Indication

Hypertension, Congestive heart failure, Oedema, Ascites

Adult dose

Adult: Per tab contains furosemide 20 mg and spironolactone 50 mg. 1-4 tabs/day. Contraindication Hypersensitivity, anuria or severe oliguria, hypovolaemia, hyponatraemia, hypotension, urinary retention due to prostatic hypertrophy, Addison's disease, renal impairment, hyperkalaemia, acute or severe liver failure. Pregnancy and lactation. Mode of Action Furosemide inhibits reabsorption of Na+, Cl- and K+. Continuous use may also lead to secondary hyperaldosteronism. Spironolactone is a specific antagonist of aldosterone. It increases Na and water excretion but retains K+. Thus it acts both as diuretic and an antihypertensive. It reduces oedema and counteracts secondary aldosteronism caused by vol depletion Na loss. K loss is reduced. Precaution Concomitant use with ACE inhibitors, monitor fluids and electrolytes including changes in serum K levels. Dilutional hyponatraemia or even a true low-salt syndrome may develop. General anaesthesia. Side Effect Fluid and electrolyte imbalance, nausea, diarrhoea, blurred vision, headache, dizziness, hypotension, photosensitisation, hepatic dysfunction, hyperglycaemia and glycosuria, rarely bone marrow depression, gynaecomastia, hirsutism, hoarseness, menstrual irregularities, loss of libido, impotence. Potentially Fatal: Severe hyperkalaemia in patients with preexisting renal impairment or taking ACE inhibitors, agranulocytosis, cardiac arrhythmias. Interaction 1. Frusemide: Aminoglycosides and ethacrynic acid (increased ototoxicity), tubocurazine, succinylcholine (effects enhanced). Sucralfate reduces effects of furosemide. Should be given 2 hr apart. NSAIDs reduce natriuretic and antihypertensive effects of furosemide. Corticosteroids may antagonise action. Digoxin levels may be increased. Warfarin effects may be reduced. Potentially Fatal: Potassium supplements or potassium-rich diet, ACE inhibitors, general anaesthetics (reduced vascular responsiveness to catecholamines), lithium toxicity. 2. Spironolactone: Sodium excretion effect may be inhibited by aspirin. May reduce ulcer-healing properties of carbenoxolone. Increased risk of nephrotoxicity when used with NSAIDs or ciclosporin. Hyperkalaemia may occur if given with potassium supplements, ACE inhibitors, angiotensin II antagonists, NSAIDs, ciclosporin or trilostane. May increase risk of orthostatic hypotension when used with barbiturates, narcotics or alcohol. May reduce vascular responsiveness to pressor amines. May increase half-life of digoxin. Potentially Fatal: Increased risk of lithium toxicity when used concurrently.

Contraindication

Hypersensitivity, anuria or severe oliguria, hypovolaemia, hyponatraemia, hypotension, urinary retention due to prostatic hypertrophy, Addison's disease, renal impairment, hyperkalaemia, acute or severe liver failure. Pregnancy and lactation.

Mode of action

Furosemide inhibits reabsorption of Na+, Cl- and K+. Continuous use may also lead to secondary hyperaldosteronism. Spironolactone is a specific antagonist of aldosterone. It increases Na and water excretion but retains K+. Thus it acts both as diuretic and an antihypertensive. It reduces oedema and counteracts secondary aldosteronism caused by vol depletion Na loss. K loss is reduced.

Precaution

Concomitant use with ACE inhibitors, monitor fluids and electrolytes including changes in serum K levels. Dilutional hyponatraemia or even a true low-salt syndrome may develop. General anaesthesia.

Side effect

Fluid and electrolyte imbalance, nausea, diarrhoea, blurred vision, headache, dizziness, hypotension, photosensitisation, hepatic dysfunction, hyperglycaemia and glycosuria, rarely bone marrow depression, gynaecomastia, hirsutism, hoarseness, menstrual irregularities, loss of libido, impotence. Potentially Fatal: Severe hyperkalaemia in patients with preexisting renal impairment or taking ACE inhibitors, agranulocytosis, cardiac arrhythmias.

Interaction

1. Frusemide: Aminoglycosides and ethacrynic acid (increased ototoxicity), tubocurazine, succinylcholine (effects enhanced). Sucralfate reduces effects of furosemide. Should be given 2 hr apart. NSAIDs reduce natriuretic and antihypertensive effects of furosemide. Corticosteroids may antagonise action. Digoxin levels may be increased. Warfarin effects may be reduced. Potentially Fatal: Potassium supplements or potassium-rich diet, ACE inhibitors, general anaesthetics (reduced vascular responsiveness to catecholamines), lithium toxicity. 2. Spironolactone: Sodium excretion effect may be inhibited by aspirin. May reduce ulcer-healing properties of carbenoxolone. Increased risk of nephrotoxicity when used with NSAIDs or ciclosporin. Hyperkalaemia may occur if given with potassium supplements, ACE inhibitors, angiotensin II antagonists, NSAIDs, ciclosporin or trilostane. May increase risk of orthostatic hypotension when used with barbiturates, narcotics or alcohol. May reduce vascular responsiveness to pressor amines. May increase half-life of digoxin. Potentially Fatal: Increased risk of lithium toxicity when used concurrently.