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PubMedDate not supplied

The diuretic effect of muzolimine (Bay g 2821) on hepatogenic ascites.

A double-blind study was carried out in 22 patients with hepatogenic ascites to examine the effectiveness of the combination of muzolimine and spironolactone in comparison with combinations of furosemide and spironolactone and placebo and spironolactone. Despite the heterogeneous and variable case material, there was no significant difference between the 3 patient groups prior to treatment. After a diuretic-free preliminary period, all patients received 300 mg spironolactone daily plus 80 mg muzolimine, 80 mg furosemide or placebo for 7 days. Before the start of treatment and at daily intervals, measurements were made of waist size, body weight, and urinary and electrolyte elimination. Blood chemistry was investigated before treatment and on Days 4 and 7. Analysis of the results showed that the combination of muzolimine and spironolactone produced a statistiscally significant stronger saluretic effects than the other two combinations. This can be explained by the different sites of action of muzolimine and spironolactone, resulting in an additive effect. Neither subjective nor objective side-effects were observed during the 7-day treatment period.

Aged↗
PubMed1976

Diuretic action of bumetanide in advanced chronic renal insufficiency.

The effect of bumetanide, a new potent diuretic, was studied in twelve patients with severe chronic renal failure (GFR 2.7 - 10.7 ml/min). Bumetanide 8 mg i.v. caused increased excretion of water and sodium in all patients. In some patients sodium excretion was greater than 50% of filtered load indicating an effect on proximal tubules. Bumetanide 2 mg i.v. was significantly less effective than 8 mg and a greater diuretic effect was produced by bumetanide 16 mg. In a comparative study bumetanide 8 mg was less potent than furosemide 250 mg, a finding in contrast to the potency rate ratio of 1/40 in other conditions. Side effects consisted of mild to moderate muscle pain and stiffness, especially localized in the neck, shoulders and calves. These side effects occurred only in patients with a GFR less than 5.3 ml/min. They were noted in all patients receiving 16 mg and in 3 out of 12 patients who took bumetanide 8 mg. There was no relationship between the occurrence of side effects and plasma bumetanide levels, electrolyte levels or the renal excretion of bumetanide and electrolytes.

Adult↗
PubMed1979

Azosemide, a "loop" diuretic, and furosemide.

Azosemide is a new monosulfamyl diuretic which inhibits solute transport throughout the thick ascending limb of the loop of Henle. This study compared equal amounts of azosemide and furosemide (20, 40, and 80 mg) in normal subjects. No differences occurred at any dose in volume, sodium, or chloride excretion when analyzed as cumulative excretion at 4, 8, or 12 hr. Azosemide 40 mg caused less potassium excretion than 40 mg of furosemide but there was no significant difference in the sodium/potassium excretion ratio. Analysis of the time course of effect showed that compared to furosemide azosemide tended to have a slower onset of effect. Differences in site of action studies between azosemide and furosemide did not manifest as differences in urinary or electrolyte excretion in our normal subjects.

Adult↗
PubMed1988

Pharmacologic effects of A-56234, a new high-ceiling diuretic.

The pharmacokinetic characteristics, the diuretic, saluretic, and uricosuric properties, and the safety of single, rising, oral doses of A-56234, a new high-ceiling diuretic, were evaluated in this double-blind, placebo-controlled, cross-over study. Each of three groups of eight subjects received placebo and three different single doses of the diuretic at 1-week intervals. Doses ranged from 0.5 to 80 mg. Significant, dose-related increases in urine volume and in urinary excretion of sodium and chloride were produced during the 24 hours after administration of 20, 40, 60, and 80 mg of the drug. Uricosuria was not observed at any dose. The drug was rapidly absorbed and displayed linear pharmacokinetics within the dose range studied. The elimination-phase plasma half-life was approximately 6 hours. Hepatic clearance was the main route of excretion in humans; only 2 to 10% of the parent drug was excreted in the urine. The drug was well tolerated and no clinically important adverse events were noted.

Adolescent↗
PubMed1994

Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure.

