Classification: Loop Diuretic

Action: Inhibits sodium and chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water together with sodium, chloride and potassium. Diuretic, antihypertensive.

Indication: Treatment of edema associated with congestive heart failure (CHF), hepatic cirrhosis, and renal disease, hypertension.

Adverse reaction: Orthostatic hypotension, thrombophlebitis, chronic arthritis, vertigo, headache, dizziness, paresthesia, restlessness, fever, photosensitivity, urticaria, pruritus. Blurred vision, tinnitus, nausea, vomiting, diarrhea. Urinary bladder spasm, agranulocytosis, jaundice, hypokalemia, hyperglycemia, metabolic alkalosis, muscle spasm, weakness.

Nursing Considerations


  • Assess patient’s underlying condition before starting therapy
  • Monitor for manifestations of hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia, hypercholermia
  • Assess fluid volume status
  • Assess patient for tinnitus, hearing loss, ear pain
  • Assess patient’s and family’s knowledge of drug therapy


  • Give in morning to avoid interference with sleep
  • Potassium replacement if potassium is <3.0 mg/dL, or use oral solution slightly, drug may be crushed if patient is unable to swallow
  • PO route: With food, if nausea occurs, absorption may be reduced
  • IV route: Do not use solution that is yellow, has a precipitate, or crystals
  • Direct IV: Give undiluted through Y-tube on 3-way stopcock; give 20mg or less/min


  • Teach patient to take medication early in the day to prevent nocturia
  • Instruct patient to take with food or milk if GI symptoms of nausea and anorexia occurs
  • Inform patient that this drug causes a loss of potassium, therefore food rich in potassium should be added to the diet
  • Instruct patient to lie down if dizziness occur
  • Teach patient to maintain a record of weight on weekly basis and notify physician of weight loss of >5 lbs.
  • Teach patient not to use alcohol or any OTC medications without physician’s approval because of the danger of serious drug reactions


  • Decreased edema
  • Patient demonstrates adjustment of lifestyle to cope with altered pattern of urination
  • Patient and family state understanding of drug therapy