Furosemide Captopril

A 47-year-old woman with multiple medical problems stabilised on warfarin (and also taking azathioprine, captopril, furosemide, insulin, capto-pril, prednisone, levothyroxine, valproic acid and zolpidem) had all her teeth removed under general anaesthetic. Sixteen days later she needed a dental abscess drained and was given oral clindamycin 300 mg four times daily with ibuprofen 600 mg for any discomfort. On day 17 she needed a suture to stop some bleeding and her INR was found to be 3.5. By day 20 she had developed more severe oral bleeding, which needed emergency room treatment. Her INR was found to have risen to 13 and her haemat-ocrit decreased to 18%. She was treated successfully with a blood transfusion and vitamin K. ... 

Acetazolamide, captopril, ethacrynic acid, furosemide, hydralazine, methazolamide, methyldopa, procainamide, thiazide diuretics, and ticlopidine... 

Drugs in Class III have good aqueous solubility but poor membrane permeability (e.g., bidisomide, bispho-sphonates, captopril, and furosemide). Food and food components would only be expected to influence absorption of drugs in this class if they affected some aspect... 

Examples of specific drugs used in the treatment of chronic heart failure include digitalis glycosides (e.g., digoxin, positive inotropic agent), diuretics (hydrochlortiazide and furosemide), and vasodilators (nitrates such as nitroglycerin, ACE inhibitors, such as captopril, and hydralazine). 

Sotalol, metoprolol, propranolol, carvedilol, nifedipine, captopril, cilazapril, milrinone, ticlopidine, acenocoumarol, furosemide, acetylsalicylic acid, salicylic acid, ibuprofen, naproxen, ketoprofen, diclofenac, paracetamol, dipyrone, mildronate, sildenafil, dexa-methasone, carbamazepine, terbinafine/urine UHPLC MS/MS Column Zorbax Rapid Resolution High Definition SB-C18 (50 x 2.1 mm, 1.8 pm) Mobile phase Solvent A 0.1 % HCOOH in water Solvent B MeOH (gradient elution) Detection MS/MS, ionization ESI Protein precipitation LOQ 0.05-0.60 ng/mL [71]... 

Enalapril, paracetamol, sotalol, dipyrone, vancomycin, captopril, fluconazole, cefazolin, metoprolol, aspirin, ticlopidine, prednisolone, propranolol, digoxin, sildenafil, furosemide, dexamethasone, carvedilol, ketoprofen, nifedipine, terbinafine, acenocoumarol, spironolactone/urine HPLC DAD Column LiChroCART Purospher STAR, RP-18e (250 x 4 mm, 5 pm) Mobile phase MeOH ACN 0.05 % TFA in water (gradient elution) Detection DAD X = 200 50 nm Adjusted to pH 7.0, protein precipitation LOD 0.01-1.44 pg/mL LOQ 0.04-4.35 pg/mL [72]... 

Lichenoid eruption e.g. p-adrenoceptor blockers, chloroquine, thiazides, frusemide (furosemide), captopril, gold, phenothiazines. 

Van Vliet, AA., Hackeng, W.H., Donker, A.XM., Meuwissen, S.G.M. Efficacy of low-dose captopril in addition to furosemide and spironolactone in patients with decompensated liver disease during blunted diuresis. J. Hepatol. 1992 15 40-47... 

In congestive heart failure, single conventional doses of captopril (25-75 mg) attenuated the natriuretic response to furosemide, while a low dose (1 mg) significantly enhanced furosemide-induced natriuresis (SEDA-17, 268) (SEDA-18, 236). The mechanism of this interaction is uncertain, but captopril did not affect delivery of furosemide to its site of action (28). In the long-term, intensive treatment with captopril enhanced the natriuretic response to furosemide (SEDA-17, 268). 

A 77-year-old woman took captopril 25 mg tds and furosemide 40 mg/day for decompensated heart failure (4). Irbesartan 75 mg/day then replaced captopril, and 3 days later she developed renal insufficiency. Irbesartan was withdrawn and her renal function normalized within 5 days. It was not stated whether her blood pressure also changed. 

KC is a 45-year-old man receiving ampicillin and gentamicin for endocarditis due to Enterococcus faecalis. He has a baseline serum Cr of 1.5 mg/dL secondary to uncontrolled diabetes mellitus. His other medications include furosemide, aspirin, and captopril. During his second week of therapy KC complains of ringing in his ears and a sensation of fullness. Risk factors for ototoxicity in KC include ... 

Antiviral agents acyclovir, amantadine, azidofhymidine Diuretics furosemide, hydrochlorothiazide, efhacrynic acid ACE inhibitors captopril, enalapril, ramipril, delapril, quinapril Antineoplastics methotrexate, azathioprine, doxorubicin, 5-fluouracil Antiepileptics valproic acid (from Ref. [95])... 

Bullous pemphigoid Tense Bullae, widespread Present or absent Furosemide, penicillamine, penicillins, sulfasalazine, captopril Supportive ... 