It is commonly assumed that thiazide diuretics are ineffective in patients with advanced renal failure (GFR < 30 ml/min/1.73 m2). Thiazides act on the nephron segment distal to the ascending thick loop of Henle, that is, the site of action of loop diuretics. Blockade of sodium reabsorption in the thiazide-sensitive segment should therefore obliterate the compensatory increase in sodium reabsorption seen after administration of loop diuretics and thus potentiate the natriuretic efficacy of loop diuretics even in advanced renal failure. In a single-blind, randomized, placebo controlled crossover study we compared the natriuretic and chloruretic effect of the loop diuretic, torasemide, given alone or in combination with the thiazide diuretic, butizid, in 10 patients with advanced renal failure (mean CIn 13.1 +/- 5.9 ml/min/1.73 m2). For two weeks patients adhered to a diet containing a standardized amount of Na+ and K+. On the 6th and 13th study days, two sham infusions were given to patients in order to assess basal 24-hour urinary electrolyte excretion. On the 7th and 14th days they were randomly allocated to receive either 50 mg i.v. torasemide in combination with a sham infusion or torasemide in combination with 20 mg i.v. butizid. Administration of torasemide alone significantly (P < 0.01) increased mean cumulative 24-hour excretion of sodium (from 154 +/- 30 to 232 +/- 59 mmol/24 hr) and chloride (from 128 +/- 21 to 233 +/- 84 mmol/24 hr) as compared with baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Comparison of loop diuretics in patients with chronic renal insufficiency.

Furosemide and bumetanide share a number of characteristics including reduced natriuretic effects in azotemic patients. It has been presumed that this condition affects each drug equally. Previous studies, however, suggest dissimilar pathways of delivery to their sites of action. Though not rigorously tested, this potential disparity might cause them to differ when used in azotemia. We, therefore, assessed the pharmacokinetic and pharmacodynamic characteristics of intravenously administered furosemide and bumetanide in ten adult patients with stable, chronic renal insufficiency (mean creatinine clearance = 14.1 +/- 2.0 ml/min/1.73 m2) in a randomized, cross-over study during controlled sodium intake. Our goals were to assess differences in diuretic effectiveness and in so doing to determine the dose required to produce a maximal response. The mean diuretic doses of 172 and 4.3 mg for furosemide and bumetanide, respectively (ratio = 40:1) were sufficient to produce a maximum response. Despite similarities in maximal fractional excretion of sodium (18.2 +/- 2.6% with furosemide vs. 19.4 +/- 4.5% with bumetanide, P = 0.687) demonstrating an equal tubular responsiveness to both drugs, overall response as quantified by cumulative natriuresis in the initial eight hour period was 52% greater with furosemide (108 +/- 17 vs. 71 +/- 7 mEq; P = 0.042). The difference in total excreted sodium was accounted for by a preserved nonrenal clearance of bumetanide (113 +/- 12 compared to 53 +/- 5 ml/min for furosemide, P = 0.001) which resulted in relatively less bumetanide in serum available to be delivered into the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Diuretic effect of bumetanide in isolated perfused kidneys of Milan hypertensive rats.

The Milan hypertensive strain of rats (MHS) is characterized in the prehypertensive phase (4 weeks of age) by a significantly faster bumetanide-sensitive cell membrane Na+,K+,Cl(-)-cotransport as compared to matched normotensive controls (MNS). The isolated kidney preparation, which allows the study of renal function under controlled in vitro conditions, was chosen to compare the natriuretic effect of the loop diuretic, bumetanide, to that of two other diuretics (amiloride and hydrocholorothiazide) acting on different parts of the nephron. Concentrations ranging from 10(-7) to 10(-4) M were tested in 4-week-old MHS and MNS. Our results showed that the natriuretic response to all diuretics was greater in MHS as compared to MNS when evaluated as absolute Na+ excretion (UNA+); this is likely because of the faster basal glomerular filtration rate (GFR) in the hypertensive strain (874 +/- 126 in MHS vs. 556 +/- 33 microliters.min-1.g-1 k wt in MNS, P less than 0.05). However, when calculated either as a difference from basal values (delta UNa+), or per ml of glomerular filtration rate, the response of MHS kidneys to amiloride and hydrochlorothiazide was similar in the two strains: delta UNa+ after amiloride at (10(-4) M was + 2.1 +/- 0.7 in MHS versus + 1.2 +/- 0.2 mumol.g-1.g-1 k wt in MNS; after hydrochlorothiazide 10(-4) M it was + 1.7 +/- 0.9 in MHS versus + 1.1 +/- 0.4 mumol.min-1.g-1 k wt in MNS, values not statistically different.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1976

