Spironolactone and Furosemide

Diuretic · Aldosterone antagonist/Loop diuretic

Indications

Refractory oedema, hypertension associated with secondary hyperaldosteronism.

Dosage

Adults: 1-4 tab daily. Children: Not recommended.

Adverse Effects

Spironolactone: Gynaecomastia, Gl upset, rash, drowsiness, headache, confusion, malaise, benign breast neoplasm, blood dyscrasias, hepatic impairment, electrolyte disturbances, leg cramps, ataxia, dizziness, changes in libido, confusion, menstrual disorders, breast pain, skin reaction, acute renal failure, alterations in voice pitch. Furosemide: Disorders of electrolyte balance, dehydration, allergic reactions, GI upset, hypotension, rash, hyperuricaemia, hyperglycaemia, raised serum creatinine.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Spironolactone: Anuria, severe or progressive renal failure. Hyperkalaemia; Addison's disease, diabetes, diabetic nephropathy. Moderate to severe renal impairment in children. Furosemide: Renal failure with anuria, hypokalaemia, hyponatraemia, hypotension, hypersensitivity to sulphonamides, in pregnancy for short time and if strictly indicated. Comatose or precomatose states associated with liver cirrhosis or encephalopathy, hypovolaemia, dehydration. Addison's disease. Precautions: Spironolactone: Renal or hepatic impairment. Long term use in young patients. Hyponatraemia, porphyria. Predisposition to acidosis. Monitor fluid, electrolytes and BUN. Furosemide: Furosemide may pass into breast milk and inhibit lactation, stop breast feeding. Prostatic hypertrophy or impaired micturition.…

Interactions

Spironolactone: K+ supplements, K+ sparing diuretics, carbenoxolone, antihypertensives, ACE inhibitors, digoxin, angiotensin II inhibitors, NSAIDs, cyclosporin, fludrocortisone, lithium, anticoagulants, tacrolimus, noradrenaline, co-trimoxazole. Furosemide: Digitalis, lithium, aminoglycosides, cephalosporins, antihypertensives, NSAIDs, digoxin, vancomycin, carbamazepine, phenytoin, corticosteroids, theophylline, risperidone, K+ - sparing diuretics, K+ suppl.

Advice to Patient

Take with meals. Contact prescriber if there is worsening of condition or no improvement. Do not take foods rich in potassium and potassium supplements.

Pharmacokinetics

SPIRONOLACTONE: Duration: Tab: 2-3 days. Bioavailability: High-fat/-calorie meal increased the bioavailability of spironolactone approx. 90%. Metabolism: Rapid and extensive; hepatic. Half-life elimination: Tab: Approx. 1-4 hrs. Susp: 1-2 hrs. Time to peak, serum: Tab: 2.6-4.3 hrs. Susp: 0.5-1.5 hrs. Excretion: Urine and bile. FUROSEMIDE: Onset of action: Diuresis: Oral, sublingual: 30-60 mins. IM: 30 mins. IV: Approx. 5 min. Symptomatic treatment with acute pulmonary oedema: Within 15-20 mins, occurs prior to diuretic effect. Peak effect: Oral, sublingual: 1-2 hrs. Duration: Oral, sublingual: 6-8 hrs. IV: 2 hrs. Metabolism: Minimally hepatic. Bioavailability: Oral Tab: 47%-64%. Oral soln: 50%. Sublingual adm of oral tab: Approx. 60%. Half-life elimination: Normal renal func: 0.5-2 hrs. End-stage renal disease: 9 hrs. Excretion: Urine (Oral: 50%, IV: 80%). Faeces.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.