Reduce furosemide dosage in patients with impaired renal function. Creatinine clearance (CrCl) is the key determinant. For CrCl 30-50 mL/min/1.73m2, consider a 25-50% dose reduction. If CrCl is below 30 mL/min/1.73m2, a significantly larger reduction (50-75%) or even omission of furosemide might be necessary. Always monitor serum electrolytes, especially potassium and sodium, closely during dose adjustment. Frequent blood tests are usually required.
Monitoring for Toxicity
Increased risk of ototoxicity and nephrotoxicity exists with impaired kidney function. Carefully monitor serum creatinine levels and conduct regular audiometric assessments, particularly in patients receiving higher doses or those with pre-existing hearing problems. Adjust the dosage based on clinical response and laboratory results. Consider alternative diuretics if furosemide proves ineffective or causes unacceptable side effects.
Specific Considerations
Patients with severe renal impairment (CrCl 2) usually require alternative diuretics to furosemide, given its potential for toxicity in this population. Close collaboration between physician and patient is vital for managing furosemide dosage effectively and safely in individuals with reduced renal function.
