Leaflet: information for the user

Furosemide Vir 40 mg tablets EFG

Read the entire leaflet carefully before you start taking this medicine, because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed for you only, and you must not give it to others even if they have the same symptoms as you, as it may harm them.
• If you experience any side effects, consult your doctor or pharmacist, even if they are not listed in this leaflet. See section 4.

Furosemida is a diuretic belonging to the sulfonamides group. It acts by increasing urine elimination (diuretic) and reducing blood pressure (anti-hypertensive).

Under the prescription of your doctor, this medication 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 should be given to the treatment of the underlying disease).

-Edemas following burns.

- Mild to moderate arterial hypertension.

Please read carefully the instructions provided in section 3. “How to take Furosemida Vir”.

Do not take Furosemida Vir

• If you are allergic to furosemide, to Furosemida Vir-type medications (sulfonamides) or to any of the other components of this medication (listed in section 6).
• If you have a decrease in your total blood volume (hypovolemia) or are dehydrated.
• If you have severe kidney problems accompanied by a decrease in urine elimination (renal insufficiency with anuria) that do not respond to this medication.

• If you have a severe decrease in your blood potassium level (severe hypokalemia) (see section 4. “Possible side effects”).

• If you have a severe deficiency of sodium salts in your blood (severe hyponatremia).
• If you are in a pre-comatose and comatose state associated with hepatic encephalopathy.
• If you are breastfeeding a baby.
• If you are pregnant, see section “Pregnancy, lactation and fertility”.

Warnings and precautions

Consult your doctor or pharmacist before starting to take furosemide.

Be especially careful with this medication:

• If you have problems with urine elimination, especially at the beginning of treatment.
• If your blood pressure is low (hypotension).
• If you have a special risk of experiencing a significant drop in blood pressure (for example, in patients with significant coronary or cerebral stenosis).
• If you have latent or manifest diabetes mellitus.
• If you have gout.
• If you have severe kidney problems associated with a severe liver disease (hepato-renal syndrome).
• If your blood protein levels are low (hypoproteinemia), in addition to having, for example, a 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 medications that may cause a decrease in blood pressure or if you have other medical conditions associated with the risk of decreased blood pressure.

During your treatment with this medication, you will generally require periodic monitoring of your blood levels of sodium, potassium and creatinine, and especially if you experience a significant loss of fluids, by vomiting, diarrhea or intense sweating. Dehydration or hypovolemia and any significant electrolyte and acid-base balance alterations should be corrected. Treatment may need to be interrupted.

Patients with advanced age and dementia who are taking risperidone should be especially careful when using concomitant risperidone and furosemide. Risperidone is a medication used to treat certain mental illnesses, such as dementia (a disease characterized by several symptoms: memory loss, problems speaking, thinking problems).

Use in athletes

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

Use of Furosemida Vir with other medications

Inform your doctor or pharmacist if you are taking, have taken recently or may need to take any other medication.

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

• High blood pressure (aliskiren)

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

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

These substances include:

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

The concomitant use of furosemide with other medications may weaken the effect of these medications as:

• Medications used to treat diabetes (antidiabetics).
• Medications used to raise blood pressure (sympathomimetics with hypertensive effect, for example, epinephrine and norepinephrine).

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

• Asthma medications (theophylline).

• Relaxants such as curare.
• Medications for depression (lithium salts): may increase the risk of lithium toxicity, including the risk of adverse effects on the heart or brain.
• Patients being treated with diuretics may experience severe hypotension and renal function deterioration, especially when administered for the first time or when administered for the first time a high dose of an ACE inhibitor or an angiotensin II receptor antagonist.
• If diuretics, antihypertensive medications, or other medications that may lower blood pressure are administered together with furosemide, a more pronounced drop in blood pressure should be anticipated.
• Medications toxic to the kidneys: the concomitant administration may potentiate the harmful effect of these medications on the kidneys.

Some anti-inflammatory and pain medications (non-steroidal anti-inflammatory drugs, including aspirin) and epilepsy medications (phenytoin) may reduce the effect of furosemide.

Furosemide may increase the toxicity of salicylates.

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

Medications such as probenecid and methotrexate, or other medications that have significant renal elimination, may reduce the effect of furosemide. In 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 blood potassium levels (hypokalemia) if administered with furosemide:

• Corticosteroids (inflammation medications).
• Carbenoxolone (medication for treating oral mucosa lesions).
• Significant amounts of licorice.
• Prolonged use of laxatives for constipation.

Some electrolyte alterations (for example, a decrease in blood potassium levels (hypokalemia) or magnesium (hypomagnesemia)) may increase the toxicity of some medications (for example, digitalis medications and medications that induce the QT interval prolongation syndrome).

Patients being treated with furosemide and receiving high doses of some cephalosporins (antibiotics) may experience a decrease in kidney function.

The concomitant administration of furosemide and cyclosporine A (medication used to prevent transplant rejection) is associated with an elevated risk of secondary gouty arthritis (inflammation of the joints) due to an increase in blood urea levels (hyperuricemia) and problems with urea elimination by the kidneys.

Patients with a high risk of developing nephropathy (kidney disease) due to radiocontrast who receive furosemide have a higher risk of kidney function deterioration.

The concomitant administration of furosemide with risperidone in elderly patients with dementia may increase mortality.

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

Pregnancy, lactation and fertility

If you are pregnant or breastfeeding, consult your doctor or pharmacist before using this medication.

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

During breastfeeding, furosemide should not be administered. If its administration is necessary, your doctor may require you to stop breastfeeding, as furosemide passes into breast milk.

