What Are The Side Effects of Furosemide in The Elderly?

Furosemide (Lasix) is a prescription medicine that increases urine flow. 

Case reports published to date have not found elderly-specific problems that would limit the drug’s effectiveness in older patients. 

But, elderly patients have higher odds of developing age-related kidney, liver, or heart problems. 

This could require extra caution and dosage adjustment for patients taking this medication. 

Here is a detailed overview of the side effects of furosemide (Lasix) in the elderly.

What is Furosemide (Lasix)?

• Type of drug: loop diuretic
• Onset of action: 1 hour after oral intake
• Peak effect: 1 to 2 hours
• Total time of therapeutic effect: 6 to 8 hours
• Half-life: 2 hours

Furosemide (Lasix) is a powerful diuretic, commonly referred to as a water pill. It has many uses. It can help treat edema (fluid retention) and swelling caused by kidney disease, liver disease, congestive heart failure, or other ailments. (1)

The drug can also treat hypertension (high blood pressure). And help patients pee when their kidneys are not working properly. 

Furosemide works by reducing blood pressure by flushing excess salt and water out of the body. As you take furosemide for edema or high blood pressure, you might lose a bit of weight. The drop in weight gain can happen as the body loses water. 

Evidence shows that persistent use of small doses of this medicine in chronic renal patients with residual diuresis can increase urine volume, including sodium excretion, compared to patients who didn’t take the drug. (2)

In order to understand why furosemide is effective, it’s important to take a look at its different mechanisms. Furosemide is often called a high-ceiling diuretic because it is stronger than other diuretics. It can reduce sodium, chloride, and potassium reabsorption from the tubule. (3)

The diuretic dose of this medicine is different for each patient. The starting dose for adults with high blood pressure is 40 mg, 2 times a day. For edema, the oral dose for adults can start from 20 mg to 80 mg daily, as a single or divided dose. 

Patients with chronic renal insufficiency often undergo therapy with large doses of loop diuretics. By activating the sympathetic nervous system, Furosemide can increase plasma renin levels. 

An additional mechanism of action is via prostaglandin synthesis. Lasix increases intrarenal prostaglandin production. This, in turn, amplifies renal blood flow. (4) (5)

What are the side effects of furosemide in the elderly?

Common side effects of furosemide (Lasix) can occur in over 1 in 100 patients. They can include: 

• Headaches
• Dizziness or confusion
• Thirst
• Dry mouth
• Increased urination (more than normal)
• Vomiting or nausea
• Injection site pain (if given furosemide injection)

Serious side effects are less likely to happen after using furosemide. Patients should contact the healthcare providers if they experience:

• Unexplained bleeding or bruising
• Dehydration
• Mouth ulcers
• Sore throat
• Increased body temperature
• Severe stomach pain
• Blood in urine
• Pain in the side
• Hearing loss or ringing in the ears

According to studies, hypokalemia (low potassium) or hypomagnesemia (low magnesium serum levels) were frequently observed furosemide side effects in the elderly. In patients with chronic heart failure, potassium loss and magnesium abnormalities could lead to arrhythmogenic effects. (6)

Furosemide can cause:

• renal dysfunction
• hypotension (too low blood pressure)
• intravascular volume depletion
• reduced glomerular filtration rate

Since the elderly are at risk of critical illnesses, it is important to take extra care. Furosemide can potentially cause low thyroid hormone levels in users with a critical illness. This drug can cause low potassium levels and low blood pressure. (7)

Since the drop in potassium can lead to muscle weakness, tiredness, vomiting, and nausea, it is crucial to contact a specialist. Low blood pressure can make the elderly feel faint or dizzy. 

People also want to know if diuretics can cause a bladder sphincter spasm. Medications called diuretics, such as furosemide, can cause bladder spasms. They can help the body get rid of excess water. Talk to a doctor if you experience side effects.

Are the side effects of furosemide different in the elderly compared to younger patients?

Current research advancements have not found geriatric-specific complications that would affect the use of Lasix in older patients. Diuretics are a go-to choice for elderly patients with cardiac failure or hypertension. Both younger and older patients should monitor their thyroid hormones and electrolyte imbalance. 

But, older users are prone to age-related kidney, liver, or heart problems. That’s why it might be important to readjust the diuretic dose for patients using furosemide. Most of the side effects of furosemide (Lasix) in the elderly can be prevented with careful management.

Side effects that can’t be prevented are caused by an allergic reaction. Symptoms include skin rash, trouble breathing, swelling, and severe dizziness. 

How to reduce side effects

Hospitalized patients often get furosemide in the form of an injection. But most people take it as an oral solution or tablet. To avoid the risk of furosemide side effects in elderly and young patients, the tips below can help.

Tell a doctor about any medications or medical conditions you might have

This includes all over-the-counter drugs or prescription products you are taking. Some herbal remedies and supplements can interact with furosemide. 

Remain hydrated at all times

Furosemide can cause fluids to drop too low. So, pay attention to signs such as muscle cramps, dry eyes, dry mouth, drowsiness, weakness, and fatigue. Drink liquid to resolve the issue. If the liquid intake is restricted, consult a specialist.

