8 Furosemide Interactions You Should Know About

Diuretics (“water pills”) are often used to treat high blood pressure. And they can also help alleviate swelling from certain medical conditions. There are many types of diuretics available, and furosemide (Lasix) is a common one you may be prescribed. 

Furosemide is sometimes taken on its own. But chances are you may be taking it with other medications. So what happens when these medications interact? 

Many times, furosemide interactions can be managed with safer alternatives or monitoring. But some over-the-counter products and alcohol can interact with it, too. We’ve detailed a few furosemide interactions and how to manage them below.

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1. Certain antibiotics

On its own, furosemide is one of several medications that can cause harm to your kidneys or ears. Certain antibiotics, like aminoglycosides and vancomycin (Vancocin), can potentially do the same.

When taken with aminoglycosides, furosemide can increase the risk of ear and kidney damage. These antibiotics are most commonly used to treat serious infections in a hospital. But tobramycin (Tobi) is also available as an inhalation for people living with cystic fibrosis. And while most of the medication stays in your lungs, ear and kidney damage have been reported.

Vancomycin is an antibiotic that’s given by mouth or infused into a vein. Both routes can potentially cause ear and kidney damage. Taking it with furosemide can increase this risk. This is especially the case if you’re older or already have kidney problems.

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Signs of ear damage include ringing in your ears, hearing loss, or balance problems. Peeing less often, swelling in your ankles or legs, and weakness can be signs of kidney damage.

Your healthcare provider will determine how to manage this interaction. In some cases, they may avoid this combination. 

2. Ethacrynic acid

Ethacrynic acid (Edecrin) is another loop diuretic that can help with swelling. Compared to other loop diuretics, it tends to have a higher risk of hearing and/or balance problems. This risk goes up if it’s combined with other loop diuretics, like furosemide. For this reason, it’s recommended to avoid taking them together.

3. Lithium

Lithium (Lithobid) is used to treat mental health conditions like bipolar disorder. It can be effective, but serious side effects are possible if your blood levels are too high. 

Low sodium levels can cause higher lithium levels in the blood, increasing the risk of lithium toxicity. And loop diuretics, like furosemide, cause your kidneys to get rid of sodium in your urine. 

So, this combination can put you at higher risk of lithium toxicity, which can be life-threatening. Symptoms include confusion, blurry vision, and muscle weakness. Because of this risk, your healthcare provider will likely avoid this combination.

4. Sucralfate

Sucralfate (Carafate) works by lining the stomach and small intestine to allow ulcers to heal. Because of this, sucralfate should be taken on an empty stomach. But it can also prevent other oral medications from being absorbed when taken together. This includes furosemide. 

The good news is that many of these interactions can be managed by separating your doses. If you’re taking furosemide and sucralfate, you should separate when you take each medication by at least 2 hours.

5. ACE inhibitors and ARBs

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) include some of the most commonly prescribed medications in the U.S. Examples of ACE inhibitors include lisinopril (Zestril) and enalapril (Vasotec). A few ARBs include losartan (Cozaar) and valsartan (Diovan). Both classes are used for high blood pressure and other cardiovascular conditions.

It’s not unusual to see ACE inhibitors or ARBs prescribed with furosemide. But this combination can increase the risk of your blood pressure getting too low (hypotension). If this happens, you may feel dizzy and even pass out. What’s more, this combination may also affect how well your kidneys function.

Your healthcare provider will monitor you closely if you’re taking these medications together. If needed, they may need to adjust your regimen. Let them know if you’re experiencing dizziness and lightheadedness. This might be a sign your blood pressure is too low.

6. Cyclosporine

Cyclosporine (Sandimmune) and cyclosporine modified (Neoral, Gengraf) are used to prevent rejection after an organ transplant. Cyclosporine modified is also used to treat certain autoimmune disorders.

On their own, loop diuretics like furosemide can increase the risk of gout attacks. This is because they cause your kidneys to reabsorb uric acid. Uric acid is a waste product that can build up in your joints and cause gout. Cyclosporine also prevents your kidneys from removing uric acid. So, this combination can increase uric acid levels and potentially cause or worsen gout.

7. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and fever. Examples include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and aspirin.

On their own, NSAIDs have a reputation of being hard on your kidneys. Taking them with furosemide can worsen this effect. What’s more, NSAIDs like ibuprofen have been shown to raise blood pressure. If you’re taking NSAIDs regularly, your blood pressure may not be as controlled.

NSAIDs can also cause ear damage, especially with higher doses and/or long-term use. This may be more likely to develop if they’re taken with furosemide. 

If you have high blood pressure, some experts recommend avoiding NSAIDs. Your healthcare provider can recommend safer alternatives for your specific situation.

8. Alcohol

If you’re taking blood pressure medications, it’s usually best to avoid or minimize alcohol. That’s because it may prevent your medications from working as well, or cause worse side effects. The same holds true for combining alcohol with furosemide.

On its own, furosemide can cause orthostatic hypotension. This is a drop in blood pressure when changing positions (like going from sitting to standing). You may feel dizzy, which can lead to fainting or falling. Slowly changing positions can help your body adjust to decreases in blood pressure.

Alcohol can worsen orthostatic hypotension from furosemide. But you may be wondering if one or two drinks is OK. This depends on your personal risk factors and health history. Talk to your healthcare provider about how much alcohol is safe to drink. 

When should I contact my healthcare provider about a furosemide interaction?

The interactions listed above don’t include all possible furosemide interactions. So, there may be other medications you’re taking that can interact with furosemide. 

If you’re ever unsure about an interaction, talk to your healthcare provider. Your pharmacist can be a good resource, too. Share your current medication list so they can check for potential interactions.

There are situations where medications are prescribed with furosemide intentionally. In this case, it’s important to let your healthcare provider know if you’re experiencing new or worsening side effects. This may include dizziness, ringing in your ears, or peeing less frequently.

Bottom line

Furosemide can interact with certain antibiotics, lithium, and NSAIDs like ibuprofen. Interactions with ethacrynic acid, cyclosporine, and alcohol can also be problematic. Your healthcare provider will determine how to manage furosemide interactions that affect you. In some cases, they may recommend safer alternatives. If not, they’ll monitor you closely and make adjustments as needed.

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Written by:

Emmeline C. Academia, PharmD, BCOP

Emmeline C. Academia, PharmD, BCOP, has been a practicing clinical pharmacist in adult oncology since 2020. She is a clinical pharmacy specialist in oncology at Beth Israel Deaconess Medical Center, in Boston.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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