What Happens When You Stop Taking Furosemide?
CardiologyHeart Failure

What Happens When You Stop Taking Furosemide?

What Happens When You Stop Taking Furosemide?

Lasix or furosemide belongs to a class of drugs called loop diuretics.

It is one of the most widely used drugs throughout the world and has got a prime role in the treatment of heart failure & fluid overload state.

The consequences of stopping furosemide depend upon the indication of its use. In patients with reduced left ventricular function, stopping or decreasing the dose of furosemide can precipitate a decompensated state of heart failure in a previously stable patient & may also necessitate the need for hospitalization.

A patient must not stop taking furosemide(lasix) without a doctor’s advice.

To buy your monthly dose of furosemide you can follow this link. Click here

Given below are the details of the common indications for the use of furosemide and the consequences of stopping it.

#1. Heart Failure

Diuretics like furosemide are the cornerstone of the treatment of volume overload in heart failure patients.

In patients with heart failure, heart muscles become weak and are unable to effectively pump the blood.

This leads to the pooling of blood within the heart chambers and in the pulmonary veins.

Increased pressure within the pulmonary veins, causes the fluid to leak from the blood vessels into the lung interstitium and alveolar spaces (lungs).

Fluid in the lung interstitium is called pulmonary edema and it causes shortness of breath initially with exertion and upon lying down.

In severe cases, shortness of breath occurs even at rest.

When the right heart is involved patients also develop swelling of feet and legs.

The entire process occurs due to excessive accumulation of fluid within the lungs and later on in the feet.

This excessive fluid is removed by diuretics like furosemide.

Furosemide is a loop diuretic that acts on kidneys at the loop of Henle and increases the removal of fluid in the form of urine.

So the above-mentioned information gives an idea that how important furosemide is for heart failure patients. And if they decrease its dose or stop taking it at all, the fluid in the lungs can increase to an extent that may require oxygen support and hospitalization.

So if a patient wants to stop furosemide, he must consult his doctor, who can adjust the dose after proper evaluation.

#2. Chronic kidney disease

Chronic kidney disease(CKD) is a condition characterized by permanent kidney damage & reduced kidney function.

These patients may have a decreased urine output which results in excessive accumulation of fluid in the body.

The body is unable to get rid of excessive fluid owing to reduced urine formation.

Fluid overload is a common problem in CKD patients and in chronic states, it may affect heart function as well.

Furosemide is commonly prescribed in these patients as it helps treat the volume overload state. It can be helpful in CKD patients who are being managed conservatively as well as in dialysis dependant patients.

Hence, if these patients stop taking furosemide, their fluid overload state may worsen.

Shortness of breath, generalized body swelling, weight gain, & fatigue are the common symptoms in patients with fluid overload.

Another potential benefit of furosemide in CKD patients is that it helps the body get rid of potassium.

Raised potassium also called hyperkalemia is a common and life-threatening problem in CKD patients.

Damaged kidneys are not able to get rid of potassium.

Excessive potassium can affect the heart and cause life-threatening rhythm abnormalities.

Therefore, maintaining normal levels of potassium is very important.

Studies have shown that the incidence of hyperkalemia in CKD patients is as high as 45-50%.

Furosemide inhibits an ion channel called Na+/K+/2Cl cotransporter.

This ion channel is present in a region of the kidney called ascending thick loop of Henle and its inhibition decreases the reabsorption of potassium.

This is how furosemide helps get rid of potassium.

Hence, stopping furosemide in CKD patients increased the chances of developing hyperkalemia and its deadly consequences.

#3. Hypertension

Furosemide is not a preferred drug for treating hypertension.

If it is being used in any patient and his blood pressure is well controlled, the doctor’s advice must be sought before stopping the drug.

Thiazide diuretics like chlorthalidone and indapamide are preferred diuretics for the treatment of hypertension.

Common Q & A on furosemide

What foods to avoid when taking furosemide?

No food is absolutely contraindicated with furosemide.

However, salt intake should be restricted as it can worsen fluid overload and hypertension.

Some herbs like dandelion, UVA Ursi, jniper buchu, hibiscus, and parsley may increase the diuretic effect of furosemide. Whereas, licorice may also enhance the side effects.

Why are my feet still swollen after taking Lasix?

The possible reasons for swollen feet even after taking lasix are as below.

  1. The dose is inadequate.
  2. Fluid overload is massive and you may need to take it for a longer duration for significant improvement in the swelling.
  3. Kidney function is decreased and a routine dose of furosemide is unable to achieve the required diuretic effect, increasing the dose may help.
  4. The swelling on the feet is not due to excessive fluid and an alternate cause should be sought.

Taking Lasix but not peeing much

One of the reasons for decreased urination even after taking furosemide could be chronic kidney disease.

Damaged kidneys are not able to produce enough urine even after taking routine doses of furosemide.

Much higher doses are required in these patients to achieve adequate diuresis.

What are the side effects of furosemide in elderly

Furosemide should be used with caution in elderly patients of age 65 or more.

Elderly patients are more prone to develop the syndrome of inappropriate antidiuretic hormone secretion (SIADH) with furosemide.

SIADH is characterized by decreased sodium levels (hyponatremia), which can cause altered conscious levels, confusion, & in severe cases seizures, coma, and even death.

It also causes hypokalemia (decreased potassium levels) which can have the following manifestations.

  • Severe muscle weakness
  • Anorexia, nausea, and vomiting
  • Cardiacc rhythm abnormalities (premature atrial complex, premature ventricular beats, sinus bradycardia, paroxysmal atrial or junctional tachycardia, atrioventricular block, and ventricular tachycardia or fibrillation)

Other side effects include dizziness, headache, blurred vision, & vertigo.

How long does it take for furosemide to reduce swelling?

After oral intake, furosemide takes 30-60 mins to begin its action, whereas the peak effect occurs in 1-2 hours.

Pulmonary edema may start to improve within 15-20 minutes.

Feet and leg swelling may take 1-2 days depending upon the degree of swelling.

Take Home

Furosemide should not be stopped without a doctor’s advice as it can worsen the fluid overload associated with heart failure and chronic kidney disease.

Also, it may increase the risk of life-threatening hyperkalemia complications in CKD patients.

1 comment

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