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Drug Safety-related Labeling Changes (SrLC)

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FUROSEMIDE (NDA-018667)

(FUROSEMIDE)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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08/31/2022 (SUPPL-43)

Approved Drug Label (PDF)

4 Contraindications

PLR conversion. Formatting changed; please refer to label for complete information.

5 Warnings and Precautions

PLR conversion. Newly created subsection titles below; please refer to label for complete information.

5.1 Fluid, Electrolyte, and Metabolic Abnormalities

5.2 Worsening Renal Function

5.3 Ototoxicity

5.4 Acute Urinary Retention

6 Adverse Reactions

PLR conversion; please refer to label for complete information.

7 Drug Interactions

PLR conversion. Reformatted into tables for each subsection below; please see label for complete information.

7.1 Effects of Furosemide on Other Drugs

7.2 Effects of Other Drugs on Furosemide

8 Use in Specific Populations

8.1 Pregnancy

PLR and PLLR conversion; please see label for complete information.

8.2 Lactation

PLR and PLLR conversion; as below:

Risk Summary

The presence of furosemide has been reported in human milk. There are no data on the effects on the breastfed infant or the effects on milk production. Doses of furosemide associated with clinically significant diuresis may impair milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for furosemide and any potential adverse effects on the breastfed infant from furosemide or from the underlying maternal condition.

8.4 Pediatric Use

PLR and PLLR conversion; as below:

Published reports indicate that premature infants with post conceptual age (gestational plus postnatal) less than 31 weeks receiving doses exceeding 1 mg/kg/24 hours may develop plasma levels which could be associated with potential toxic effects including ototoxicity [see Warnings and Precautions (5.3)].

Furosemide in the first year of life, especially in patients born pre-term, may precipitate nephrocalcinosis/nephrolithiasis [see Warnings and Precautions (5.2)].

8.5 Geriatric Use

Information unchanged from prior label.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

PATIENT COUNSELING INFORMATION

PLR conversion; newly created subsection, as below:

Fluid, Electrolyte, and Metabolic Abnormalities

Advise patients that they may experience symptoms from excessive fluid and/or electrolyte losses. The postural hypotension that sometimes occurs can usually be managed by getting up slowly. Potassium supplements and/or dietary measures may be needed to control or avoid hypokalemia [see Warnings and Precautions (5.1)].

Advise patients that furosemide may increase blood glucose levels and thereby affect urine glucose tests [see Warnings and Precautions (5.1)].

Photosensitivity

The skin of some patients may be more sensitive to the effects of sunlight while taking furosemide [see Adverse Reactions (6)].

Advise hypertensive patients to avoid medications that may increase blood pressure, including over-the-counter products for appetite suppression and cold symptoms [see Drug Interactions (7.1)].

This product’s labeling may have been updated. For the most recent prescribing information, please visit www.pfizer.com.

Other

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09/22/2016 (SUPPL-36)

Approved Drug Label (PDF)

5 Warnings and Precautions

  • Cases of tinnitus and reversible or irreversible hearing impairment and deafness have been reported. (addition underlined)

6 Adverse Reactions

Dermatologic-Hypersensitivity Reactions

  • Toxic epidermal necrolysis (2) Stevens-Johnson Syndrome (3) Erythema multiforme (4) Drug rash with eosinophila and systemic symptoms (5) Acute generalized exanthematous pustulosis (6) Exfoliative dermatitis (7) Bullous pemphigoid (8) Purpura (9) Photosensitivity (10) Rash (11) Pruritus (12) Urticaria (additions underlined)

7 Drug Interactions

Additions are underlined:

  • Furosemide may decrease arterial responsiveness to norepinephrine. However, norepinephrine may still be used effectively… Simultaneous administration of sucralfate and Furosemide Injection may reduce the natriuretic and antihypertensive effects of furosemide… Patients receiving both drugs should be observed closely to determine if the desired diuretic and/or antihypertensive effect of furosemide is achieved. The intake of furosemide and sucralfate should be separated by at least 2 hours…
  • Phenytoin interferes directly with renal action of furosemide… There is evidence that treatment with phenytoin leads to decrease intestinal absorption of furosemide, and consequently to lower peak serum furosemide concentrations…

  • Concomitant use of cyclosporine and furosemide is associated with increased risk of gouty arthritis secondary to furosemide-induced hyperurecemia and cyclosporine impairment of renal urate excretion… High doses (greater than 80 mg) of furosemide may inhibit the binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by an overall decrease in total thyroid hormone levels…