Furosemide interactions to avoid

In this article:

• Furosemide drug interactions
• Other furosemide interactions and considerations
• How to minimize furosemide interactions
• When to talk to a healthcare provider about furosemide interactions
• Frequently asked questions about furosemide interactions

In this article

• Furosemide drug interactions
• Other furosemide interactions and considerations
• How to minimize furosemide interactions
• When to talk to a healthcare provider about furosemide interactions
• Frequently asked questions about furosemide interactions

Furosemide, also known by the brand name Lasix, is a loop diuretic, which is also called a water pill. Loop diuretics work on the part of the kidneys called the loop of Henle. They help the kidneys eliminate extra water and salt from the body through the urine. Furosemide is approved by the Food and Drug Administration (FDA) to treat adults and children with edema (swelling) associated with congestive heart failure (CHF), liver cirrhosis, or kidney (renal) disease. It’s also approved to treat adults with high blood pressure, either alone or in combination with other medications. 

Like other diuretics, furosemide may interact with certain medications, supplements, and foods. It’s important to understand these furosemide interactions in order to avoid serious side effects. 

Furosemide drug interactions

Furosemide interacts with various prescription and over-the-counter (OTC) medications, including certain antibiotics, several types of blood pressure medications, and others, as outlined below.

Certain antibiotics

Aminoglycoside antibiotics have a potentially serious side effect called ototoxicity, which causes inner ear damage. It can affect hearing and balance and cause tinnitus (ringing in the ears). Furosemide is also associated with ototoxicity. Combining furosemide with an aminoglycoside antibiotic, such as Tobi (tobramycin), an inhaled medication used to treat respiratory infections in people with cystic fibrosis, can increase the risk of ototoxicity. The risk is even higher in people with kidney problems. The prescribing information states that combining furosemide with an aminoglycoside antibiotic should be avoided except in a life-threatening situation. 

Vancomycin is another antibiotic that may cause ototoxicity. Experts recommend using caution in prescribing vancomycin with furosemide. For example, a healthcare provider may prescribe the combination if there are no other alternatives and monitor the patient closely.

Another class of antibiotics, cephalosporins, can potentially interact with furosemide. Furosemide can increase the risk of kidney problems associated with cephalosporins, even in people with minor or occasional kidney problems. Examples of cephalosporins include Keflex (cephalexin) and Omnicef (cefdinir). Healthcare providers may avoid the combination or closely monitor the patient if the combination is prescribed. 

ACE inhibitors and angiotensin receptor blockers (ARBs)

ACE inhibitors and ARBs are prescription drugs used to treat high blood pressure and other heart-related conditions. 

• Examples of ACE inhibitors include Altace (ramipril), Vasotec (enalapril), and Zestril (lisinopril). 
• Examples of ARBs include Cozaar (losartan), Diovan (valsartan), and Benicar (olmesartan). 

Some people take a combination of one of these medications with furosemide. However, with this combination, there is a risk of severely low blood pressure and kidney problems, including kidney failure. If furosemide is prescribed with one of these drugs, the patient will closely monitor their blood pressure and be asked about experiencing symptoms of low blood pressure, such as dizziness and lightheadedness. A decreased dose or change in medication may be required. 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications used to treat pain, inflammation, and fever. There are many NSAIDs available—including some by prescription and some that are available OTC. Examples of NSAIDs include Motrin (ibuprofen), Celebrex (celecoxib), Indocin (indomethacin), Aleve (naproxen), and Mobic (meloxicam). 

NSAIDs may affect the kidneys, and there is a higher risk of kidney problems when a diuretic is combined with an NSAID. NSAIDs can also affect how well furosemide works and cause fluid retention. Those who take furosemide with an NSAID should be closely monitored for blood pressure as well as kidney function. Because NSAIDs can be found in many OTC products, including pain relievers and cough and cold products, check with a healthcare provider before choosing an OTC medication. A healthcare provider may recommend an acetaminophen product like Tylenol instead.

Thyroid hormones

People who take high doses of furosemide (more than 80 mg daily) and a thyroid hormone replacement medication, such as Synthroid (levothyroxine), may experience irregularities in thyroid hormone levels. People who require thyroid hormones and a high dose of furosemide should be closely monitored.

Ethacrynic acid

Ethacrynic acid is a strong diuretic that is sometimes prescribed when other diuretics have not worked. This medication should never be used with furosemide, as both medications have the potential to increase the toxicity of the other one, especially ototoxicity.

Lithium

Lithium is a mood stabilizer used to treat bipolar disorder. Lithium should not be taken with diuretics because diuretics can cause lithium to clear the body more slowly, causing a high risk of lithium toxicity, a life-threatening condition that requires emergency medical treatment. 

Sucralfate

Sucralfate is a medication used to prevent and treat duodenal ulcers. Combining furosemide and sucralfate can decrease the effectiveness of furosemide. Patients who take both medications should take them at least two hours apart from each other and should be closely monitored to ensure that furosemide is working properly. 

