Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease.

Abstract

SUMMARY The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P< 01) and respiratory rate (P< 0 05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.Spironolactone, a pharmacological antagonist of the adrenal mineralocorticoid,l has been used for some years in the treatment of congestive heart failure (CHF). By competitively binding to specific nuclear macromolecules in the distal convoluted renal tubular cells, this agent inhibits aldosterone's regulatory effects on electrolytes, increasing sodium excretion and decreasing potassium excretion.2 Spironolactone is particularly effective in the treatment of patients with CHF who are taking diuretics, because it neutralises the kaliuretic effect of the thiazides and enhances natriuresis.We have used spironolactone in the treatment of CHF for about 10 years at this hospital. However, its use in infants has been poorly documented. We therefore wished to compare the efficacy of spironolactone with that of a conventional potassium supplement, given in conjunction with digoxin and diuretic, in infants who had CHF secondary to congenital heart disease. Patients and methods

Spironolactone effect on potassium supplementation in paediatric cardiac intensive care patients

“…evaluated the efficacy of spironolactone for congestive heart failure in 21 infants receiving concomitant digoxin and chlorothiazide. Compared to the patient group that received potassium supplements, potassium values were similar between each group, although the authors did not state potassium ranges . It has been suggested that this lack of effect on potassium may be due to age related responsiveness of the distal convoluted tubule in the kidney to aldosterone, as has been reported in the premature infant population …”

“…Compared to the patient group that received potassium supplements, potassium values were similar between each group, although the authors did not state potassium ranges. 7 It has been suggested that this lack of effect on potassium may be due to age related responsiveness of the distal convoluted tubule in the kidney to aldosterone, as has been reported in the premature infant population. 6,8 Patients in the spironolactone group had an increased use of continuous infusion furosemide, even though there was no difference in the total milligrams of drug received between the two groups.…”

Effect of Regular Medication Using Super High Dose Diuretics for Pleural Effusions at Early Stage After the Fontan Procedure

“…We hypothesized that the dose of furosemide and spironolactone, 2 mg/kg/day of each, is not enough for postoperative management and made a new regimen of 6 mg/kg/day of each drugs. Traditionally, heart failure due to congenital heart disease has been treated using two drugs, which are spironolactone and one of the following：thiazide, furosemide, or ethacrynic acid 11) . Our regimen was established and drugs were selected in accordance with this concept.…”

Development and validation of an HPLC method for the determination of spironolactone and its metabolites in paediatric plasma samples

“…The use of spironolactone in infants and children was first reported in 1964 when administration of the drug to three infants produced a moderate diuresis [2]. Since then spironolactone has been widely utilized in the management of congestive heart failure associated with congenital heart disease [3][4][5], bronchopulmonary dysplasia or chronic lung disease [5][6][7][8][9] and paediatric ascites [10,11]. Although frequently prescribed, there is a lack of published research documenting the safety and efficacy of spironolactone in the paediatric population.…”