Metolazone and spironolactone in cirrhosis and the nephrotic syndrome

Abstract

Eighteen patients with hepatic cirrhosis or nephrotic syndrome and having edema and/or ascites were treated during successive periods with metolazone 5 to 40 mg/day, spironolactone 100 mg/day, and with both diuretics concurrently. Metolazone alone produced a marked diuresis, natriuresis, and weight loss in 8 patients. Spironolactone alone had little effect, but the addition of metolazone renewed diuresis and natriuresis and resulted in additional substantial weight losses in all patients responsive to metolazone alone. Concurrent spironolactone and metolazone also induced moderate diuretic effects in some patients who failed to respond to either drug alone. The drugs were well tolerated; the administration of spironolactone with metolazone prevented decreases in serum potassium, which had occurred during treatment with metolazone alone.

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

“…Hence, potentially 67% (normo/euvolemic) of NS patients can be treated with diuretics alone. However, the published literature on diuretics alone in severe edema is mostly limited to reports of its use in patients (usually adults) with chronic edema and obvious signs of volume overload as in GN and chronic renal failure (21)(22)(23)(24)(25).…”

The non-immunosuppressive management of childhood nephrotic syndrome

“…metolazone)’ diuretic therapy is considered necessary, careful monitoring to avoid hypokalaemia and alkalosis is required. The addition of amiloride or the mineralocorticoid receptor antagonist spironolactone to loop diuretic therapy can minimise hypokalaemia, although the absolute diuretic effect of these drugs is debatable [ 144 , 145 ].…”

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“…It is also said that Metolazone causes electrolyte abnormalities less frequently, hence it does not commonly cause hyperlipidemia and hyperglycemia found in other thiazide diuretics [18]. In studies, Metolazone was found to increase urine output in various fluid overload states such as Ascites/Liver Cirrhosis [19,20], Nephrotic Syndrome [19,21] and Chronic Kidney Disease [22]. There are numerous studies also in patients with Congestive Heart Failure, with varying results [14,19,21,23].…”