Last update: May 13, 2019

Furosemide

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Diuretic drug with action on the Henle's loop of the nephron. Indicated in the treatment of edema secondary to heart failure, hepatic or renal disease and in the treatment of hypertension.
Oral or parenteral administration once or twice a day.

Although the manufacturer says that it is excreted in the mother's milk (Cinfa 2018, Sanofi 2018), at latest update, relevant published data on excretion into breast milk were not found.

Its high protein-binding capacity and short acting (short half-life) make excretion into breast milk in significant amount unlikely (Kearney 2018).
Because of a low oral bioavailability, mostly in the neonatal period (Kearney 2018), absorption from the ingested milk is thought to be minimal.

No problems have been observed in infants whose mothers have taken Furosemide (Anderson 2018 & 2016, Soussan 2014, Anderson 2003, Ito 1993).
Authorized use in the neonatal period.

Anecdotally and poorly proven, furosemide was used along with water restriction for inhibition of lactation (Cominos 1976). Furosemide does not reduce prolactin levels (Kalk 1977).
Despite some older studies, there is no scientific evidence that diuretics reduce breast milk production (Rowe 2013).

Several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding (Briggs 2017, Hale 2017 p 409, Kearney 2018, Malachias 2016, Schaefer 2007 p691).

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable.

Long-term treatment with diuretic drugs, particularly Thiazides with long-lasting effect and action on the Henle's loop, may compromise the state of hydration of the nursing mother. Must make an adjustment (decrease) of the dose based on the estimated milk production and monitor milk production.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

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Thank you for helping to protect and promote breastfeeding.

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Other names

Furosemide in other languages or writings:

Group

Furosemide belongs to this group or family:

Tradenames

Main tradenames from several countries containing Furosemide in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 44 - 71 %
Molecular weight 331 daltons
Protein Binding 99 %
VD 0,1 - 0,2 l/Kg
pKa 4,25 -
Tmax 1 - 2 hours
T1/2 0,5 - 1,5 hours

References

  1. AEMPS-Cinfa. Furosemida. Ficha técnica. 2018 Full text (in our servers)
  2. Sanofi. Furosemide. Drug Summary. 2018 Full text (in our servers)
  3. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  4. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  5. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  6. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. 11th edition (acces on line) 2017
  7. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  8. Anderson PO, Manoguerra AS, Valdés V. A Review of Adverse Reactions in Infants From Medications in Breastmilk. Clin Pediatr (Phila). 2016 Abstract
  9. Soussan C, Gouraud A, Portolan G, Jean-Pastor MJ, Pecriaux C, Montastruc JL, Damase-Michel C, Lacroix I. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014 Abstract
  10. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  11. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, second edition. London. 2007
  12. Anderson PO, Pochop SL, Manoguerra AS. Adverse drug reactions in breastfed infants: less than imagined. Clin Pediatr (Phila). 2003 Abstract
  13. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Abstract
  14. Smith DE, Lin ET, Benet LZ. Absorption and disposition of furosemide in healthy volunteers, measured with a metabolite-specific assay. Drug Metab Dispos. 1980 Abstract
  15. Kalk WJ, Cominos DC, van der Walt A, van Rooyen AJ. The effect of furosemide on serum prolactin levels in the postpartum period. S Afr Med J. 1977 Abstract
  16. Cominos DC, van der Walt A, van Rooyen AJ. Suppression of postpartum lactation with furosemide. S Afr Med J. 1976 Abstract

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