Indications
- Congestive heart failure
- Liver cirrhosis, with collection of fluid in the abdominal cavity (ascites)
- Essential hypertension
- Swelling due to excess fluid retention (edema)
- Overproduction of aldosterone (hyperaldosteronism).
Pharmacology
This is a combination of a potassium sparing diuretic, Spironolactone and loop diuretic, Furosemide. Spironolactone and Furosemide have different but complementary mechanism and site of action. Therefore, when given together they produce synergistic or additive diuretic effects. Furosemide component inhibits the Na+/K+/2Cl- co-transporter in the ascending Loop of Henle and blocks the reabsorption of sodium, potassium, and chloride ions thereby increasing the quantity of sodium and the volume of water excreted in the urine. This characteristically induces potassium loss. The Spironolactone component inhibits the reabsorption of sodium in exchange for potassium at the distal tubule by antagonizing the action of aldosterone so that sodium excretion is greatly favored and the excess loss of potassium, induced by the Furosemide, is reduced.
Dosage & Administration
Furosemide 20 and spironolactone 50 mg: 1 to 4 tablets daily according to the patient’s response.
Interaction
When taken together with ACE inhibitors or potassium salts there is an increased risk of hyperkalemia. Spironolactone increases the levels of cardiac glycosides such as Digoxin in the blood. Spironolactone decreases the ulcer healing effects of Carbenoxolone. Corticosteroids, such as – Hydrocortisone, may also cause potassium loss and severe depletion may occur if they are used with Furosemide. When taken together with drugs that decrease blood pressure there is an increased risk of a large drop in blood pressure and fainting, especially when given with the first dose of ACE inhibitors (eg Captopril). The blood pressure lowering and diuretic effects of Furosemide may be reduced or abolished when used together with Indomethacin and possibly other non-steroidal anti-inflammatory drugs (NSAIDs).
Contraindications
Side Effects
Adverse reactions that are known to be associated with the combination of Spironolactone and Furosemide are fatigue, blood disorders, skin rashes, diarrhea, constipation, nausea, vomiting, abdominal pain, hyperglycemia, hypotension, abnormal enlargement of breasts in the male (gynecomastia), irregular menstrual cycle, disturbances in the levels of electrolytes in the blood, impotence.
Pregnancy & Lactation
Pregnancy: Spironolactone and its metabolites may cross the placental barrier. The use of spironolactone in pregnant women requires that the anticipated benefit be weighed against the possible hazards to the mother and fetus. Animal teratology studies indicate that Furosemide may cause fetal abnormalities. Therefore, Furosemide should only be used in women in child bearing age when appropriate contraceptive measures are taken or if the potential benefits justify the potential risks to the fetus.
Lactation: Metabolites of Spironolactone have been detected in breast milk. If use of Spironolactone is considered essential, an alternative method of infant feeding should be instituted. Furosemide is excreted in breast milk and breast-feeding should be discontinued if treatment is essential.
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