Cyclosporine

Cyclosporine is an immunosuppressant medication used for various purposes, including rheumatoid arthritis and psoriasis, and it prevents organ rejection after a transplant. Combining furosemide and cyclosporine increases the risk of gouty arthritis due to a buildup of uric acid. 

Cisplatin

Cisplatin is a chemotherapy drug used to treat certain types of cancers. Combining cisplatin and furosemide increases the risk of ototoxicity. Also, cisplatin can cause kidney damage, so the furosemide dose should be lowered if taken with cisplatin, and fluids should be monitored closely. 

Phenytoin

Dilantin (phenytoin) is an anticonvulsant medication used to prevent and treat seizures. Phenytoin interferes with the way furosemide works on the kidneys, decreasing its absorption and efficacy. If this combination is prescribed together, close monitoring is needed. 

Other furosemide interactions and considerations

Additionally, there are several other interactions, dietary considerations, and other considerations associated with furosemide.

Furosemide and alcohol

Furosemide can cause a person to feel dizzy and lightheaded. In some cases, furosemide can also cause a drop in blood pressure or a faint feeling when standing up too quickly. This is called orthostatic hypotension. Alcohol can worsen these side effects. Being more dizzy and lightheaded can increase the risk of falls and fractures. Consult a healthcare provider about alcohol consumption. While taking furosemide, it’s best to avoid alcohol. Getting up slowly and holding onto something sturdy for support is a good idea to avoid falls. When getting out of bed, go slow and rest each foot on the floor for a few minutes before standing up.

Furosemide and dietary changes

While taking furosemide, a healthcare provider may recommend taking a potassium supplement or eating more dietary potassium, such as bananas, raisins, prunes, and orange juice, and implementing certain dietary changes, such as a low-salt or a low-fat diet. They may also recommend staying hydrated by drinking certain fluids daily. Ask the healthcare provider for more information on dietary changes that may be needed to make while taking furosemide.

Furosemide and licorice

Eating large amounts of licorice while taking furosemide can increase the risk of hypokalemia (low potassium levels). If eaten on occasion, chances are it won’t be a problem. However, if licorice is regularly consumed, check with the healthcare provider regarding an interaction with furosemide.

Furosemide and certain medical conditions

Furosemide is not safe for everyone. Do not take this medication if you:

• Are allergic to furosemide or any ingredient in the medication
• Produce very little or no urine
• Experience dehydration

There are also many medical conditions where the healthcare provider will weigh benefits and risks when deciding if furosemide can be taken, so make sure your healthcare provider knows about any medical conditions you may have. 

How to minimize furosemide interactions

Furosemide has many potential interactions, but in many cases, it can still be taken safely with some precautions. 

Always consult a healthcare provider before beginning a new medicine. Before starting furosemide, make the provider aware of any medical conditions, especially if you: 

• Are pregnant, trying to become pregnant, or breastfeeding
• Are vomiting
• Have diarrhea
• Have gout
• Have heart disease
• Have an electrolyte imbalance (involving magnesium, calcium, potassium, or sodium)
• Have liver disease
• Have a thyroid condition 
• Have kidney disease 
• Are allergic to furosemide, sulfa drugs (also known as sulfonamides), or any other medicines

Tell your healthcare provider about all medications being taken, including prescription and OTC medicines, vitamins, and supplements. While taking furosemide, do not start any new medications unless approved by a healthcare professional.

A healthcare provider may need to change or adjust the dose of furosemide (or another medicine) if there is a potential drug interaction. Always take medication as directed by a healthcare provider. 

While taking furosemide, be aware of potential warning signs of drug interactions, such as symptoms of low potassium levels like muscle cramps, fatigue, and fast or irregular heartbeat. If there are any questions or concerns about drug interactions, always consult a healthcare provider for medical advice. 

When to talk to a healthcare provider about furosemide interactions

While this article provides an overview of furosemide interactions, it is not a complete list of every possible interaction. Inform healthcare providers of all medications that you take, encompassing prescription and OTC drugs, vitamins, and dietary supplements, alongside any existing medical conditions that you have. This helps ensure proper management and monitoring of any interactions with furosemide. Also, while taking furosemide, do not start any new medication unless approved by a healthcare provider.

Frequently asked questions

Can you take furosemide with ibuprofen?

Taking NSAIDs with furosemide may increase the risk of kidney problems. Your healthcare provider may recommend Tylenol (acetaminophen) instead of ibuprofen while you’re taking furosemide.

Is it safe to drink alcohol while on furosemide?

It’s best to avoid drinking alcohol until you know how furosemide affects you. Drinking alcohol while taking furosemide could increase the risk of side effects and make you feel dizzy.

What supplements should you avoid with furosemide?

You should avoid taking licorice and herbal diuretics while taking furosemide.