Furosemide in Pregnancy and Breastfeeding

Risk Factor: CM*
Class: Diuretics

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Furosemide is a potent diuretic. The drug has caused maternal deaths and abortions in rabbits at doses 2, 4, and 8 times the maximum recommended human dose of 600 mg/day (1). An increase in the incidence and severity of hydronephrosis (distention of the renal pelvis and in some cases of the ureters) has also been observed in the offspring of mice and rabbits (1). Wavy ribs and some skeletal defects have been observed in the offspring of rats given furosemide during organogenesis (2). These effects appeared to be caused directly or indirectly by the diuretic action of the drug (2).

Cardiovascular disorders, such as pulmonary edema, severe hypertension, or congestive heart failure, are probably the only valid indications for this drug in pregnancy. Furosemide crosses the placenta (3). Following oral doses of 2540 mg, peak concentrations in cord serum of 330 ng/mL were recorded at 9 hours. Maternal and cord levels were equal at 8 hours. Increased fetal urine production after maternal furosemide therapy has been observed (4,5). Administration of furosemide to the mother has been used to assess fetal kidney function by provoking urine production, which is then visualized by ultrasonic techniques (6,7). Diuresis was found more often in newborns exposed to furosemide shortly before birth than in controls (8). Urinary sodium and potassium levels in the treated newborns were significantly greater than in the nonexposed controls.

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 350 newborns had been exposed to furosemide during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 18 (5.1%) major birth defects were observed (15 expected). Specific data were available for six defect categories, including (observed/expected) 2/4 cardiovascular defects, 1/1 oral clefts, 0/0 spina bifida, 1/1 polydactyly, 1/1 limb reduction defects, and 3/1 hypospadias. Only with the latter defect is there a suggestion of an association, but other factors, including the mother's disease, concurrent drug use, and chance, may be involved.

After the 1st trimester, furosemide has been used for edema, hypertension, and toxemia of pregnancy without causing fetal or newborn adverse effects (9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 and 31). Many investigators now consider diuretics contraindicated in pregnancy, except for patients with cardiovascular disorders, since they do not prevent or alter the course of toxemia and they may decrease placental perfusion (32,33,34 and 35). A 1984 study determined that the use of diuretics for hypertension in pregnancy prevented normal plasma volume expansion and did not change perinatal outcome (36). Thus, diuretics are not recommended for the treatment of pregnancy-induced hypertension because of the maternal hypovolemia characteristic of this disease.

Administration of the drug during pregnancy does not significantly alter amniotic fluid volume (30). Serum uric acid levels, which are increased in toxemia, are further elevated by furosemide (37). No association was found in a 1973 study between furosemide and low platelet counts in the neonate (38). Unlike the thiazide diuretics, neonatal thrombocytopenia has not been reported for furosemide.

[*Risk Factor D if used in pregnancy-induced hypertension.]

Breast Feeding Summary

Furosemide is excreted into breast milk (1,39). No reports of adverse effects in nursing infants have been found. Thiazide diuretics have been used to suppress lactation (see Chlorothiazide).

