Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety

Santos, J.; Planas, Ramón; Pardo, Albert; Durández, Rosa; Cabré, Eduard; Morillas, Rosa María; Granada, María Luisa; Jiménez, J.; Quintero, Enrique; Gassull, Miquel A.

doi:10.1016/s0168-8278(03)00188-0

Cited by 151 publications

(97 citation statements)

References 21 publications

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“…Spironolactone and eplerenone are weak natriuretic agents when given acutely; however, at least in the case of spironolactone (eplerenone has not been similarly studied) when given to patients with cirrhosis and ascites or HF a significant natriuretic response can occur particularly if combined with a loop diuretic [26,27] Although eplerenone has lower in vitro affinity than spironolactone for the aldosterone receptor, both compounds display similar in vivo efficacy in blocking aldosterone mediated changes in the urinary Na + : K + ratio. Differences between the in vitro and in vivo pharmacological properties of eplerenone and spironolactone may be explained by differing in vivo study conditions and/or a lesser degree of protein binding for eplerenone.…”

Section: Pharmacodynamicsmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Mineralocorticoid Blocking Agents and their Effects on Potassium Homeostasis

2005

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Spironolacotone and eplerenone are mineralocorticoid-blocking agents used for their ability to block both the epithelial and non-epithelial actions of aldosterone. Spironolactone is a non-selective mineralocorticoid receptor antagonist with moderate affinity for both progesterone and androgen receptors. The latter property increases the likelihood of endocrine side effects with spironolactone including loss of libido, menstrual irregularities, gynecomastia and impotence. Eplerenone is a next generation aldosterone receptor antagonist selective for aldosterone receptors alone. This lesser affinity for progesterone and androgen receptors was arrived at by replacing the 17-alpha -thioacetyl group of spironolactone with a carbomethoxy group. Eplerenone is further distinguished from spironolactone by its shorter half-life and the fact that it does not have any active metabolites. Both eplerenone and spironolactone are effective antihypertensive agents and each has been shown to improve the morbidity and mortality of heart failure. Eplerenone or spironolactone use can increase serum potassium values and occasionally results in clinically relevant hyperkalemia. This is more apt to occur with spironolactone due to the very long half-life of several of its active metabolites.

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Section: Pharmacodynamicsmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Mineralocorticoid Blocking Agents and their Effects on Potassium Homeostasis

2005

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“…Preliminary studies have tested the safety and tolerability of HSS and furosemide combination [19], and suggest that combination therapy is preferred instead of treatment with furosemide alone [20]. In patients with RA, ascites level, PE, and leg edema were significantly better in patients treated with high-dose furosemide+HSS [13].…”

Section: Discussionmentioning

confidence: 99%

High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis

Yakar¹,

Demır²,

Doğan³

et al. 2016

CIM

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Purpose: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA.Methods: This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2.5 g bid); and, Group C (n= 27) repeated large-volume-paracentesis (RLVP) with albumin infusion. Patients without hyperkalemia were administrated 100 mg of spironolactone/day. During the follow-up; INR, creatinine, and total bilirubin levels were measured to determine the change in MELD (model of end stage liver disease) score.Results: Hepatic encephalopathy (HE), severe episodes of spontaneous bacterial peritonitis (SBP) and pleural effusions (PE) occurred more frequently in Group C. Improvement in Child-Pugh and MELD score was better in Group A and B than Group C. In Group B, improvements were seen in the Child-Pugh and MELD score, reduction in body weight, duration and number of hospitalization. In Groups A and B, remarkable increases in diuresis were observed (706±116 to 2425±633 mL and 691±111 to 2405±772 mL) and serum sodium levels also improved. HE and SBP were occurred more often in group C (p<0.002). Hospitalization decreased significantly in Group B (p<0.001). There was no significant difference in survival among groups. Conclusion:High dose oral furosemide with salt ingestion may be an alternative, effective, safe and well-tolerated method of therapy for RA.SUPPLEMENT

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“…Diuretics are indicated for all patients with grade 2 ascites. Patients with their first episode of ascites usually respond with spironolactone 50-100 mg/day [18,19,[28][29][30]. Patients with recurrent episodes of ascites should receive the combination of spironolactone 100 mg/day with furosemide 40 mg/day.…”

Section: Moderate-volume Ascitesmentioning

confidence: 99%

Ascites

Cárdenas¹,

Graupera²,

Ginès³

2015

Cirrhosis: A Practical Guide to Management

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Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety

Cited by 151 publications

References 21 publications

Pharmacokinetics and Pharmacodynamics of Mineralocorticoid Blocking Agents and their Effects on Potassium Homeostasis

Pharmacokinetics and Pharmacodynamics of Mineralocorticoid Blocking Agents and their Effects on Potassium Homeostasis

High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis

Ascites

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