Loop diuretics Cisplatin

PLATINUM COMPOUNDS DIURETICS-LOOP t risk of auditory toxic effects with cisplatin Loop diuretics cause tinnitus and deafness as side-effects. Additive toxic effects on auditory system likely Monitor hearing (auditory function) regularly, particularly if patients report symptoms such as tinnitus or impaired hearing... 

Uses Edema, HTN, CHF, h atic cirrhosis Action Loop diuretic -1- reabsorption of Na Cr in ascending loop of Henle distal tubule Dose 5-20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic -1- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions t Risk of ototox W/ aminoglycosides, cisplatin t effects W/ thiazides t effects OF anticoagulants, antih5rpCTtensives, Li, salicylates X effects IT/barbiturates, carbamaz ine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandehon EMS t Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

Ototoxicity Ototoxicity (vestibular and cochlear) is directly related to high peak plasma levels and duration of treatment. Deafness may be irreversible and has been known to affect fetuses in utero. Patients simultaneously receiving another ototoxic drug such as the loop diuretics furosemide, bumetanide, ethacrynic acid (see p. 227) or cisplatin (see p. 396), are particulary at risk. Vertigo and loss of balance may also occur because these drugs affect the vestibular apparatus. 

Acute renal failure, e.g. cuninoglycosides, cisplatin Nephrotic syndrome, e.g. penicillamine, gold, cap-topril (only at higher doses than now recommended) Chronic renal failure, e.g. NSAIDs Functional impairment, i.e. reduced ability to dilute and concentrate urine (lithium), potassium loss in urine (loop diuretics), acid-base imbalance (acetazolamide). 

AG aminoglycosides, AM antimalarial drugs, CP cisplatin, CB carboplatin, HC hair cell, LD loop diuretics... 

The manufacturers consider that the eoneurrent use of nephrotoxic drugs could potentially decrease the elearanee of pemetrexed and therefore increase its toxicity. - In the UK, the manufacturer specifically mentions aminoglycosides, loop diuretics, platinum compounds (see also (a) cisplatin above) and ciciosporin, and recommends caution with combined use, and, if necessary, close monitoring of creatinine clearance. ... 

Decreased magnesium levels, that is, levels of 1.2 mEq/L (0.64 mmol/L) or less, may be noted in patients with conditions that cause excessive urinary loss of magnesium, including poorly controlled diabetes and alcohol abuse, or in patients using drugs such as loop and thiazide diuretics (e.g., Lasix, Bumex, Edecrin, and hydrochlorothiazide), cisplatin (which is used widely to treat cancer), and the antibiotics gentamicin, amphotericin, and cyclosporine. Hypomagnesemia also can... 

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