Driving and operating machines

This medication may cause dizziness or somnolence. This may occur more frequently at the beginning of treatment, when your doctor increases your dose or if you consume alcohol. Do not drive or operate tools or machines if you feel dizzy or somnolent.

Some adverse effects (e.g. an undesirable drop in blood pressure) may impair your ability to concentrate and react, and therefore constitute a risk in situations where these skills are of special importance (e.g. operating vehicles or machinery).

This medication contains less than 23 mg of sodium (1 mmol) per tablet; it is essentially “sodium-free”.

Follow exactly the administration instructions for this medication as indicated by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

Remember to take your medication.

Take this medication on an empty stomach, swallowing it without chewing and with sufficient liquid.

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

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

For adults, it is recommended to start treatment with half, one or two tablets (20 to80 mg of furosemide) per day. 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 per day, up to a maximum of 40 mg per day.

Your doctor will indicate the duration of your treatment with this medication. Do not discontinue treatment before.

If you take more Furosemida Vir than you should

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

An accidental overdose could lead to a severe decrease in blood pressure (which may progress to shock), kidney problems (acute renal insufficiency), coagulation problems (thrombosis), delirium, paralysis affecting soft muscles (flaccid paralysis), apathy, and confusion.

No specific antidote is known.

Treatment for overdose will be based on symptoms.

If you forgot to take Furosemida Vir

Do not take a double dose to compensate for the missed doses.

Like all medicines, this medicine mayproduceside effects, although not everyone will experience them.

Side effects have been grouped according to their frequency:

Very frequent(may affect more than1 in 10 patients)

• electrolyte imbalances (including symptomatic ones), dehydration, and a decrease in total blood volume (hypovolemia), particularly in elderly patients, elevated levels of creatinine and triglycerides in the blood.

Frequent(may affect up to1 in 10 patients)

• decreased levels ofsodium(hypnatremia), chloride (hypochloremia), and potassium (hypokalemia), increased levels of cholesterol and uric acid in the blood, andgout attacks.
• increased urine volume.
• mental changes (hepatic encephalopathy) in patients with liver problems (hepatic cell insufficiency).
• increased blood viscosity (hemoconcentration).

Not very frequent(may affect up to1 in 100 patients)

• alteration of glucose tolerance. May manifest latent diabetes mellitus.
• nausea.
• tinnitus, although usually of a transient nature, especially in patients with renal insufficiency, decreased levels of proteins in the blood (hypoproteinemia), and/or after a rapid intravenous administration of furosemide. Deafness (sometimes irreversible).
• itching, prickling, rashes, blisters, and more severe reactions such as erythema multiforme, pemphigoid, exfoliative dermatitis, purpura, and photosensitivity reactions.
• decreased platelet levels (thrombocytopenia).

Rare(may affect up to1 in 1,000 patients)

• allergic inflammation of blood vessels(vasculitis).
• allergic renal reaction (tubulointerstitial nephritis).
• vomiting, diarrhea.
• subjective sensation of ringing in the ears (tinnitus).
• severe allergic reactions (anaphylactic or anaphylactoid) (e.g., with shock).
• sensation of numbness in the extremities (paresthesias).
• decreased white blood cell levels (leucopenia), increased levels of a type of white blood cell, eosinophils (eosinophilia).
• fever.

Very rare(may affect up to1 in 10,000 patients)

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

Frequency unknown(cannot be estimated from available data)

• decreased levels ofcalcium(hypocalcemia), magnesium (hypomagnesemia), increased levels of urea in the blood, metabolic alkalosis, pseudo-Bartter syndrome in the case of misuse and/or prolonged use of furosemide.
• alteration of blood coagulation(thrombosis).
• increased levels of sodium and chloride in the urine, urinary retention (in patients with partial obstruction of urine flow), kidney stone formation (nephrocalcinosis/nephrolithiasis) in premature infants, renal failure.
• severe vesicular reactions of the skin and mucous membranes (Stevens-Johnson syndrome), severe skin alteration characterized by blistering and exfoliative lesions (toxic epidermal necrolysis), generalized acute pustular exanthema (PEGA), anddrug hypersensitivity syndrome with eosinophilia and systemic symptoms (DRESS), lichenoid reactions,characterized by small lesions, which produce itching, red-purple in color, polygonal shape, appearing 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 severe hypokalemia (see "Do not use Furosemide IV").
• increased risk of persistence of the "ductus arteriosus permeable" when furosemide is administered to premature infants during the first weeks of life.

Like other diuretics, prolonged administration of this medicine may increase the elimination of sodium, chloride, water, potassium, calcium, and magnesium. These alterations manifest with intense thirst, headache, confusion, muscle cramps, painful muscle contractions, especially in the extremities (tetany), muscle weakness, alterations in heart rhythm, and gastrointestinal symptoms.

Reporting of side effects

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

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

Sensitive to light. Store in the original packaging.

This medication does not require special temperature storage conditions.

Do not use this medication after the expiration datethat appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Medications should not be disposed of through drains or trash. Dispose of packaging and unused medications at the SIGRE collection pointat the pharmacy. If in doubt, ask your pharmacist how to dispose of unused packaging and medications. By doing so, you will help protect the environment.

Composition of Furosemida Vir

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

Appearance of the product and contents of the packaging

Furosemida Vir is presented in packaging of 10 and 30 tablets.

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

Holder of the marketing authorization and responsible for manufacturing

Industria Química y Farmacéutica VIR, S.A.

C/Laguna 66-70. Polígono Industrial Urtinsa II

28923 Alcorcón (Madrid)

Spain

Last review date of this leaflet: April 2024

The detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS)http://www.aemps.gob.es/