Drug Interactions of Loop Diuretics

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© Loop Diuretics can interact majorly with drugs such as Digoxin, Digitoxin, Sotalol, Dofetilide, Droperidol, Metolazone, Foscarnet, Arsenic Trioxide, Ketanserin, Bepridil, Cisplatin, Aminoglycoside Antibiotics and some Antivirals. © Moderate interaction of Loop Diuretics includes ACE Inhibitors, NSAIDs, Antidiabetics and Ginseng.

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Drug Interactions of Antihypertensives (Part 7) (Drug Interactions of Loop Diuretics):

Drug Interactions of Antihypertensives (Part 7) (Drug Interactions of Loop Diuretics) Dr. P.Naina Mohamed PhD Pharmacologist

Introduction:

Introduction An adverse drug interaction is defined as an interaction between one or more coadministered medications which leads to alteration of the effectiveness or toxicity of any of the coadministered medications . Drug interactions can be caused by prescription and over-the-counter (OTC) medications, herbal products or vitamins , foods , diseases, and genetics ( family history ). It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses. With this amount of medicine use, the probability that a person will take two prescribed drugs that may interact with one another is very high.

Antihypertensives:

Antihypertensives The common Antihypertensives include… Angiotensin converting enzyme inhibitors (ACEIs) Angiotensin receptor blockers (ARBs) Direct Renin Inhibitors (DRIs) Calcium channel blockers (CCBs) Diuretics Adrenergic Beta Blockers Adrenergic Alpha Blockers

Diuretics:

Diuretics The most common Diuretics include… Loop Diuretics : Furosemide ( Frusemide ) Bumetanide Torsemide Ethacrynic acid Thiazide Diuretics : Hydrochlorothiazide Chlorthalidone Chlorthiazide Indapamide Methy clothiazide Metalazone Potassium Sparing Diuretics : Aldosterone antagonists : Spironolactone Eplerenone Epithelial sodium channel blockers : Amiloride Triamterene

Loop Diuretics & Digitalis Glycosides:

Loop Diuretics & Digitalis Glycosides Frequent monitoring of potassium and magnesium with appropriate replacement is recommended. Educate patients about the importance of maintaining adequate intake of dietary potassium and/or potassium supplements.

Loop Diuretics + Sotalol:

Loop Diuretics + Sotalol Use caution if sotalol is used concomitantly with a diuretic. Monitor the patient for signs of sotalol toxicity (Prolonged QTc interval, faintness, dizziness, and tachycardia).

Loop Diuretics + Dofetilide:

Loop Diuretics + Dofetilide Loop diuretics and Dofetilide should be coadministered with caution. Monitor the patient for signs of dofetilide toxicity including prolonged QT interval, faintness, dizziness, and tachycardia.

Loop Diuretics & Droperidol :

Loop Diuretics & Droperidol Droperidol should be administered with extreme caution in patients taking Loop diuretics.

Loop Diuretics & Arsenic Trioxide:

Loop Diuretics & Arsenic Trioxide Avoid concurrent use of arsenic trioxide with loop diuretics. Monitor electrolytes more frequently if coadministration is required.

Loop Diuretics & Ketanserin:

Loop Diuretics & Ketanserin Monitor for prolongation of the QT interval, if patients must receive ketanserin and loop diuretics . Substituting a potassium-sparing diuretic would be advisable.

Loop Diuretics + Bepridil:

Loop Diuretics + Bepridil Monitor serum potassium and magnesium. Consider switching the patient to a potassium-sparing diuretic to reduce the possibility of hypokalemia.

Frusemide & Aminoglycoside Antibiotics:

Frusemide & Aminoglycoside Antibiotics The concomitant use of furosemide and Aminoglycoside Antibiotics should be avoided. Monitor for additive ototoxicity or nephrotoxicity, if concurrent therapy is required.

Frusemide & Cisplatin:

Frusemide & Cisplatin Administer furosemide at lower doses and with positive fluid balance when given for forced diuresis during cisplatin therapy. Consider monitoring renal and auditory function, if cisplatin and furosemide are coadministered .

Loop Diuretics & Metolazone:

Loop Diuretics & Metolazone Use caution if Metolazone and a Loop diuretic are used concomitantly. Closely monitor fluids and electrolytes status.

Loop Diuretics & Foscarnet:

Loop Diuretics & Foscarnet A thiazide diuretic is recommended, if a diuretic is clinically indicated .

Frusemide & Antivirals:

Frusemide & Antivirals Monitor for increased adverse events associated with furosemide.

Loop Diuretics & ACEIs:

Loop Diuretics & ACEIs Discontinue the diuretic two to three days prior to adding an ACE inhibitor, if possible. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.

Loop Diuretics & NSAIDs :

Loop Diuretics & NSAIDs Use caution when NSAIDs and loop diuretics are coadministered . Monitor the patients for diuretic efficacy and for signs of renal failure.

Diuretics & Antidiabetics:

Diuretics & Antidiabetics Monitor glucose levels more frequently, if a diuretic and an antidiabetic agent used concomitantly.

Loop Diuretics & Ginseng:

Loop Diuretics & Ginseng Patients should be advised to discontinue use of ginseng and germanium-supplemented ginseng products while taking loop diuretics.

Conclusion:

Conclusion Minimizing the risk for drug interactions should be a goal in drug therapy to reduce the occurrence of significant morbidity and mortality. The patients with hypertension should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist. The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening , education, and follow up on suspected drug interactions. If possible, the hypertensive patients are recommended to fill all their prescriptions at one pharmacy.

References:

References Stockley’s Drug Interactions, 9e Karen Baxter http://www.micromedexsolutions.com http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911556/ http://www.sciencedirect.com/science/article/pii/S0006291X14014910 http://jpet.aspetjournals.org/content/248/3/1175.abstract

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