(Vinylaryloxy)acetic acids. A new class of diuretic agents. 1. (Diacylvinylaryloxy)acetic acids.

A series of (diacylvinylaryloxy)acetic acids was synthesized and tested in dogs for saluretic and diuretic activity. Several compounds exhibit a high order of activity, the most active being [2,3-dichloro-4-(2,2-diacetylvinyl)-phenoxy]acetic acid (3). This compound is about three times as potent as [2,3-dichloro-4-(2-methylenebutyryl)-phenoxy]acetic acid (ethacrynic acid) but is qualitatively similar in causing a prompt increase in the excretion of water and in the excretion of sodium and chloride ions in approximately equimolar amounts. Saturation of the double bond of 3 virtually abolishes activity lending support to the hypothesis that the saluresis induced by these compounds, like that of ethacrynic acid, is related at least in part to a chemical reaction with protein-bound sulfhydryl groups. Four mercaptan adducts of 3 were prepared; these probably function as prodrugs in producing saluresis. The adduct with mercaptoacetic acid is as active as 3 itself.

Acetates↗
PubMed1988

Mechanisms of reduced effects of loop diuretics in healthy volunteers and in patients with renal disease.

Although most patients respond well to loop diuretics, poor response is sometimes a problem and some underlying mechanisms were addressed in this study. The renal response to continuous infusion of furosemide was investigated in eight healthy volunteers during controlled isotonic dehydration and after full restoration of volume losses. A rapidly reversible acute tolerance developed in parallel with dehydration and activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS). Dehydration also reduced the renal clearance of furosemide substantially, but only decreased the urinary delivery rate of the drug (the principal determinant of the diuretic effect) to a minimal extent. Delayed tolerance to an i.v. bolus dose of furosemide was found in 12 healthy volunteers after 1 week of oral furosemide treatment with and without angiotensin converting enzyme inhibition. No pharmacokinetic changes were seen. This type of tolerance was not related to dehydration or activation of RAAS. Thus, the induced decrease in renal sensitivity to furosemide was probably due to an intrarenal (structural?) adaptation. The pharmacokinetics and pharmacodynamics of piretanide were studied in six healthy volunteers and 22 patients with chronic renal failure (glomerular filtration rate 1-28 ml/min). Poor response to the diuretic action of the drug was found in the patients. This was entirely due to a decrease in the fraction of piretanide excreted unchanged in the urine, and the renal sensitivity to the drug was normal. Multiple daily doses of piretanide of maximally 24 mg are recommended for optimal efficiency in renal failure. Substantial changes in pharmacokinetics of furosemide were found after manipulation of plasma albumin in five patients with nephrosis, while the urinary delivery of the drug scarcely changed. Neither the induced alterations in proteinuria nor those in plasma volume influenced the renal sensitivity to furosemide significantly. Some methodological observations proved to be of significance. Creatinine was found to be an unreliable marker of GFR because of its substantial tubular secretion and reabsorption, both of which were related to the degree of hydration. Likewise, lithium was considered an unreliable marker of proximal tubular reabsorption, since there were reasons to suspect furosemide-sensitive distal lithium reabsorption.

Adult↗
PubMed1997

Dose-dependent cardiovascular, renal, and endocrine effects of furosemide in conscious lambs.

