– Loop diuretic
– Oedema associated with renal, hepatic or congestive heart failure
Forms and strengths
– 20 mg and 40 mg tablets
– Adult: start with 20 mg once daily. Increase, if necessary, according to clinical response up to 80 mg once daily or 2 times daily (max. 160 mg daily). Once oedema decrease, reduce to 20 to 40 mg once daily.
– According to clinical response
Contra-indications, adverse effects, precautions
– Do not administer to patients with dehydration, severe hypokalaemia and hyponatraemia.
– May cause:
• dehydration, hypotension, hypokalaemia, hyponatraemia, hyperuricemia;
• renal impairment, deafness, photosensitivity.
– Avoid or monitor combination with NSAIDs, ACE inhibitors (risk of renal impairment); ototoxic drugs (e.g. aminoglycosides, quinine); lithium (increased plasma concentrations of lithium).
– Monitor combination with:
• drugs that provoke hypotension (e.g. haloperidol, amitriptyline) and antihypertensive drugs (risk of hypotension);
• potassium-depleting drugs (e.g. corticosteriods, laxatives, amphotericin B), sodium-depleting drugs (e.g. SSRI, carbamazepine);
• oral antidiabetics and insulin (risk of hyperglycaemia).
– Pregnancy: administer only if clearly needed
– Breast-feeding: CONTRA-INDICATED (excreted in milk and reduces milk production)
– Preferably take in the morning.
– A potassium-rich diet (dates, bananas, mangos, oranges, tomatoes, etc.) is recommended during treatment. If potassium level is < 3.5 mmol/litre, administer a sustained-release potassium supplement.
– Diuretics are not indicated in the treatment of nutritional oedema or oedema associated with pre-eclampsia.
– Storage: below 25 °C -