References

  1. Product information. Furosemide. Mylan Pharmaceuticals, 2000.
  2. Shepard TH. Catalog of Teratogen Agents. 9th ed. Baltimore, MD:The Johns Hopkins University Press, 1998:215.
  3. Beermann B, Groschinsky-Grind M, Fahraeus L, Lindstroem B. Placental transfer of furosemide. Clin Pharmacol Ther 1978;24:5602.
  4. Wladimiroff JW. Effect of furosemide on fetal urine production. Br J Obstet Gynaecol 1975;82:2214.
  5. Stein WW, Halberstadt E, Gerner R, Roemer E. Effect of furosemide on fetal kidney function. Arch Gynekol 1977;224:1145.
  6. Barrett RJ, Rayburn WF, Barr M Jr. Furosemide (Lasix) challenge test in assessing bilateral fetal hydronephrosis. Am J Obstet Gynecol 1983;147:8467.
  7. Harman CR. Maternal furosemide may not provoke urine production in the compromised fetus. Am J Obstet Gynecol 1984;150:3223.
  8. Pecorari D, Ragni N, Autera C. Administration of furosemide to women during confinement, and its action on newborn infants. Acta Biomed (Italy) 1969;40:211.
  9. Pulle C. Diuretic therapy in monosymptomatic edema of pregnancy. Minerva Med 1965;56:16223.
  10. DeCecco L. Furosemide in the treatment of edema in pregnancy. Minerva Med 1965;56:158691.
  11. Bocci A, Pupita F, Revelli E, Bartoli E, Molaschi M, Massobrio A. The water-salt metabolism in obstetrics and gynecology. Minerva Ginecol 1965;17:10310.
  12. Sideri L. Furosemide in the treatment of oedema in gynaecology and obstetrics. Clin Ter 1966;39:33946.
  13. Wu CC, Lee TT, Kao SC. Evaluation of new diuretic (furosemide) on pregnant women. A pilot study. J Obstet Gynecol Republ China 1966;5:31820.
  14. Loch EG. Treatment of gestosis with diuretics. Med Klin 1966;61:15125.
  15. Buchheit H, Nicolai KH. Influence of furosemide (Lasix) on gestational edemas. Med Klin 1966;61:15158.
  16. Tanaka T. Studies on the clinical effect of Lasix in edema of pregnancy and toxemia of pregnancy. Sanka To Fujinka 1966;41:91420.
  17. Merger R, Cohen J, Sadut R. Study of the therapeutic effects of furosemide in obstetrics. Rev Fr Gynecol 1967;62:25965.
  18. Nascimento R, Fernandes R, Cunha A. Furosemide as an accessory in the therapy of the toxemia of pregnancy. Hospital (Portugal) 1967;71:13740.
  19. Finnerty FA Jr. Advantages and disadvantages of furosemide in the edematous states of pregnancy. Am J Obstet Gynecol 1969;105:10227.
  20. Das Gupta S. Frusemide in blood transfusion for severe anemia in pregnancy. J Obstet Gynaecol India 1970;20:5215.
  21. Kawathekar P, Anusuya SR, Sriniwas P, Lagali S. Diazepam (Calmpose) in eclampsia: a preliminary report of 16 cases. Curr Ther Res 1973;15:84555.
  22. Pianetti F. Our results in the treatment of parturient patients with oedema during the five years 19661970. Atti Accad Med Lomb 1973;27:13740.
  23. Azcarte Sanchez S, Quesada Rocha T, Rosas Arced J. Evaluation of a plan of treatment in eclampsia (first report). Ginecol Obstet Mex 1973;34:17186.
  24. Bravo Sandoval J. Management of pre-eclampsia-eclampsia in the third gyneco-obstetrical hospital. Cir Cirjjands 1973;41:48794.
  25. Franck H, Gruhl M. Therapeutic experience with nortensin in the treatment of toxemia of pregnancy. Munch Med Wochenschr 1974;116:5214.
  26. Cornu P, Laffay J, Ertel M, Lemiere J. Resuscitation in eclampsia. Rev Prat 1975;25:80930.
  27. Finnerty FA Jr. Management of hypertension in toxemia of pregnancy. Hosp Med 1975;11:5265.
  28. Saldana-Garcia RH. Eclampsia: maternal and fetal mortality. Comparative study of 80 cases. In VIII World Congress of Gynecology and Obstetrics. Int Cong Ser 1976;396:589.
  29. Palot M, Jakob L, Decaux J, Brundis JP, Quereux C, Wahl P. Arterial hypertensions of labor and the postpartum period. Rev Fr Gynecol Obstet 1979;74:1736.
  30. Votta RA, Parada OH, Windgrad RH, Alvarez OH, Tomassinni TL, Patori AA. Furosemide action on the creatinine concentration of amniotic fluid. Am J Obstet Gynecol 1975;123:6214.
  31. Clark AD, Sevitt LH, Hawkins DF. Use of furosemide in severe toxaemia of pregnancy. Lancet 1972;1:356.
  32. Pitkin RM, Kaminetzky HA, Newton M, Pritchard JA. Maternal nutrition: a selective review of clinical topics. Obstet Gynecol 1972;40:77385.
  33. Lindheimer MD, Katz AI. Sodium and diuretics in pregnancy. N Engl J Med 1973;288:8914.
  34. Christianson R, Page EW. Diuretic drugs and pregnancy. Obstet Gynecol 1976;48:64752.
  35. Gant NF, Madden JD, Shteri PK, MacDonald PC. The metabolic clearance rate of dehydroisoandrosterone sulfate. IV. Acute effects of induced hypertension, hypotension, and natriuresis in normal and hypertensive pregnancies. Am J Obstet Gynecol 1976;124:1438.
  36. Sibai BM, Grossman RA, Grossman HG. Effects of diuretics on plasma volume in pregnancies with long-term hypertension. Am J Obstet Gynecol 1984;150:8315.
  37. Carswell W, Semple PF. The effect of furosemide on uric acid levels in maternal blood, fetal blood and amniotic fluid. J Obstet Gynaecol Br Commonw 1974;81:4724.
  38. Jerkner K, Kutti J, Victorin L. Platelet counts in mothers and their newborn infants with respect to antepartum administration of oral diuretics. Acta Med Scand 1973;194:4735.
  39. Product information. Lasix. Hoechst-Roussel Pharmaceuticals, 1990.

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Questions and Answers

What is the toxic dose of Furosemide in humans?, Toxic dose or lethal dose of furosemide. Cant seem to find this in the net or my books. All i can find in the net is the toxic dose of furosemide for animals.

The acute toxicity of furosemide has been determined in mice, rats and dogs. In all three, the oral LD50 exceeded 1000 mg/kg body weight while the intravenous LD50 ranged from 300 to 680 mg/kg. The acute intragastric toxicity in neonatal rats is 7 to 10 times that of adult rats.

