Probenecid Furosemide

Simultaneous acetazolamide, amiloride, bendroflumethiazide, bumetanide, chlorthalidone, cyclothiazide, ethacrynic acid, furosemide, probenecid, spironolactone, triamterene... 

Herraez-Hernandez, R. Campins-Falcd, R Sevillano-Cabeza, A. Improved screening procedure for diuretics. J.Liq.Chromatogr., 1992, 15, 2205-2224 [LOD 10-1000 ng mL gradient urine hydroxsme-thyltheophylline (IS) extracted acetazolamide, amiloride, bendroflumethiazide, bumetanide, chlorthalidone, cyclothiazide, ethacrynic acid, furosemide, probenecid, spironolactone, triamterene]... 

Chen C, Scott D, Hanson E, Franco J, Berryman E, Volberg M, Liu X. Impact of Mrp2 on the biliary excretion and intestinal absorption of furosemide, probenecid, and methotrexate using eisai hyperbilirubinemic rats. Pharm Res 2003b 20 31-37. 

Drugs that may affect penicillins include allopurinol, aminoglycosides (parenteral), aspirin, beta blockers, chloramphenicol, erythromycin, ethacrynic acid, furosemide, indomethacin, phenylbutazone, probenecid, sulfonamides, tetracycline, and thiazide diuretics. Drugs that may be affected by penicillins include aminoglycosides (parenteral), anticoagulants, beta blockers, chloramphenicol, cyclosporine, oral contraceptives, erythromycin, heparin, and vecuronium. 

Uses Infxns of resp tract, skin/soft tissue, scarlet fevCT, S5 philis Action Bactericidal -1- cell wall synth Dose Adults. 0.6-4.8 million Units/d in doses ql2-24h give probenecid at least 30 min prior to PCN to prolong action Feds. 25,000-50,000 Units/kg/d IM daily-bid Caution [B, M] Contra AU gy Disp Inj SE Pain at inj site, int stitial n hritis, anaphylaxis Interactions t Effects W/probenecid t penicillin 1/2-life Wf ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics T risk of bleeding W/ anticoagulants -1- effects Wf chloramphenicol, macrolides, tetracyclines -1- effects OF OCPs EMS See Penicillin G, Aqueous OD See Penicillin G, Aqueous... 

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... 

The loop diuretics are rapidly absorbed. They are eliminated by the kidney by glomerular filtration and tubular secretion. Absorption of oral torsemide is more rapid (1 hour) than that of furosemide (2-3 hours) and is nearly as complete as with intravenous administration. The duration of effect for furosemide is usually 2-3 hours and that of torsemide is 4-6 hours. Half-life depends on renal function. Since loop agents act on the luminal side of the tubule, their diuretic activity correlates with their secretion by the proximal tubule. Reduction in the secretion of loop diuretics may result from simultaneous administration of agents such as NSAIDs or probenecid, which compete for weak acid secretion in the proximal tubule. Metabolites of ethacrynic acid and furosemide have been identified, but it is not known if they have any diuretic activity. Torsemide has at least one active metabolite with a half-life considerably longer than that of the parent compound. 

Probenecid has been reported to inhibit renal elimination of many drugs acyclovir (325,326), allopurinol (327), bumetanide (328), cephalosporins (329-334), cidofovir (335), ciprofloxacin (336), famotidine (337), fexofenadine (338), furosemide (339), and oseltamivir (Ro 64-0802) (340). Recent studies have elucidated that probenecid is a potent inhibitor of renal organic anion transporters (OAT1 and OAT3) with the Ki values lower than the unbound plasma concentration of probenecid, indicating the interaction with probenecid includes inhibition of the basolateral uptake process mediated by OAT1 and/or OAT3. 

Honari J, Blair AD, Cutler RE. Effects of probenecid on furosemide kinetics and natriuresis in man. Clin Pharmacol Ther 1977 22 395-401. 

Cephalosporins Cimetidine Furosemide NSAIDs Probenecid Ranitidine Tetracycline Various anticancer ... 

P-Lactam antibiotics Cephalosporins Cidofovir Furosemide Ganciclovir Methotrexate NSAIDs Probenecid Tetracycline Zidovudine KW-3902 ... 

Displacement of bilirubin from its albmnin bond. Various endogenous substances (e. g. long-chain fatty acids and bile acids) or exogenous compounds (e. g. medication, such as ampicillin, ajma-line, quinidine, furosemide, indomethadn, probenecid, rifampicin, sulphonamide etc., and X-ray contrast media) can compete with bilirubin, not only with respect to its specific binding site, but also for its carrier protein. 

Flomeida M, Roberts C, Branch RA. Influence of probenecid and spironolactone on furosemide kinetics in man. Clin Pharmacol Ther 1977 22 402-409. 

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