An open comparative study of two diuretic combinations, frusemide/amiloride (‘Frumil’) and bumetanide/potassium chloride (‘Burinex’ K), in the treatment of congestive cardiac failure in hospital out-patients

Abstract

Forty elderly patients, aged 68 to 89 years, with congestive cardiac failure, who were attending a hospital out-patients department, entered an open, parallel group, comparative study of two diuretic combinations, 40 mg frusemide plus 5 mg amiloride per tablet and 0.5 mg bumetanide plus 573 mg slow-release potassium chloride per tablet. Patients were assigned at random to receive one or other combination for 8 weeks, dosage being determined by the severity of the individual patient's condition (range 1 to 3 tablets frusemide/amiloride; 2 to 6 tablets bumetanide/potassium chloride). Clinical assessments, including visual analogue scores for dyspnoea at rest and on effort, and laboratory measurements of serum potassium and magnesium levels were carried out on entry and after 2, 4 and 8 weeks of treatment. Other variables were monitored before, during and/or after treatment. Although significant decreases were reported in dyspnoea severity scores at rest and on effort only in the bumetanide/potassium chloride group, global assessment of the patients' condition by patient and clinician at the end of the study indicated that both treatments produced improvement, and a greater proportion of patients considered treatment as satisfactory in the frusemide/amiloride group. Both drug combinations were well-tolerated and only a few minor side-effects were reported. Serum potassium levels were maintained in both treatment groups but there was a significant decrease in mean serum magnesium levels in patients on bumetanide/potassium chloride. Hyponatraemia was also detected in 2 patients on this combination. An increase in body weight was recorded in both groups, the increase being significant in patients receiving bumetanide/potassium chloride.

A Comprehensive Review of the Loop Diuretics: Should Furosemide Be First Line?

“…One final assessment of the pharmacologic effects of torsemide on the myocardial tissue of patients with HF was conducted in 2 studies by L6pezet al 23 ,24 Theseinvestigators tested the theorythat myocardial accumulation of collagen fibers leads to deterioration of left-ventricular function. This fibrosis is the result of increased synthesis by collagen fibroblasts and/ordecreased collagen degradation as a result of increased aldosterone," In the firststudy, changes in myocardial volume occupied by collagen, serum carboxy-terminal telopeptide of collagen type I, car': boxy-terminal peptideof procollagen type I (PIP),and indexes of collagen type I synthesisand degradation in patientsreceiving either furosemide or torsemide were compared.This was a randomized, open-label,parallel-group study of 36 While it is important to note the pharmacologic variations betweenthe loop diuretics, it is arguably more important to assess whether any of these differences translate into positiveclinicaloutcomes (Table 3). [25][26][27][28][29][30][31][32][33][34][35][36] Comparative Safety and Efficacy in Heart Failure: Furosemide vs Torsemide Murray et al 25 assessed the impact of furosemide and torsemideon hospitalreadmissions secondaryto HF exacerbations over a 12-month period.…”

Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions – Part I: Loop Diuretics

“…There have been a few head-to-head comparisons of loop diuretics in patients with HF. Small, open-label RCTs with short-term follow-up found few differences in symptoms or diuresis between furosemide and bumetanide [59][60][61]. However, others suggested that mortality, hospitalisation, symptoms, and quality of life were better with torsemide compared to furosemide [62][63][64]; a definitive trial followed (Table 3).…”

Effect of short‐term treatment with bumetanide, quinapril and low‐sodium diet on dogs with moderate congestive heart failure

“…Preliminary studies suggest that bumetanide-induced hypokalaemia is less marked than that caused by frusemide. 25,26 However, it is possible that both the potassium-sparing effect of quinapril as an ACEI and the potassium supplement contained in the specific diet recommended for dogs with heart con-ditions 22 may have influenced these preliminary results. Urinary potassium FE rose considerably postadministration, a finding also reported by many authors.…”