Severe Electrolyte Disturbances Associated With Metolazone and Furosemide

Black, William L.; Shiner, Philip T.; Román, Jorge Zarco

doi:10.1097/00007611-197804000-00011

Cited by 22 publications

(13 citation statements)

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“…We expected a decline in p-potassium, and adjusted the dose of potassium supplements based on regularly measurements of p-potassium. This approach seems to avoid dangerous episodes of hypokalemia [31].…”

mentioning

confidence: 99%

Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature

Rosenberg

Gustafsson

Galatius

et al. 2005

Cardiovasc Drugs Ther

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confidence: 99%

Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature

Rosenberg

Gustafsson

Galatius

et al. 2005

Cardiovasc Drugs Ther

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“…Historically, metolazone has been the most frequently investigated intervention, and although it is another cost‐effective oral option for combination diuretic therapy, concerns exist with its prolonged half‐life and potential for metabolic derangements including persistent hypokalemia and contraction alkalosis . Prior to the current study, despite its recommendation in national guidelines, there had been no published investigation of intravenous CTZ when added to standard intravenous furosemide to augment diuresis in hospitalized patients with heart failure.…”

Section: Discussionmentioning

confidence: 98%

Comparison of the Effects of Combination Diuretic Therapy with Oral Hydrochlorothiazide or Intravenous Chlorothiazide in Patients Receiving Intravenous Furosemide Therapy for the Treatment of Heart Failure

Kissling

Pickworth

2014

Pharmacotherapy

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Among hospitalized patients with heart failure receiving intravenous loop diuretics, the addition of either oral hydrochlorothiazide or intravenous chlorothiazide augmented diuresis. Urine output increased to a greater extent with intravenous chlorothiazide compared with oral hydrochlorothiazide. However, given the positive response observed, ease of administration, and lower drug cost, oral hydrochlorothiazide should still be considered as an option for combination diuretic therapy in this patient population.

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“…Such combinations of diuretics, each acting on different segments of the nephron-known as "sequential nephron blockade"-break the resistance to diuretics in edematous states [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Although this physiologically grounded rationale is more effective than high-dose monotherapy when a rapid and robust diuretic response is needed, such treatment may lead to complications such as fluid and electrolyte disturbances [13,28,29].…”

Section: Introductionmentioning

confidence: 99%

Torasemide significantly reduces thiazide-induced potassium and magnesium loss despite supra-additive natriuresis

Knauf

Mutschler

Velázquez

et al. 2009

Eur J Clin Pharmacol

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Background Resistance to high-dose loop diuretics can be overcome either by co-administration with thiazides or by treatment with medium-dose loop diuretics combined with thiazides. Combination therapy has been proven to be superior to high-dose loop diuretic monotherapy for cardiac and renal edema. However, such a strongly efficacious short-term regimen is often complicated by undesired effects, including circulatory collapse and electrolyte disturbances. The question of whether the loop diuretic/ thiazide combinations are efficacious and safe when conventional doses are combined has not yet been answered. Methods The effects of hydrochlorothiazide (HCT) and torasemide (TO) given alone on the excretion of Na + , Cl -, K + , Mg 2+ , and Ca 2+ were compared with the effects of combined administration of the diuretics in 12 healthy volunteers. Results The co-administration of HCT (25 mg) with TO (5 or 10 mg) strongly increased Na + excretion. However, the combination significantly reduced K + and Mg 2+ excretion. The K + -sparing effect of the HCT/TO combination was shown to be due to a significant reduction in the HCTinduced increase in fractional K + excretion by the loop diuretic. Total excretion of Ca 2+ relative to Na + excretion was less with the HCT/TO combination than with TO given alone. Conclusion The enhancement of desired NaCl excretion by the HCT/TO combination with significant reduction of undesired loss of K + and Mg 2+ meets clinical requirements but has to be validated in long-term clinical trials.

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Severe Electrolyte Disturbances Associated With Metolazone and Furosemide

Cited by 22 publications

References 0 publications

Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature

Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature

Comparison of the Effects of Combination Diuretic Therapy with Oral Hydrochlorothiazide or Intravenous Chlorothiazide in Patients Receiving Intravenous Furosemide Therapy for the Treatment of Heart Failure

Torasemide significantly reduces thiazide-induced potassium and magnesium loss despite supra-additive natriuresis

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