From what I understand the use of mice, rats, and dogs gives a good base and ball park figure for humans. Obviously a scientific experiment with humans would be unethical so all we have to go on are the anecdotal cases which have a lot ofextraneouss variables; though evenanalysiss and meta analysis on over doses in humans nearly always support the estimate that was determined in animals. So 50% of human adults will die at 1000 mg/kg body weight orally and 300 to 680 mg/kg intravenously.Hope it helps!

My dog has congestive heart failure. can i give him an extra dose of furosemide?, My dog has congestive heart failure. He has been doing bad lately and the docter hasn't been in to see him. We are going to put him down tuesday but until then we want to make him as comfortable as possible. I was wondering if anyone knows if it is okay to give him a second dose of furosemide 20mg pills even if it wasn't directed by the doctor to do so?

Normally, I'd say no. But in this case, I can't see any harm. Since he'll be put down soon, it can only make him more comfortable.

Best of luck.

What natural diuretic can I take instead of the Furosemide prescribed.?, After perusing net I have found that Furosemide COULD be causing tingling in my face and lips and tingling in legs. Although Doctor has not diagnosed symptoms as being related to this diuretic. Taking Atenolol for High Blood Pressure, and diuretic is needed as well. What alternatives do I have besides cutting out salt.

Corn silk is a highly effective diuretic, as is dandelion. With diuretics, there is risk of potassium depletion however, dandelion replaces the potassium and is one of the safest diuretics. Drink some dandelion tea, cool (temperature) or take dandelion capsules. It is important to take potassium with other diuretics.

Why might your patients become dizzy when taking furosemide?, Does anyone know why patients might become dizzy after taking furosemide (Lasix)?

It depletes your potassium and that causes an electrolyte imbalance. If a patient is dizzy on Lasix they need to get their electrolytes checked ASAP as they may be out of whack and need potassium supplements/.

What is the best way to prevent kidney stones when taking furosemide?,

Guys, that's not the correct thing to say to someone who is taking a diuretic. That advice can be potentially dangerous if this person takes that to mean massive amounts of water or other fluids.

Proper hydration is important, but leave that advice to his/her physician. This person is on a diuretic for a reason, and you don't know this person's medical history.

Talk to your doctor about kidney stone prevention. When you are on medication DON'T seek the opinions of the general public about your health, it can be dangerous.

what is the dosage of a diuretic "furosemide" to to lose approximately 4 kg before a fighting match?, If I wanted to lose weight rapidly before a fighting match and is using a diuretic called furosemide to do so, how much can my body handle, or dosage recommended without losing top physical abilites? How how long would it take for me to gain it back? I am hoping to lose 7 kgs before the match and i am currently 66kg.

I would not recommend using furosemide to lose rapid water weight just for a fighting match. Get a gentler diuretic from the drugstore. Furosemide is a potassium wasting diuretic and in order to take it you also need to be on a potassium supplement to replace the lost potassium. (both dosages are best regulated by your doctor and are based on your bloodwork results). Too much potassium or too little potassium in your system can cause severe muscle cramping and may even stop your heart from beating correctly and could result in death.

Try going to the local drugstore and get an over the counter
diuretic. It will be much safer for you.

My boyfriend is taking Furosemide for fluid retention before his heart surgery but he is gaining weight?, He is due to have heart surgery soon. Dr. gave him this pills but he is gaining weight his belly is big and thighs. Dr. needs to replace his aorta and mitral valve. I'm very concerned, is this normal? Also he does not seem to be loosing any weight but gaining, I think his condition is getting worse . Please anybody knows what we should do? Thank you!

hello there im a nurse and very familiar with lasix and what it does and i can tell u that it is so normal that ur bf is gaining weight because he probably has heart failure if he needs his aorta and mitral valve replaced and the only advice i can give is that ask the DR. if he could switch his diuretic (lasix) to zroxylyn i think thats how u spell it its a very new type of diuretic and it works a whole hell of alot better than lasix........with lasix u lose potassium and with this new pill u dont lose potassium...just ask ur doctor about something new for the fluid overload!

I have an enlarged heart and have to take furosemide each day. However, I find that it?, causes me pain and my kidneys feel under great pressure and I always feel the need to go to the loo. So I've substituted this with a herbal compound which seems to be just as effective without the side effects. Though I do take furosemeide at least twice a week.

Would it be advisable for me to have a chat with my very busy GP or would it be okay for me to carryon as I'm doing.

Keeping down the edema is the job of a diuretic. In your case it's Lasix (furosemide). You have Congestive Heart Failure you need to take your meds daily. It helps lower your Blood Pressure and eliminate excess fluids in the tissues, especially the lungs.

Taking Furosemide while breastfeeding. Safe for the baby?, After how many hours the medication would be cleared from my sistems so it doesn't pass in the breastmilk?

According to the World Health Organization, furosemide may inhibit lactation and should be avoided while breastfeeding. Its action continues for 6 hours (usually) and if you're taking it, I'm guessing you're taking it on a schedule that is designed to *keep* it in your system at all times. Check with your doctor about taking a different diuretic instead. Spironolactone is another medication in the same class that is considered compatible with breastfeeding.