Furosemide absorption in patients with cirrhosis

Fredrick, Mark J.; Pound, David; Hall, Stephen D.; Brater, D. Craig

doi:10.1038/clpt.1991.23

Cited by 32 publications

(17 citation statements)

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“…Torasemide has high bioavailability (>80%) and a rapid rate of absorption in patients with chronic renal failure or cirrhosis [7,9,11], whereas that of furosemide is diminished in both cirrhosis [4] and congestive heart failure [1,16,17]. Since torasemide revealed long diuretic action comparing furosemide in cats and dogs, torasemide is able to decrease administration time and increasing quality of life in treating severe congestive heart failure in cats and dogs.…”

Section: Discussionmentioning

confidence: 99%

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The Effects of the Loop Diuretics Furosemide and Torasemide on Diuresis in Dogs and Cats

Uechi

Matsuoka

Kuwajima

et al. 2003

The Journal of Veterinary Medical Science

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ABSTRACT. Torasemide is a new loop diuretic that combines the effects of furosemide and spironolactone. There are no reports on the effects of torasemide in cats and dogs. This study compared the diuretic effects of furosemide and torasemide in cats and dogs. Cats with pressure overload cardiac hypertrophy were given oral placebo, torasemide 0.3 mg/kg, or furosemide 1 mg/kg or 3 mg/kg. Con trol and mitral regurgitation dogs were given oral placebo, torasemide 0.2 mg/kg, and furosemide 2 mg/kg for 7 days. Urine samples were obtained at baseline and 1, 2,3,4,5,6,8,12, and 24 hr after each drug dose. Urine volume and urine Na + and K + were measured. Both furosemide and torasemide increased urine volume 1 hr after administration. Furosemide caused a dose-dependent increase in urine volume that peaked at 2-3 hr in cats and dogs. The diuretic effect of furosemide disappeared 6 hr after administration, while that of torasemide peaked 2-4 hr after administration and persisted for 12 hr in cats and dogs. In MR dogs, torasemide for 7 days signi ficantly decreased urine potassium excretion. Plasma aldosterone increased with torasemide, whereas there was no change with furosemide. In conclusion, about 1/10 concentration of torasemide was as potent as furosemide and had a longer diuretic effect in cats and dogs . These data suggest that torasemide is useful for treating congestive heart failure or edema in cats and dogs. KEY WORDS: diuretic agent, feline, heart failure, renal function, urine.J. Vet. Med. Sci. 65(10): 1057-1061, 2003 Torasemide is a pyridyl sulfonylurea with a chemical structure between those of loop diuretics and Cl-channel blockers [5,13,20]. The main tubular site of action of torasemide is the ascending limb of the loop of Henle, where it interacts with the Na + , 2Cl -, K + cotransporter localized in the luminal surface [19,20]. Torasemide and furosemide cause a significant, dose-dependant increase in urine flow and the urinary excretion of sodium and potassium [14]. Torasemide has more potent, longer-acting diuretic activity than furosemide [3]. Congestive heart failure, which is characteristically associated with fluid retention and shortness of breath, is a leading cause of morbidity and mortality. Therefore, animals with congestive heart failure require management with diuretics, such as thiazide, bumetanide, and furosemide. Furosemide is the diuretic most frequently given for edema. Although torasemide has beneficial effects in chronic congestive heart failure in humans [8], there are fewer clinical reports than on furosemide. In veterinary medicine, there are no reports on the dose or diuretic effects of torasemide for dogs and cats. Therefore, this study compared the diuretic effects of torasemide and furosemide in dogs and cats. MATERIALS AND METHODSThis study followed the Guidelines for Institutional Laboratory Animal Care and Use of the School of Veterinary Medicine and Animal Science at Kitasato University.Cat study: This study used 8 clinically healthy domestic short hair cats (4 males, 4 fem...

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Section: Discussionmentioning

confidence: 99%

“…Con trol and mitral regurgitation dogs were given oral placebo, torasemide 0.2 mg/kg, and furosemide 2 mg/kg for 7 days. Urine samples were obtained at baseline and 1, 2,3,4,5,6,8,12, and 24 hr after each drug dose. Urine volume and urine Na + and K + were measured.…”

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confidence: 99%

The Effects of the Loop Diuretics Furosemide and Torasemide on Diuresis in Dogs and Cats

