Spironolactone + Frusemide Pharmacology
Spironolactone + Frusemide
2.Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
4.Decrease in blood pressure
14.Increased blood sugar level
15.Increased level of uric acid in the blood (hyperuricaemia) which may cause gout.
16.Disturbances in the levels of electrolytes (eg potassium, calcium, magnesium) in the blood
20.Changes in libido
21.Disturbance in the normal numbers of blood cells in the blood
22.Severe blistering skin reactions, eg Stevens-Johnson Syndrome
2.People with a low volume of fluid in their blood (hypovolaemia), eg due to blood loss or dehydration.
6.Kidney failure caused by poisoning with agents that have damaged the kidney or liver
8.People who are losing consciousness due to liver cirrhosis that is affecting the brain
2.Decreased kidney function
3.Enlarged prostate gland
2.Fluid retention (ascites and oedema) in liver cirrhosis
4.Duodenal and gastric bleeding
16.Altered levels of blood urea nitrogen
17.Gastro intestinal disturbances
4.Acute and progressive renal insufficiency
3.Fluid and electrolyte imbalance
3.Diagnosis of primary hyperaldosteronism
Digitalis glycosides: Interaction is complex and may result in increased serum digoxin levels & subsequent digitalis toxicity.
Cyclosporin: Increased risk of hyperkalaemia.
Potassium Preparations: May result in hyperkalaemia, possibly with cardiac arrhythmias or cardiac arrest, especially in patients with impaired renal functions.
Salicylates: Diuretic effects reduced by salicylates.
Carbenoxolone: Ulcer healing effect antagonised by spironolactone.
Food: Increased absorption of spironolactone.
Lab tests: Interferes with radio-immuno assay for measuring digoxin, resulting in falsely elevated serum digoxin.
Oedema: 25 to 200mg/day in divided doses.
Diagnosis of primary hyperaldosteronism: 400mg/day (short test) or up to four weeks (long test)
Hirsutism: 25 to 200mg/day in divided doses.
Premenstrual syndrome: 25mg four times on fourteenth day of menstrual cycle.
It increase local prostaglandin synthesis and increases systemic venous capacitance and decreases left ventricular filling pressure. This causes relief in left ventricular failure and pulmonary edema. It causes renal and peripheral vasodilatation and decrease in peripheral resistance. It is preferred in the initial treatment of congestive heart failure for rapid mobilization of oedema fluid.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure.
Distribution: It is widely distributed in a plasma protein bound form and crosses placenta. Metabolism: It is partly metabolized by glucuronide conjugation.
Excretion: Excreted as unchanged drug mainly through urine. Some drug is excreted through faeces
I.V.: 2 to 5 minutes
I.M.: 10 to 20 minutes
I.V.: 2 hours
9. Frequent urination
11. Altered renal function tests
13. Altered liver function tests
14. Dry mouth
15. Hypo calcaemia
16. Hypo kalaemia
17. Hypo natraemia
18. Transient deafness
19. Gastro intestinal disturbances
20. Visual impairment
21. Muscle cramps
22. Decreased tolerance to carbohydrates
23. Hyper uricaemia.
24. Electrolyte imbalance
25. Orthostatic hypotension
26. Aplastic anaemia
2. Hypo kalaemia
3. Hypo volaemia
5. Hepatic coma
6. Hypersensitivity to the drug
7. Anuric renal failure
2. Renal impairment
4. Diabetes mellitus
5. Hypersensitivity to Sulfonamides
6. Fluid and electrolyte imbalance
7. Long term purgatives
8. Hepatic cirrhosis
9. Chronic Diarrhoea and dehydration.
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Acute pulmonary Oedema
5. Cerebral Oedema
6. Refractory Oedema
9. Forced diuresis in drug over dosage.
Aminoglycoside antibiotics: Frusemide increases potential for ototoxicity.
Cisplatin: Frusemide increases potential for ototoxicity.
Digitalis glycosides: Diuretics induced potassium loss may precipitate digitalis toxicity, increased frequency of cardiac arrhythmias.
NSAIDs: Effect of frusemide reduced.
Lithium: Therapeutic and toxic effects of lithium increased.
Metolazone: Profound diuresis and greater than predicted electrolyte loss related to the ability of metolazone to block proximal tubular sodium reabsorption useful in patients refractory to frusemide.
Non-depolarizing muscle relaxants: Action of succinylcholine & tubocurarine potentiated by low doses reversed by high doses.
Food: Efficacy reduced when administered with food.
Propranolol: Plasma propranolol level may be increased.
Clofibrate: Increased diuretic responses.
Hydantoins: May decrease the diuretic effects.
Oedema: 40mg in the morning. Increased if required; based on patient`s response up to 80mg.
Maintenance dosage: 20 to 40mg daily or on alternate days.
Maximum dose: 600mg/day.
Adult: 20 to 50mg as slow I.V. or I.M. injection. Increased by 20mg every 2hours. Higher I.V. doses must be infused
Children: 0.5 to 1.5mg/kg/day.
Maximum child dose: 20mg/day.
Oliguria: 250mg/day. Gradually increased; by 250mg at every 4 to 6 hours.
Maximum dose: 2gm
Hypertension: 40mg orally twice daily. Adjust the dosage according to patient`s response.
Hypercalcaemia: 120mg orally/day or 80 to 100mg I.V. every 1 to 2 hours
Acute pulmonary Oedema:
Adults: 40mg slow I.V. injection. Then 80mg within 1hour if required.
Children: 1mg/kg I.V.or I.M. Every 2 hours until desired response is gained.
Maximum dose: 6mg/kg/day.
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