In recent experiments in conscious lambs, we showed that in addition to its well-known natriuretic and diuretic effects, i.v. injection of 2 mg/kg of furosemide resulted in a sustained increase in heart rate and an age-dependent increase in plasma renin activity. To determine whether these responses were dose dependent, we measured various parameters of cardiovascular, renal, and endocrine function in six chronically instrumented lambs. Three of seven doses of furosemide were tested at 48-h intervals; the range of doses was 0 to 7.5 mg/kg. A dose-dependent transient pressor response occurred within 20 min of furosemide administration; the duration of this response increased with increasing doses. Heart rate increased 40 min after doses of furosemide > or = 0.25 mg/kg; this response was not dose dependent. Renin increased following all doses; the peak and the duration of the renin response were dose dependent. These data provide new information on the dose-dependent cardiovascular, renal, and endocrine responses to furosemide in conscious newborn lambs.

Aldosterone↗
PubMed1975

Quinuclidine chemistry. 4. Diuretic properties of cis-3-amino-2-benzhydrylquinuclidine.

A number of 3-amino-2-benzhydrylquinuclidines were tested for diuretic activity in both rats and dogs. The Schiff base formed from 2-benzhydryl-3-quinuclidinone and benzylamine was reduced with NaBH4 to a mixture of isomers, the cis isomer being preponderants. cis-2-Benzhydryl-3-benzylaminoquinuclidine was isolated by chromatography and debenzylat:d to cis-3-amino-2-benzhydrylquinuclidine, the most active compound in this series. The corresponding trans isomer was considerably less active. It was made by reacting the mesylate of cis-2-benzhydr-l-3-quinuclidinol with Nan3 to form trans-3-azido-2-benzhydrylquinuclidine which was reduced with LiAlH4. In dose-response studies (sodium excretion as a function of dose) in rats the maximal or ceiling effect of cis-3-amino-2-benzhydrylquinuclidine was considerably greater than that of hydroflumethiazide but less than that of furosemide. An unusual biphasic dose-response was seen in dogs with cis-3-amino-2-bezhydrylquinuclidine, centering around 10 mg/kg.

Animals↗
PubMed1999

Efficacy of indapamide in central diabetes insipidus.

BACKGROUND: Central diabetes insipidus (CDI) results from deficient vasopressin (antidiuretic hormone) secretion and causes polydipsia and polyuria. Desmopressin, a synthetic analog of vasopressin, is the drug of choice in the treatment of CDI, but in mild cases, there are alternative drugs that can be used, including chlorpropamide, carbamazepine, and thiazides. METHODS: In this study, we investigated the efficacy of treatment with indapamide, which is an antihypertensive diuretic oral agent, in 20 consecutive patients with CDI. The diagnosis of CDI was established by water-deprivation and vasopressin tests. Before the study, serum and urinary osmolality, daily urinary volume, and serum electrolyte levels were measured in all 20 patients. Indapamide (2.5 mg/d) was administered for 10 days, and then the investigations were performed again; for purposes of comparison, 250 mg/d of chlorpropamide was also administered to 11 of the 20 patients who had been given indapamide. RESULTS: Indapamide revealed a 40.56% +/- 9.70% (mean +/- SD) (range, 19.6%-55.0%) reduction in 24-hour urinary volume and an increase in urinary osmolality, as well as a decrease in serum osmolality, and was as effective as chlorpropamide (P<.05) in the treatment of CDI. CONCLUSION: Because of its low cost and lack of significant adverse effects, indapamide may be a suitable, easy-to-use alternative oral agent for some patients with CDI.

Adolescent↗
PubMed1992

Modulation of electrolyte excretion by potassium retaining diuretics.