Uechi

Matsuoka

Kuwajima

et al. 2003

The Journal of Veterinary Medical Science

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“…For unknown Table 2 Comparison between acute and chronic hepatic complications of cardiac failure reasons, the pharmacologic response in patients with liver dysfunction and HF is diminished, and there is a net decreased in sodium excretion when compared with healthy individuals taking the same dose. No adjustments are necessary if renal function is normal [115] . In patients with severe HF, amiodarone has proven to be effective for suppressing ventricular arrhythmias, reducing sudden death and cardiac mortality, and improving exercise tolerance and ejection fraction.…”

Section: Congestive Hepatopathymentioning

confidence: 99%

Hepato-cardiac disorders

Fouad¹,

Yehia²

2014

WJH

111

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Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato�cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. �ifferential diagnoses of liver injury are extremely important in a cardiologist's clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic conges� tive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplanta� tion may lead to the improvement of all cardiac chang� es and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases

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“…10.14,ISl No significant differences in VI, of furosemide were reported in patients with severe nephrotic syndrome,l14] Furthermore, the til, of furosemide does not change significantly in the presence of varying degrees of liver dysfunction, regardless of whether or not ascites is present. [31] Therefore, the variable t y, in patients with oedema may be primarily influenced by the underlying heart, renal or liver disease, rather than the oedema per se. [39 ] Total plasma clearance (CL) and renal clearance (CLR) of furosemide in patients with CRF are sig- In conclusion, the relative importance of the +1 +1 +1…”

Section: 3 Eliminationmentioning

confidence: 99%

“…The changes in protein binding and V ss of furosemide in oedematous disorders are more likely to be the result of: (i) hypoalbuminaemia in patients with nephrotic syndrome [39] or liver cirrhosis; [31] or (ii) the competition for the binding sites on plasma proteins by endogenous uraemic metabolites in patients with CRF; [42] than the oedema per se. However, the presence of ascites may additionally affect the distribution of furosemide in patients with severe liver failure, as it leads to a decreased effective plasma volume and diminished perfusion, which may cause greater retention of furosemide in the tissues and therefore increase the V ss of the drug.…”

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confidence: 99%

Pharmacokinetic Changes in Patients With Oedema

Vrhovac

Sarapa

Bakran

et al. 1995

Clinical Pharmacokinetics

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The pharmacokinetics of furosemide (frusemide) in patients with oedema have been relatively well studied, but in many studies it is unclear whether the disease or the oedema per se has the major effect. The rate of absorption of oral furosemide in patients with oedema was decreased, but total bioavailability was almost unchanged. The peak serum concentration (Cmax) and time taken to achieve Cmax were either decreased or unchanged. Binding of furosemide to plasma proteins is lower in patients with congestive heart failure (CHF), decompensated liver cirrhosis (DLC) and nephrotic syndrome, probably as a result of hypoalbuminaemia. The elimination half-life (t1/2) can be unchanged (CHF, DLC) or prolonged (chronic renal failure: CRF). Plasma and renal clearance are reduced in patients with CRF and nephrotic syndrome, but are almost unchanged in CHF and DLC. Disease-induced disorders are mainly responsible for the alterations of furosemide pharmacokinetics in oedematous conditions, while the influence of oedema per se is probably not clinically relevant. The pharmacokinetics of digoxin have been studied in a small number of studies only. In patients with CHF, considerable interindividual differences have been found. Because digoxin has a narrow therapeutic window, this drug should be administered cautiously to oedematous patients. Theophylline has higher bioavailability in patients with oedema, with a significantly higher Cmax in patients with hepatic cirrhosis and CHF than in healthy volunteers (29 and 22%, respectively). Furthermore, clearance decreases and t1/2 increases in these patients. Angiotensin converting enzyme (ACE) inhibitors are often administered as prodrugs, and their pharmacokinetic profile could be influenced by the diseases that accompany oedematous states. However, the effect of oedema is difficult to discriminate from that of the disease. Individual ACE inhibitors are affected differently, but importantly the dosage of perindopril should be reduced in patients with CHF, while for most other ACE inhibitors the changes in pharmacokinetic parameters are clinically irrelevant. In conclusion, studies on pharmacokinetic changes in oedema are limited. Besides affecting absorption (after oral administration) and conversion of the prodrug to the active form, probably as a result of the associated disease, oedema has not been proven to cause any clinically relevant changes in pharmacokinetic parameters for individual drugs. However, further studies of this aspect of pharmacokinetics are needed.

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Furosemide absorption in patients with cirrhosis

Cited by 32 publications

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The Effects of the Loop Diuretics Furosemide and Torasemide on Diuresis in Dogs and Cats

The Effects of the Loop Diuretics Furosemide and Torasemide on Diuresis in Dogs and Cats

Hepato-cardiac disorders

Pharmacokinetic Changes in Patients With Oedema

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