FUROSEMIDE VIR 40 mg TABLETS

1. What is Furosemide Vir and what is it used for

Furosemide is a diuretic belonging to the group of sulfonamides. It acts by increasing urine elimination (diuretic) and reducing blood pressure (antihypertensive).

Always under the prescription of your doctor, this medicine is indicated for the treatment of:

• Edema (swelling due to fluid accumulation) associated with congestive heart failure, liver cirrhosis (ascites), and kidney disease, including nephrotic syndrome (priority is given to treating the underlying disease).
• Edema following burns.
• Mild to moderate arterial hypertension.

2. What you need to know before taking Furosemide Vir

Read carefully the instructions provided in section 3, "How to take Furosemide Vir".

Do not take Furosemide Vir

• If you are allergic to furosemide, to medicines of the Furosemide Vir type (sulfonamides), or to any of the other components of this medicine (listed in section 6).
• In case of decreased total blood volume (hypovolemia) or dehydration.
• If you suffer from severe kidney problems, accompanied by a decrease in urine elimination (renal insufficiency with anuria), that do not respond to this medicine.

• If you have a severely decreased level of potassium in the blood (severe hypokalemia) (see section 4, "Possible side effects").

• If you suffer from a severe deficiency of sodium salts in the blood (severe hyponatremia).
• In case of pre-coma and coma associated with hepatic encephalopathy.
• If you are breastfeeding a baby.
• If you are pregnant, see the section "Pregnancy, breastfeeding, and fertility".

Warnings and Precautions

Consult your doctor or pharmacist before starting to take furosemide.

Be particularly careful with this medicine:

• If you have problems with urine elimination, especially at the start of treatment.
• If your blood pressure is low (hypotension).
• If you are at special risk of suffering a pronounced drop in blood pressure (for example, in patients with significant coronary or cerebral stenosis).
• If you have latent or manifest diabetes mellitus.
• If you suffer from gout.
• If you have severe kidney problems associated with severe liver disease (hepato-renal syndrome).
• If your blood protein levels are low (hypoproteinemia), in addition to suffering, for example, from nephrotic syndrome (see section 4, "Possible side effects").
• In premature children (see section 4, "Possible side effects").
• There is a possibility of exacerbation or activation of systemic lupus erythematosus.
• If you are an elderly person, if you are being treated with medicines that can cause a decrease in blood pressure, or if you have other medical conditions that have associated risk of decreased blood pressure.

During treatment with this medicine, periodic monitoring of your blood levels of sodium, potassium, and creatinine will generally be required, especially if you suffer from severe fluid loss due to vomiting, diarrhea, or intense sweating. Dehydration or hypovolemia, as well as any significant electrolyte and acid-base imbalance, should be corrected. Treatment interruption may be required.

Elderly patients with dementia who are taking risperidone should be particularly careful with the concomitant use of risperidone and furosemide. Risperidone is a medicine used to treat certain mental illnesses, such as dementia (a disease characterized by several symptoms: memory loss, speech problems, thinking problems).

Athletes

This medicine contains furosemide, which can produce a positive result in doping tests.

Use of Furosemide Vir with other medicines

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.

Inform your doctor if you are being treated with medicines for:

• high blood pressure (aliskiren)

The effect of treatment may be affected if furosemide is used at the same time as other medicines.

Certain substances may increase their toxicity in the ear or kidneys if administered together with this medicine. Therefore, they should only be administered together if there are medical reasons that require it.

These substances include:

• Aminoglycoside antibiotics (infection medicines) such as gentamicin, kanamycin, and tobramycin.
• Cancer medicines (cisplatin).

The concomitant use of furosemide with other medicines may weaken the effect of these medicines, such as:

• Medicines used for diabetes (antidiabetics).
• Medicines used to increase blood pressure (sympathomimetics with a hypertensive effect, for example, epinephrine and norepinephrine).

In other cases, concomitant use may increase the effects of these medicines, such as:

• Asthma medicines (theophylline).

• Muscle relaxants like curare.
• Medicines for depression (lithium salts): may increase the risk of lithium toxicity, including the risk of harmful effects on the heart or brain.
• Patients undergoing treatment with diuretics may suffer from severe hypotension and deterioration of kidney function, especially when an ACE inhibitor (Angiotensin-Converting Enzyme) or an angiotensin II receptor antagonist is administered for the first time or at a high dose.
• If medicines for high blood pressure, diuretics, or other medicines that can decrease blood pressure are administered together with furosemide, a more pronounced drop in blood pressure should be expected.
• Medicines toxic to the kidneys: concomitant administration may potentiate the harmful effect of these medicines on the kidneys.