Triamterene and amiloride belong to the potassium retaining diuretics of the cycloamidine type. These agents exert natriuretic as well as antikaliuretic effects. After administration of high doses an additional magnesium-sparing property also becomes evident. Whereas amiloride is only metabolized to a minor extent, triamterene is rapidly bio-transformed to the phase-I metabolite, hydroxytriamterene, and the phase-II metabolite, hydroxytriamterene sulphuric acid ester. This acidic phase-II metabolite is still diuretically active, but its electrolyte excretion profile is different from the parent compound: although the natriuretic properties are not altered, the potassium retention is very weak. Further studies in rats with cycloamidine derivatives of the triamterene type containing neutral, acidic or basic side chains at the phenyl moiety as well as with basic pteridine derivatives, revealed further evidence that the natriuretic, antikaliuretic and antimagnesiuretic effects can be influenced almost independently by structural variations of the parent drug. Thus, it was possible to obtain compounds predominantly increasing sodium excretion without affecting potassium or magnesium excretion. On the other hand, substances could be developed with mainly antikaliuretic effects, or compounds, which enhanced sodium and reduced magnesium excretion and did not interfere with the potassium elimination. Based on these findings, it can be concluded that distal tubular transport of sodium, potassium and magnesium may be influenced independently from each other. These renal effects of triamterene and its derivatives seem to be independent of their antiarrhythmic actions, as suggested by recent studies.

Animals↗
PubMed1983

[Saluretic and diuretic effects of xipamide-triamterene combinations in varying dose ratios in rats].

The saluretic and diuretic properties of 4-chloro-5-sulfamoyl-2',6'-salicyloxylidide (xipamide) and 2,4,7-triamino-6-phenyl-pteridine (triamterene) were determined in rats following sole and combined application in various dosages and dose ratios. Xipamide dosages ranged from 0.01-30 mg/kg body weight. Xipamide, when given alone, revealed a significant dose-dependent increase in sodium excretion and urine volume compared to control animals even in the smallest dose to be tested (0.01 mg/kg). Triamterene as sole agent led to an increased sodium and water excretion when given in a natriuretic threshold dose of approximately 1.0 mg/kg. Potassium excretion was slightly enhanced following xipamide application and decreased significantly with triamterene treatment. The combined application of xipamide and triamterene in dose ratios of 1:1-1:4 (xipamide/triamterene) resulted in an increased sodium excretion which was almost additive following high triamterene dosages. Potassium elimination decreased significantly when threshold triamterene dosages were added. High triamterene dosages in all dose ratios of the combined application resulted in potassium levels which only could be registered following sole triamterene application.

Animals↗
PubMed1998

Soy isoflavonoids exhibit in vitro biological activities of loop diuretics.

Intake of soyfoods containing isoflavonoids is related to positive effects on heart and kidney diseases. Urinary equol, a potent inhibitor of Na+-K+-2Cl- cotransport, originates from the metabolism of daidzein by intestinal bacteria. Loop diuretics (eg, furosemide), acting through inhibition of Na+-K+-2Cl- cotransport, are used to maintain adequate blood volume. In the present work, we compare isoflavonoids' inhibition of cotransport and effects on the function and hemodynamics of isolated perfused rat kidneys with those of furosemide. Equol [IC50 (half-maximal inhibitory concentration): 23.6 +/- 3.6 micromol/L], genistein (IC50: 34.8 +/- 2.6 micromol/L), and daidzein (IC50: 140.0 +/- 24 micromol/L) inhibited bumetanide-sensitive rubidium uptake in LLC-PK1 cells. The IC50 of equol and genistein was close to that of furosemide (IC50: 10.3 +/- 2.7 micromol/L). Furosemide, equol, and genistein stimulated water, sodium, and potassium excretion by isolated rat kidneys in the same temporal pattern. None of the isoflavonoids significantly increased the glomerular filtration rate, but genistein induced significant vasorelaxation. We conclude that isoflavonoids exhibit biological activities of furosemide in vitro, at concentrations similar to those reported for other in vitro effects. More research is needed to evaluate the participation of cotransport inhibition by isoflavonoids in the healthful effects claimed for soy intake.

Animals↗
PubMed1989

Hypotensive and diuretic effects of atrial natriuretic factor in diabetic patients.

