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Combinations that are not recommended

In isolated cases intravenous administration of furosemide within 24 hours of taking chloral hydrate may lead to flushing, sweating attacks, restlessness, nausea, increase in blood pressure and tachycardia. Use of Frumil concomitantly with chloral hydrate is, therefore, not recommended.

Furosemide may potentiate the ototoxicity of aminoglycosides and other ototoxic drugs. Since this may lead to irreversible damage, these drugs must only be used with furosemide if there are compelling medical reasons.

Precautions for use

There is a risk of ototoxic effects if cisplatin and furosemide are given concomitantly. In addition, nephrotoxicity of cisplatin may be enhanced if furosemide is not given in low doses (eg. 40 mg in patients with normal renal function) and with positive fluid balance when used to achieve forced diuresis during cisplatin treatment.

Oral furosemide and sucralfate must not be taken within two hours of each other because sucralfate decreases the absorption of furosemide from the intestine and hence, reduces its effect.

Furosemide decreases the excretion of lithium salts and may cause increased serum lithium levels, resulting in increased risk of lithium toxicity, including increased risk of cardiotoxic and neurotoxic effects of lithium. Therefore, it is recommended that lithium levels are carefully monitored in patients receiving this combination.

Patients who are receiving diuretics may suffer severe hypotension and deterioration in renal function, including cases of renal failure, especially when an angiotensin converting enzyme inhibitor (ACE inhibitor) or angiotensin II receptor antagonist is given for the first time or for the first time in an increased dose. Consideration must be given to interrupting the administration of furosemide temporarily or at least reducing the dose of furosemide for 3 days before starting treatment with or increasing the dose of an ACE inhibitor or angiotensin II receptor antagonist.

Caution should be exercised and the risks and benefits of treating a patient on risperidone with furosemide or other potent diuretics should be considered prior to the decision to use.

High doses of furosemide may inhibit binding of thyroid hormones to carrier proteins when administered with levothyroxine, and thereby lead to an initial transient increase in free thyroid hormones, followed by an overall decrease in total thyroid hormone levels. It is recommended that thyroid hormones be monitored.

Take into account

When amiloride is taken in combination with potassium salts, with drugs which reduce potassium excretion, with nonsteroidal anti-inflammatory drugs or with ACE-inhibitors, an increase in potassium concentration and hyperkalaemia may occur.

Concomitant administration of non-steroidal anti-inflammatory drugs including acetylsalicylic acid may reduce the effect of Amiloride HCl amd Furosemide (Frumil). In patients with dehydration or hypovolaemia, non-steroidal anti-inflammatory drugs may cause acute renal failure. Salicylate toxicity may be increased by furosemide.

Attenuation of the effects of Amiloride Hydrochloride, Furosemide (Frumil) may occur following concurrent administration of phenytoin.

Carbenoxolone, corticosteroids, prolonged use of laxatives or ingestion of liquorice in large amounts may increase the risk of developing hypokalaemia.

Some electrolyte disturbances (eg. hypokalaemia, hypomagnesaemia) due to furosemide may increase the toxicity of certain other drugs (eg. digitalis preparations and drugs inducing QT interval prolongation syndrome). Amiloride may cause raised blood digoxin levels.

If antihypertensive agents, diuretics or other drugs with blood-pressure lowering potential are given concomitantly with Frumil, a more pronounced fall in blood pressure must be anticipated.

Methotrexate, probenecid and other drugs which, like furosemide, undergo significant renal tubular secretion may reduce the effects of furosemide. Conversely furosemide may decrease renal elimination of these drugs. In the case of high dose treatment (in particular of both furosemide and the other drugs), this may lead to an increased risk of adverse effects due to furosemide or the concomitant medication.

The effect of anti-diabetics drugs and blood pressure-increasing sympathomimetics (eg. adrenaline, noradrenaline) may be reduced. The effects of curare-type muscle relaxants or of theophylline may be increased.

The harmful effects of nephrotoxic drugs on the kidney may be increased by furosemide.

Impairment of renal function may develop in patients receiving concurrent treatment with furosemide and high doses of certain cephalosporins.

Concomitant use of cyclosporine A and furosemide is associated with increased risk of gouty arthritis secondary to furosemide-induced hyperuricemia and cyclosporine impairment of renal urate excretion.

Patients who were at high risk for radiocontrast nephropathy treated with furosemide experienced a higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast.

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