Also analyzed acebutolol, acetaminophen, alprazolam, amphetamine, atenolol, betaxolol, brotizolam, caffeine, camazepam, captopril, chloroquine, clobazam, clomipramine, cloth-iapine, clotiazepam, cloxazolam, cocaine, codeine, diclofenac, dihydralazine, dihydrocodeine, dihydroergotamine, diphenhydramine, domperidone, doxepin, droperidol, ergota-mine, ethyl loflazepate, fenethylline, fluoxetine, flupentixol, flurazepam, furosemide, gliclazide, hydrochlorothiazide, hydroxyzine, ibuprofen, imipramine, ketazolam, loprazo-1am, lorazepam, lormetazepam, maprotUine, medazepam, mepyramine, methadone, methaqualone, methyldopa, methylphenidate, metoclopramide, metoprolol, mexiletine, mianserin, midazolam, minoxidil, morphine, nadolol, nitrazepam, oxprenolol, papaverine, pentazocine, phenprocoumon, phenylbutazone, pipamperone, piritramide, practolol, pra-zepam, prazosin, promazine, promethazine, propoxyphene, propranolol, prothipendyl, quinine, sotalol, sulpride, thioridazine, trazodone, triazolam, trimipramine, tripelennamine, lyramine, verapeunil, yohimbine... 

Noninterfering amiloride, acebutolol, acenocoumarol, acetaminophen, aspirin, allopuri-nol, ambroxol, amoxicillin, atenolol, bendroflumethiazide, benzbromarone, bezafibrate, biperiden, bisacodyl, bromazepam, butizide, captopril, cimetidine, ciprofloxacin, clobu-tinol, clonidine, cotinine, diazepam, diclofenac, digitoxin, digoxin, dihydrocodeine, dihy-droergotamine, diltiazem, doxepin, doxycycline, enalapril, erythromycin, fenoterol, furosemide, glibenclamide, heparin, h3qjoxanthine, ibuprofen, indomethacin, isosorbide... 

Displaces warfarin from plasma protein binding sites. Reduces natriuretic and diuretic effects of furosemide and antihypertensive effects of thiazides, beta blockers, prazosin, and captopril. 

Starting with a low dose of the ACE inhibitor reduces the risk of first-dose hypotension. In a study in 8 patients with hypertension, treated with a diuretic (mainly furosemide or hydrochlorothiazide) for at least 4 weeks, captopril was started in small increasing doses from 6.25 mg. Symptomatic postural hypotension was seen in 2 of the 8 patients, but was only mild and transient. ... 

Hypotension is more common in patients with heart failure who are receiving large doses of diuretics. In a study in 124 patients with severe heart failure, all receiving furosemide (mean dose 170 mg daily range 80 to 500 mg daily) and 90 also receiving the potassium-sparing diuretic spironolactone, the addition of captopril caused transient symptomatic hypotension in 44% of subjects. The captopril dose had to be reduced, and in 8 patients it was later discontinued. In addition, four patients developed symptomatic hypotension after 1 to 2 months of treatment, and captopril was also discontinued in these patients. ... 

The risk of ACE inhibitor-induced renal impairment in patients with or without renovascular disease can be potentiated by diuretics. " In an analysis of 74 patients who had been treated with captopril or lisinopril, reversible acute renal failure was more coimnon in those who were also treated with a diuretic (furosemide and/or hydrochlorothiazide) than those who were not (11 of 33 patients compared with 1 of 41 patients). Similarly, in a prescription-event monitoring study, enalapril was associated with raised creatinine or urea in 75 patients and it was thought to have contributed to the deterioration in renal function and subsequent deaths in 10 of these patients. However, 9 of these 10 were also receiving loop or thiazide diuretics, sometimes in high doses. Retrospective analysis of a controlled study in patients with hypertensive nephrosclerosis identified 8 of 34 patients who developed reversible renal impairment when treated with enalapril and various other antihypertensives including a diuretic (furosemide or hydrochlorothiazide). In contrast, 23 patients treated with placebo and various other antihypertensives did not develop renal impairment. Subsequently, enalapril was tolerated by 7 of the 8 patients without deterioration in renal function and 6 of these patients later received diuretics. One patient was again treated with enalapril with recurrence of renal impairment, but discontinuation of the diuretics (furosemide, hydrochlorothiazide, and triamterene) led to an improvement in renal function despite the continuation of enalapril. ... 

Acute, fatal, renal failure developed in 2 patients with cardiac failure within 4 weeks of being treated with enalapril and furosemide, and in 2 similar patients renal impairment developed over a longer period. Reversible renal failure developed in a patient with congestive heart failure when captopril and metolazone were given. ... 

Sommers De K, Meyer EC, Moncrieff J. Acute interaction of furosemide and captopril in healthy salt-replete man. SAfr Tydskr Wet (1991) 87, 375-7. 

However, the manufaeturer has found no evidenee of an assoeiation between orlistat and hypertension. In elinieal studies, orlistat use was asso-eiated with a small reduetion in blood pressure eompaied with placebo, which was as a result of weight reduction. Moreover, the incidence of hypertension of new onset and hypertensive crisis did not differ between orlistat and placebo (1.2% versus 1.3%, and 0% versus 0.1%, respectively). In studies in healthy subjects, orlistat had no effect on steady-state losar-tan pharmacokinetics, and no clinically significant effect on the pharmacokinetics of single-dose captopril, atenolol, furosemide or nifedipine. ... 

A retrospective analysis of 14 patients without renal impairment taking potassium supplements and either furosemide or hydrochlorothiazide, found that the levels of serum potassium, during a 4-year period, had not significantly increased after the addition of captopril. Another study in 6 healthy subjects found that intravenous potassium chloride caused virtually the same rise in serum potassium levels in those given enalapril as in those given a placebo. ... 

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