Plasma levels of atrial natriuretic factor (ANF), and the effects of intravenously infused ANF (99-126) on renal filtration and blood pressure, were studied during different sodium intakes in six patients with uncomplicated diabetes mellitus. The change from a low (25 mmol/day) to a high (241 mmol/day) sodium intake was associated with a 2.5 fold increase in circulating immunoreactive ANF. On both sodium diets, an infusion of synthetic ANF (99-126) given at two different rates caused a progressive decrease of arterial pressure. On a low but not on a high sodium intake arterial hypotension occurred in two patients. Moreover, on a high sodium intake, ANF did not significantly modify glomerular filtration rate, the effective renal plasma flow and the plasma concentrations of renin and aldosterone. It increased the fractional excretion of sodium by 72%. On a low sodium intake ANF caused a progressive fall of glomerular filtration rates and effective renal plasma flow. It increased the fractional excretion of sodium by 100%, and increased plasma renin and aldosterone levels. In patients with uncomplicated diabetes mellitus, circulating ANF responds physiologically to variations in sodium intake. A low sodium diet could predispose to arterial hypotension and renal functional impairment during infusion of ANF (99-126).

Adult↗
PubMed2004

Diuretic effects of subcutaneous furosemide in human volunteers: a randomized pilot study.

BACKGROUND: Furosemide is usually administered by the oral or intravenous route to cardiac patients with hypertension and heart failure, as well as edema. Occasionally, furosemide cannot be administered by these routes. OBJECTIVE: To evaluate the diuretic/natriuretic efficacy of subcutaneously administered furosemide in healthy volunteers. METHODS: This single-center, double-blind, placebo-controlled, randomized, crossover pilot study compared the diuretic effect of subcutaneously administered furosemide and NaCl 0.9% (placebo) in 12 healthy volunteers. The study was conducted over 5 days. Baseline values were determined on day 1. On days 3 and 5, each volunteer was injected with either furosemide 20 mg (2 mL) or 2 mL of placebo subcutaneously. A washout period occurred on day 4. Fluid and dietary intake were controlled on all 3 data collection days. Primary outcome measures consisted of urine volume voided, urine sodium concentration, onset time and volume of initial urine output, and number of voids during 8 hours of urine collection. RESULTS: All outcomes demonstrated statistically significant differences when treatment and placebo groups were compared (p < 0.05). Adverse effects most commonly reported by the participants were minor and included transient burning and stinging at the injection site. CONCLUSIONS: This study demonstrates that subcutaneously administered furosemide is a viable alternative when the oral or intravenous route of administration is not desirable or possible in humans. However, the results of this study need to be corroborated in various patient populations.

Adult↗
PubMed1998

Kinins mediate the inhibition of atrial natriuretic peptide diuretic effect induced by pepsanurin.

Pepsanurin is a peptidic fraction resulting from pepsin digestion of plasma globulins, that inhibits ANP renal excretory actions. We studied whether kinin-like peptides mediate the anti-ANP effect by testing if pepsanurin: 1) was blocked by the kinin B2 receptor antagonist HOE-140, 2) was produced from kininogen, and 3) was mimicked by bradykinin. Anti-ANP activity was assessed in anesthetized female rats by comparing the excretory response to two ANP boluses (0.5 microgram i.v.) given before and after i.p. injection of test samples. Pepsanurin from human or rat plasma (1-5 mL/kg), and bradykinin (5-20 micrograms/kg), dose-relatedly inhibited ANP-induced water, sodium, potassium and cyclic GMP urinary excretion, without affecting arterial blood pressure. The same effect was exerted by pepsin hydrolysates of purified kininogen, whereas hydrolysates of kininogen-free plasma had no effect. HOE-140 (5 micrograms, i.v.) did not alter baseline, or ANP-induced excretion, but blocked the anti-ANP effects of pepsanurin. Histamine (15 micrograms/kg) plus seroalbumin hydrolysates did not affect ANP response, despite inducing larger peritoneal fluid accumulation as compared with pepsanurin or bradykinin. We concluded that kinins cleaved from kininogen mediate the anti-ANP effects of pepsanurin by activation of kinin B2 receptors, independently of changes in systemic arterial pressure or peritoneal fluid sequestration.

Adrenergic beta-Antagonists↗