Certain medicines for inflammation and pain (non-steroidal anti-inflammatory drugs, including acetylsalicylic acid) and medicines for epilepsy (phenytoin) may reduce the effect of furosemide.

Furosemide may increase the toxicity of salicylates.

This medicine and sucralfate should not be administered together, with an interval of less than 2 hours, as the effect of furosemide may be reduced.

Medicines such as probenecid and methotrexate or other medicines that have significant renal elimination may reduce the effect of furosemide. With high-dose treatment, they may increase serum levels and increase the risk of adverse effects due to furosemide or concomitant administration.

The following substances may increase the risk of reducing potassium levels in the blood (hypokalemia) if administered with furosemide:

• Medicines for inflammation (corticosteroids).
• Carbenoxolone (medicine for the treatment of oral mucosa lesions).
• Large amounts of licorice.
• Prolonged use of laxatives for constipation.

Certain electrolyte disturbances (e.g., decreased potassium or magnesium levels in the blood) may increase the toxicity of certain medicines (e.g., digitalis medicines and medicines that induce QT interval prolongation syndrome).

Patients undergoing treatment with furosemide who receive high doses of certain cephalosporins (antibiotics) may suffer from a decrease in kidney function.

The concomitant administration of furosemide and cyclosporin A (a medicine used to prevent transplant rejection) is associated with an increased risk of gouty arthritis (joint inflammation) secondary to an increase in blood urea levels and kidney urea elimination problems.

Those patients at high risk of suffering from nephropathy (kidney disease) due to contrast media who receive furosemide have a higher likelihood of suffering from kidney function deterioration.

The administration of furosemide together with risperidone in elderly patients with dementia could increase mortality.

High doses of furosemide administered with levothyroxine may lead to a transient initial increase in free thyroid hormones, followed by a general decrease in total thyroid hormone levels.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

If you are pregnant, you will only use furosemide if there are medical reasons that require it.

During breastfeeding, do not administer furosemide. In the case that its administration is essential, your doctor may require you to interrupt breastfeeding, as furosemide passes into breast milk.

Driving and using machines

This medicine may cause dizziness or drowsiness. This can happen more frequently at the start of treatment, when your doctor increases the dose, or if you consume alcohol. Do not drive or operate tools or machines if you feel dizzy or drowsy.

Certain side effects (e.g., an undesirable pronounced drop in blood pressure) may impair the ability to concentrate and react, and therefore constitute a risk in situations where these skills are particularly important (e.g., operating vehicles or machinery).

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; that is, it is essentially "sodium-free".

3. How to take Furosemide Vir

Follow exactly the administration instructions of this medicine indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Remember to take your medicine.

Take this medicine on an empty stomach, swallowing it whole and with sufficient liquid.

If you estimate that the action of this medicine is too strong or too weak, inform your doctor or pharmacist.

Your doctor will prescribe the lowest sufficient dose to produce the desired effect.

In adults, it is recommended to start treatment with half, one, or two tablets (20 to 80 mg of furosemide) daily. The maintenance dose is half to one tablet per day, and the maximum dose will be indicated by your doctor and will depend on your response to treatment.

Use in children

In infants and children, it is recommended to administer 2 mg/kg of body weight daily, up to a maximum of 40 mg per day.

Your doctor will indicate the duration of your treatment with this medicine. Do not suspend your treatment before.

If you take more Furosemide Vir than you should

In case of overdose or accidental ingestion, consult your doctor or go to the emergency department of the nearest hospital, accompanied by this package leaflet, or call the Toxicology Information Service, telephone 91 562 04 20, indicating the medicine and the amount ingested.

An accidental overdose could lead to a severe drop in blood pressure (which may evolve into shock), kidney problems (acute renal failure), coagulation problems (thrombosis), delirium, flaccid paralysis of soft muscles, apathy, and confusion.

No specific antidote is known.

In case of overdose, treatment will be based on symptoms.

If you forget to take Furosemide Vir

Do not take a double dose to make up for forgotten doses.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Side effects have been grouped by frequency:

Very common(may affect more than 1 in 10 patients)

• electrolyte disturbances (including symptomatic ones), dehydration, and decreased total blood volume (hypovolemia), particularly in elderly patients, elevated creatinine and triglyceride levels in the blood.

