Dosage/Direction for Use
Oral Hypertension, Oedema, Ascites due to congestive heart failure Adult: Per tab contains furosemide 20 mg and spironolactone 50 mg. 1-4 tabs/day. |
Contraindications
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.
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Special Precautions
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.
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Adverse Reactions
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. |
Drug Interactions
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. |
Food Interaction
Bioavailability of frusemide reduced but absorption of spironolactone improved.
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Lab Interference
Frusemide produces falsely low urinary sugar values by clinistix or diastrix method.
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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.
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CIMS Class
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ATC Classification
C03CA01 - furosemide ; Belongs to the class of high-ceiling sulfonamide diuretics.
C03DA01 - spironolactone ; Belongs to the class of aldosterone antagonists. Used as potassium-sparing diuretics. |