Acetazolamide (Diamox) in the Treatment of Congestive Heart-Failure

Hanley, T.; Platts, Margaret M.

doi:10.1016/s0140-6736(56)90105-2

Cited by 28 publications

(10 citation statements)

References 9 publications

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“…In addition, several studies outdating the current era of heart failure treatment with neurohumoral blockers used acetazolamide as an effective agent to break loop diuretic resistance. 11,12,14 The current study extrapolates these findings to contemporary treated AHF patients with advanced cardiorenal disease and confirms that acetazolamide is a safe and effective drug to use in this context. A potential trend towards less heart failure readmissions was observed in the current study, yet only after 7-8 months Kaplan-Meier curves seemed to diverge clearly.…”

Section: Discussionsupporting

confidence: 79%

“…Diuresis, natriuresis, net fluid balance and subjective improvement of dyspnoea were significantly greater in patients receiving acetazolamide. In addition, several studies outdating the current era of heart failure treatment with neurohumoral blockers used acetazolamide as an effective agent to break loop diuretic resistance . The current study extrapolates these findings to contemporary treated AHF patients with advanced cardiorenal disease and confirms that acetazolamide is a safe and effective drug to use in this context.…”

Section: Discussionsupporting

confidence: 76%

“…However, an observational study in AHF has found that the addition of acetazolamide improves loop diuretic efficiency with approximately 100 mmol sodium excreted in surplus for every 40 mg furosemide‐equivalent dose administered . Other small studies, often before the era of evidence‐based heart failure treatment, corroborate these findings and make acetazolamide an interesting agent to study in combination with loop diuretics for prevention or treatment of diuretic resistance . Acetazolamide blocks sodium bicarbonate reabsorption in the renal proximal tubules, offering more sodium to Henle's loop, hence boosting the effect of loop diuretics, which might be especially useful in states of poor renal blood flow .…”

Section: Introductionmentioning

confidence: 98%

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Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance

Verbrugge

Martens

Ameloot

et al. 2019

European J of Heart Fail

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Aims To investigate the effects of acetazolamide on natriuresis, decongestion, kidney function and neurohumoral activation in acute heart failure (AHF). Methods and results This prospective, two‐centre study included 34 AHF patients on loop diuretics with volume overload. All had a serum sodium concentration < 135 mmol/L and/or serum urea/creatinine ratio > 50 and/or an admission serum creatinine increase of > 0.3 mg/dL compared to baseline. Patients were randomised towards acetazolamide 250–500 mg daily plus bumetanide 1–2 mg bid vs. high‐dose loop diuretics (bumetanide bid with daily dose twice the oral maintenance dose). The primary endpoint was natriuresis after 24 h. Natriuresis after 24 h was similar in the combinational treatment vs. loop diuretic only arm (264 ± 126 vs. 234 ± 133 mmol; P = 0.515). Loop diuretic efficiency, defined as natriuresis corrected for loop diuretic dose, was higher in the group receiving acetazolamide (84 ± 46 vs. 52 ± 42 mmol/mg bumetanide; P = 0.048). More patients in the combinational treatment arm had an increase in serum creatinine levels > 0.3 mg/dL (P = 0.046). N‐terminal pro‐B‐type natriuretic peptide reduction and peak neurohumoral activation within 72 h were comparable among treatment arms. There was a non‐significant trend towards lower all‐cause mortality or heart failure readmissions in the group receiving acetazolamide with low‐dose loop diuretics vs. high‐dose loop diuretic monotherapy (P = 0.098). Conclusion Addition of acetazolamide increases the natriuretic response to loop diuretics compared to an increase in loop diuretic dose in AHF at high risk for diuretic resistance. Trial registration: http://ClinicalTrials.gov NCT01973335.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 98%

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Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance

Verbrugge

Martens

Ameloot

et al. 2019

European J of Heart Fail

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“…On its own, acetazolamide increases natrium and bicarbonate excretion, urine alkalosis, and blood acidosis . Acetazolamide was used alone or in combination with mercurial diuretics in the 1950s and 1960s to treat volume overload in AHF . With the discovery of potent loop diuretics, their use has been largely abandoned, despite the pathophysiological rationale for inhibition of proximal sodium reabsorption.…”

Section: Discussionmentioning

confidence: 99%

“…42 Acetazolamide was used alone or in combination with mercurial diuretics in the 1950s and 1960s to treat volume overload in AHF. 43 With the discovery of potent loop diuretics, their use has been largely abandoned, despite the pathophysiological rationale for inhibition of proximal sodium reabsorption. One observational study in patients with AHF and marked volume overload found that the addition of acetazolamide (500 mg administered as intravenous bolus on top of loop diuretic therapy) improved loop diuretic efficacy with approximately 100 mmol sodium excreted per 40 mg of furosemide equivalent dose.…”

Section: Acetazolamidementioning

confidence: 99%

Rationale and design of the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial

Mullens

Verbrugge

Nijst

et al. 2018

European J of Heart Fail

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Aims Decisive evidence on the optimal diuretic agent, dosing schedule, and administration route is lacking in acute heart failure (AHF) with congestion. The Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial is designed to test the hypothesis that the carbonic anhydrase inhibitor acetazolamide, a potent inhibitor of proximal tubular sodium reabsorption, improves decongestion when combined with loop diuretic therapy in AHF, potentially leading to better clinical outcomes. Methods The ADVOR trial is set up as a multicentre, randomized, double‐blind, placebo‐controlled study, aiming to recruit 519 patients with AHF and clinically evident volume overload. All study participants receive high‐dose intravenous loop diuretics as background therapy and are randomized towards intravenous acetazolamide at a dose of 500 mg once daily vs. placebo, stratified according to including study centre and ejection fraction (< 40% vs. ≥ 40%). The primary endpoint is successful decongestion with no more than trace oedema assessed on the third morning after hospital admission, with good diuretic efficacy defined as a urine output > 3.5 L during the first 30–48 h of decongestive treatment. Secondary endpoints include all‐cause mortality or heart failure readmission after 3 months, length of hospital stay for the index admission, and longitudinal changes in the EuroQol‐5 dimensions questionnaire. Conclusion ADVOR will investigate if acetazolamide combined with loop diuretic therapy improves decongestion in AHF with volume overload.

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Therapie der Herzinsuffizienz

Schwiegk¹,

Jahrmärker²

1960

Herzinsuffizienz Pathophysiologie·Pathologie·Therapie

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Acetazolamide (Diamox) in the Treatment of Congestive Heart-Failure

Cited by 28 publications

References 9 publications

Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance

Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance

Rationale and design of the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial

Therapie der Herzinsuffizienz

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