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Furosemide Injection

[07 July 2014]

Products Affected - Description

Furosemide Injection, 10 mg/mL, American Regent
2 mL vial (NDC 00517-5702-25)
4 mL vial (NDC 00517-5704-25)
10 mL vial (NDC 00517-5710-25)
 
Furosemide Injection, 10 mg/mL, Hospira
10 mL vial (NDC 00409-6102-10)

Reason for the Shortage

  • Fresenius Kabi (formerly APP) has furosemide injection on shortage due to increased demand for the product.1
  • American Regent had temporarily suspended manufacture of most drug products including furosemide in April, 2011.2
  • American Regent resumed manufacturing in Shirley, New York in early-May, 2011.
  • Hospira has furosemide on shortage due increased demand.3,4,5 
  • Wockhardt has discontinued all furosemide injection presentations.6

Available Products

Furosemide Injection, 10 mg/mL, Claris7
2 mL vial (NDC 36000-0063-05)
4 mL vial (NDC 36000-0064-05)
10 mL vial (NDC 36000-0065-05)

Furosemide Injection, 10 mg/mL, Fresenius Kabi1
 
2 mL vial (NDC 63323-0280-02)
4 mL vial (NDC 63323-0280-04)
10 mL vial (NDC 63323-0280-10)
 
Furosemide Injection, 10 mg/mL, Hospira4,5
2 mL vial (NDC 00409-6102-02)
4 mL vial (NDC 00409-6102-04)
4 mL syringe (NDC 00409-9631-04)
10 mL Luer lock syringe (NDC 00409-1639-10)

Estimated Resupply Dates

  • American Regent has furosemide 10 mg/mL 2 mL, 4 mL, and 10 mL vials on back order and the company cannot estimate a release date.2,3
  • Hospira has furosemide 10 mg/mL 10 mL vials on back order and the company estimates a release date in late-July 2014.5

Implications for Patient Care

Furosemide injection is indicated in the adjunctive treatment of acute pulmonary edema; edema associated with congestive heart failure and hepatic cirrhosis; edema caused by renal diseases including nephrotic syndrome, acute glomerulonephritis, and chronic renal failure; and hypertension, either as a single agent or in combination with other antihypertensives.8-10 The preferred route of administration of furosemide is oral, although the injection may be administered when a rapid onset of action is required, or when patients cannot take oral medications.8-10

Safety

  • Loop diuretics can cause water and electrolyte imbalances from potent diuresis and individualized dosing and supervision is recommended.8-13
  • Patients who are allergic to sulfonamides are at risk for a cross-reaction with sulfonamide-type diuretics and should not receive these agents except for ethacrynic acid.8-13

Alternative Agents & Management

During this shortage, use oral loop diuretics when possible. Furosemide is available as an oral liquid if tablets are not tolerated. Furosemide is the only loop diuretic available in an oral liquid presentation.8-13 Several injectable loop diuretics are available when oral furosemide is not a viable option. Table 1 compares the pharmacodynamics of and Table 2 provides information on dosages for injectable loop diuretics.

Related Shortages

References

  1. Fresenius Kabi (personal communications). June 9 and 30, July 12, 16, and 22, August 3 and 23, October 15, November 15, December 7 and 20, 2010; January 5, 12, and 27, March 25, May 11, June 8, July 27, August 29, September 16, October 17, November 11, December 1, 2011; January 4, February 1 and 28, March 20, April 11, May 29, June 7, July 3 and 23, August 7 and 22, October 1 and 22, November 5 and 30, December 7 and 21, 2012; January 14, February 28, March 18, April 1, 17, and 25, May 9, June 10, July 22, August 19, September 17, October 22, November 13, 2013; January 3, February 14, May 6 and 19, and July 1, 2014.
  2. American Regent (personal communications). June 9 and 30, July 12, August 2 and 24, September 8 and 20, October 12, November 16, and December 7, 21, and 30, 2010; January 24, March 23, April 21, and May 31, 2011.
  3. American Regent (website). July 27, August 31, September 20, October 17, November 14, December 1, 2011; January 4 and 31, February 28, March 20, April 11, May 30, June 11, July 3 and 25, August 8 and 21, September 28, October 24, November 5, December 4, 10, and 20, 2012; January 14, February 28, March 18, April 1, 16, and 29, May 8, June 12, July 22, August 19, September 19, October 23, November 15, 2013; January 2, February 18, May 9 and 20, and July 7, 2014.
  4. Hospira (personal communications). June 9 and 30, July 12 and 14, August 5 and 26, September 16 and 20, October 12 and 15, November 15, December 7, 20, and 28, 2010; January 4 and 25, February 3, March 23, May 10, June 16, August 29, December 1, 2011; January 4 and 31, February 28, March 20, June 12, July 3 and 24, August 6 and 22, October 1 and 24, and December 10 and 26, 2012; April 1 and 17, June 12, and July 22, 2013.
  5. Hospira (website) July 27, August 29, September 20, October 17, November 14, 2011; April 11, May 30, June 11, November 6, December 4, 2012; January 15, March 1 and 19, April 29, May 13 and 24, August 19, September 19, October 23, November 15, 2013; January 7, and February 18, May 9 and 20, and July 7, 2014.
  6. Wockhardt (personal communications). May 19, 2010.
  7. Claris Lifesciences (personal communications). May 20 and July 7, 2014.
  8. Loop Diuretics. In: McEvoy GK, ed. AHFS 2010 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2010:2737-2750.
  9. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc.; 2010.
  10. Anon. Drug Evaluation: Furosemide. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2010.
  11. Anon. Drug Evaluation: Bumetanide. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2010.
  12. Anon. Drug Evaluation: Torsemide. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2010.
  13. Anon. Drug Evaluation: Ethacrynic acid. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2010.

Updated

Updated July 7, 2014 by Jane Chandramouli, PharmD, Drug Information Specialist. Created January 22, 2002, by Erin R. Fox, PharmD, Director, Drug Information Service, and Cathy Wick, PharmD, Pharmacy Practice Resident. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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