Common(may affect up to 1 in 10 patients)

• decreased sodium (hyponatremia), chloride (hypochloremia), potassium (hypokalemia) levels, increased cholesterol and uric acid levels in the blood, and gout attacks.
• increased urine volume.
• mental disturbances (hepatic encephalopathy) in patients with liver problems (hepatocellular insufficiency).
• increased blood viscosity (hemoconcentration).

Uncommon(may affect up to 1 in 100 patients)

• altered glucose tolerance. Latent diabetes mellitus may manifest.
• nausea.
• hearing disorders, although usually transient, especially in patients with renal insufficiency, decreased protein levels in the blood (hypoproteinemia), and/or after too rapid intravenous administration of furosemide. Deafness (sometimes irreversible).
• itching, rash, eruptions, blisters, and more severe skin reactions such as erythema multiforme, pemphigoid, exfoliative dermatitis, purpura, and photosensitivity reaction.
• decreased platelet levels (thrombocytopenia).

Rare(may affect up to 1 in 1,000 patients)

• allergic inflammation of blood vessels (vasculitis).
• allergic kidney reaction (tubulointerstitial nephritis).
• vomiting, diarrhea.
• subjective sensation of ringing (tinnitus).
• severe allergic reactions (anaphylactic or anaphylactoid) (e.g., with shock).
• tingling sensation in the limbs (paresthesia).
• decreased white blood cell count (leukopenia), increased eosinophil count.
• fever.

Very rare(may affect up to 1 in 10,000 patients)

• inflammation of the pancreas (acute pancreatitis).
• liver problem (cholestasis), increased liver enzymes (transaminases).
• decreased granulocyte count (agranulocytosis), decreased red blood cell count (aplastic or hemolytic anemia).

Frequency not known(cannot be estimated from available data)

• decreased calcium (hypocalcemia), magnesium (hypomagnesemia) levels, increased urea level in the blood, metabolic alkalosis, pseudo-Bartter syndrome in the case of misuse and/or prolonged use of furosemide.
• blood coagulation disorder (thrombosis).
• increased sodium and chloride levels in the urine, urine retention (in patients with partial obstruction of urine flow), kidney stone formation (nephrocalcinosis/nephrolithiasis) in premature infants, kidney failure.
• severe skin and mucous membrane reactions (Stevens-Johnson syndrome), severe skin disorder characterized by blistering and exfoliative lesions (toxic epidermal necrolysis), acute generalized exanthematous pustulosis (AGEP), and drug hypersensitivity syndrome with eosinophilia and systemic symptoms (DRESS), lichenoid reactions, characterized as small, itchy, reddish-purple lesions, with a polygonal shape, that appear on the skin, genitals, or mouth.

• exacerbation or activation of systemic lupus erythematosus.

• dizziness, fainting, and loss of consciousness, headache.
• cases of rhabdomyolysis have been reported, often in cases where there is a severe decrease in potassium levels in the blood (severe hypokalemia) (see section "Do not use Furosemide Vir").
• increased risk of persistence of the "ductus arteriosus permeable" when furosemide is administered to premature infants during the first weeks of life.

As with other diuretics, after prolonged administration of this medicine, there may be an increase in the elimination of sodium, chloride, water, potassium, calcium, and magnesium. These disturbances manifest as intense thirst, headache, confusion, muscle cramps, painful muscle contraction, especially in the limbs (tetany), muscle weakness, cardiac rhythm disturbances, and gastrointestinal symptoms.

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist, even if it is possible side effects not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Furosemide Vir

Keep this medicine out of the sight and reach of children.

Sensitive to light. Store in the original package.

This medicine does not require special temperature storage conditions.

Do not use this medicine after the expiration date that appears on the package after CAD. The expiration date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Deposit the packages and medicines you no longer need at the SIGRE Point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of packages and medicines you no longer need. This way, you will help protect the environment.

6. Packaging Content and Additional Information

Furosemida Vir Composition

• The active ingredient is furosemide. Each tablet contains 40 mg of furosemide.
• The other components (excipients) are: corn starch, magnesium carbonate, corn starch pregelatinized, sodium lauryl sulfate, povidone, magnesium stearate.

Product Appearance and Packaging Content

Furosemida Vir is available in packages of 10 and 30 tablets.

Round tablets, white in color, with a diameter of 8 mm, scored on one side. The score serves to divide the tablet into equal doses.

Marketing Authorization Holder and Manufacturer

Industria Química y Farmacéutica VIR, S.A.

C/Laguna 66-70. Polígono Industrial Urtinsa II

28923 Alcorcón (Madrid)

Spain

Date of the last revision of this prospectus: April 2024

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/