to the specific situation to ensure patient safety and efficacy.

Reference materials:https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=eac958dd-8d43-e44e-e053-2995a90a4d5e