Evaluation of Spironolactone in Combination with Furosemide in Cirrhotic Patients with Permagna (Large) Ascites

https://doi.org/10.22146/jmpf.30285

Tuty Mulyani(1*), Fita Rahmawati(2), Neneng Ratnasari(3)

(1) Faculty of Pharmacy, Banjarmasin Muhammadiyah Health College
(2) Faculty of Pharmacy, Univesitas Gadjah Mada
(3) RSUP Dr. Sardjito Yogyakarta Faculty of Medicine, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Ascites happens in 50% of patients with liver cirrhosis, Some of them experienced permagna ascites (large ascites). Based on the European Association for the Study of the Liver (EASL) guidelines in 2010, therapy of permagna ascites (large ascites) is paracentesis followed by restriction of sodium intake and diuretics. The use of diuretics can cause side effects such as hyperkalemia and hypokalemia. The aims of this study is to determine the effectiveness and safety of the combination of spironolactone and furosemide in patients with liver cirrhosis with permagna ascites.This study was an analytical observational study with retrospective cohort design. This study was done through a search of cirrhotic patients with permagna ascites’ medical record during January 2010-December 2014. This study was conducted at RSUP Dr. Sardjito. A total of 19 subjects categorized in the tense group and 39 subjects were in non-tense group. The effectiveness of diuretics seen by decreasing 1 cm/day of the patient's abdominal girth daily and the achievement of minimum of fluid balance -500 ml/day. Effectiveness data was analyzed by using independent t-test statistic. Side effects data was analyzed descriptively. There are no significantly different in reduction of abdominal girth and achieving fluid balance between cirrhotic patients with tense and non-tense ascites (p> 0.05); Adverse events of diuretics occurs in 5 patients, consist of hypokalemia 2 patients (3.45%), hyperkalemia 2 patients (3.45%) and hyponatraemia 1 patient (1.72%).

Keywords


sirosis hati; ascites permagna; kombinasi spironolakton dan furosemid; efektivitas dan efek samping;liver cirrhosis; large ascites; combination of spironolactone and furosemide; effectiveness and safety

Full Text:

PDF


References

Sease JM, Timm EG, Stragand JJ. Portal Hypertension and Cirrhosis. In: DiPiro J, Talbert RL, Yee G, Wells B, Posey L., eds. Pharmacotherapy A Pathophysiologic Approach. 9th ed. McGraw Hill Professional; 2014.

Runyon BA. Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012. Am Assoc Study Liver Dis Pract Guidel. 2013:2087-2107.

Lee JM, Han K-H, Ahn SH. Ascites and spontaneous bacterial peritonitis: an Asian perspective. J Gastroenterol Hepatol. 2009;24(9):1494-1503. doi:10.1111/j.1440-1746.2009.06020.x.

European Association for the Study of the Liver. EASL: clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397-417.

Kashani A, Landaverde C, Medici V, Rossaro L. Fluid retention in cirrhosis: Pathophysiology and management. Qjm. 2008;101(2):71-85. doi:10.1093/qjmed/hcm121.

Santos J, Planas R, Pardo A, et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol. 2003;39(2):187-192. doi:10.1016/S0168-8278(03)00188-0.

Angeli P, Fasolato S, Mazza E, et al. Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial. Gut. 2010;59(1):98-104. doi:10.1136/gut.2008.176495.

Kuiper JJ, van Buuren HR, de Man RA. Ascites in cirrhosis: A review of management and complications. Neth J Med. 2007;65(8):283-288.

Thomas MN, Sauter GH, Gerbes AL, et al. Automated low flow pump system for the treatment of refractory ascites: a single-center experience. Langenbeck’s Arch Surg. 2015;400(8):979-983. doi:10.1007/s00423-015-1356-1.

Pere Gines, Paolo Angeli, Kurtz lenz, Soren Moller, Kevin Moore, Richard Moreau, Carlo Merkel GG-T. Clinical Practice Guidelines EASL clinical practice guidelines on the management of ascites , spontaneous bacterial peritonitis , and hepatorenal syndrome in cirrhosis Clinical Practice Guidelines. J Hepatol. 2010;53(May):397-417. doi:10.1016/j.jhep.2010.05.004.

Yakar T, Demir M, Dogan O, Ozer B, Serin E. High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis. 2016;39(6):52-60.

Rosner MH, Gupta R, Ellison D, Okusa MD. Management of cirrhotic ascites: Physiological basis of diuretic action. Eur J Intern Med. 2006;17(1):8-19. doi:10.1016/j.ejim.2005.08.003.

Shaikh S, Mal G, Khalid S, Baloch GH, Akbar Y. Frequency of hyponatraemia and its influence on liver cirrhosis-related complications. J Pak Med Assoc. 2010;60(2):116-120.

Farida Y. Analisis penggunaan obat pada komplikasi sirosis hati. J Manaj dan Pelayanan Farm. 2013;4:77-84.

Fortune B, Cardenas A. Ascites, refractory ascites and hyponatremia in cirrhosis. Gastroenterol Rep. 2017;5(2):104-112. doi:10.1093/gastro/gox010.

Raza MA, Qureshi UF, Humayoun MA, Waseem T, Akram J. Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites. Eur J Gastroenterol Hepatol. 2011;23(2):184-188. doi:10.1097/MEG.0b013e328342af25.

Yan L, Xie F, Lu J, et al. The treatment of vasopressin V2-receptor antagonists in cirrhosis patients with ascites: a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2015;15:65. doi:10.1186/s12876-015-0297-z.

Moore KP. Guidelines on the management of ascites in cirrhosis. Gut. 2006;55(suppl_6):vi1-vi12. doi:10.1136/gut.2006.099580.

El-Bokl MA, Senousy BE, El-Karmouty KZ, et al. Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites. World J Gastroenterol. 2009;15(29):3631-3635. doi:10.3748/wjg.15.3631.

Pericleous M, Sarnowski A, Moore A, Fijten R, Zaman M. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome. Eur J Gastroenterol Hepatol. 2016;28(3):e10-e18. doi:10.1097/MEG.0000000000000548.

Senousy BE, Draganov P V. Evaluation and management of patients with refractory ascites. World J Gastroenterol. 2009;15(1):67-80. doi:10.3748/wjg.15.67.

Rena NMR a, Wibawa IDN. Albumin infusion in liver cirrhotic patients. Acta Med Indones. 2010;42(3):162-168. doi:10.1267/science.040579197.



DOI: https://doi.org/10.22146/jmpf.30285

Article Metrics

Abstract views : 7084 | views : 63097

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

©Jurnal Manajemen dan Pelayanan Farmasi
Faculty of Pharmacy
Universitas Gadjah Mada
Creative Commons License
View My Stats