Monitor the body for any electrolyte abnormalities

Furosemide can cause electrolyte depletion. This can lead to fast or irregular heart rate (arrhythmia), vomiting, nausea, confusion, diarrhea, constipation, etc. 

Avoid laxatives and NSAIDs while on furosemide

Popular pain relievers like ibuprofen and aspirin can decrease the effectiveness of Lasix. And increase the risks to the hearing and kidneys. Laxatives can lead to water loss, which can further amplify the risks of electrolyte depletion and dehydration. 

Stand up slowly after using furosemide

Many elderly patients can experience dizziness. If you stand up too quickly, you might need to sit back down again. 

Make sure you are not allergic to furosemide

Check the package ingredients for any potential allergic reactions. 

Talk to a doctor if you experience common side effects

They can suggest a dosage reduction or lifestyle changes that can supply the body with nutrients, vitamins, and minerals. 

What are the dangers of taking Lasix?

Lasix doesn’t cause psychological or physical dependence. But, it can trigger temporary withdrawal symptoms when a patient abruptly stops taking it. Lasix changes the system’s hormonal mechanism that regulates diuresis (urination). 

When a person uses Lasix for a long time and abruptly discontinues it, their body tries to overcompensate. So, it retains too much salt and water, causing high blood pressure or fluid build-up. These effects can subside in a couple of days. 

But, patients with serious heart disease, especially the elderly, might need monitoring during this period. Lasix overdose can cause rapid water elimination and lead to electrolyte depletion and dehydration. It also amplifies the risk of hearing loss. 

Lasix is never administered to patients:

• Who are allergic to the drug.
• Whose kidneys can’t produce anuria (urine)

This drug is used with caution in people older than 65. Older users often start at the lowest possible dose and require regular monitoring. This includes those with urinary retention problems, poor renal function, history of heart arrhythmias, gout, and diabetes. Lasix might worsen or activate lupus. It can increase blood sugar levels. 

When it comes to Lasix and breastfeeding, the drug can affect lactation presence. The medication could decrease the amount of milk the body creates. There are not enough trials in breastfeeding women taking furosemide. 

Before suggesting these prescription drugs, the doctor should weigh the potential benefits against the possible risk. So, if you are planning to get pregnant or you are breastfeeding, consult a specialist. 

What to avoid while taking furosemide 

Furosemide has many drug interactions. Some of these include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Blood pressure medication
• Specific antibiotics (i.e., vancomycin and aminoglycosides)
• Ethacrynic acid (Edecrin)
• Lithium (Lithobid)
• Alcohol

Foods

Foods to avoid while taking furosemide are natural licorice and chronic or excessive alcohol consumption. Licorice in large amounts can cause low potassium. At the same time, alcohol can increase the odds of orthostatic hypotension.

What you can do instead is eat more potassium-rich foods. This includes leafy greens, starchy veggies, nuts, beans, etc. Since this medication can lead to potassium depletion, foods high in potassium can come in handy. 

Here is a more detailed outlook on the interaction mechanism. According to literature reports on insulin aspart furosemide, Lasix can interfere with blood glucose control. And decrease the effectiveness of other diabetic meds and insulin aspart. 

The combination of aspirin (acetylsalicylic acid) and furosemide could increase the risk of salicylate toxicity and acute renal failure. Loop diuretics can increase the odds of ototoxicity with higher doses of salicylates.

Furosemide used with Celiprolol increases the risk of hypotension (low blood pressure).
Using furosemide and carvedilol increases the odds of hypotension. When carvedilol and furosemide are used together, they can also slow the heart rate. 

Natural diuretics

Many people who want to decrease the odds of side effects are opting for a natural alternative to furosemide. Some dietary supplements and herbs could help excrete water from the system. They can help with water and sodium retention. 

These include:

• Juniper
• Hawthorn
• Parsley
• Ginger
• Dandelion

But, consult a specialist before using any natural products with diuretic properties. Fluid retention could be the result of some medication or medical condition. And sometimes natural products are not enough to get the desired effect. That’s where using the right medicine can help. 

Natural diuretics can help the body urinate more often and ease fluid retention in relatively healthy individuals. 

If you plan to use natural diuretics, make sure to eat a healthy diet, cut back on salt, and get enough physical activity. This can also prove useful for those on medication. 

Always let a healthcare expert know about any herbal or dietary supplements you consider taking. They can offer some practical health tips on the products you could try.

Conclusion

Furosemide is a strong diuretic capable of removing excess fluid held in the body. It is used alone or alongside other drugs for treating high blood pressure. The typical furosemide side effects are electrolyte imbalance and dehydration. 

According to the latest reports, there are no elderly-specific problems that would limit the usefulness of this medicine in geriatric patients. But, seniors are more prone to age-related medical complications. In such cases, the doctor often readjusts the dose or recommends regular monitoring. 

It’s important to tell a doctor if you have medical problems like diabetes, dehydration, bladder issues, anemia, hearing problems, liver disease, or others. The product can also interact with other medications and increase the odds of side effects.

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