Canis ISSN: 2398-2942

Therapeutics: diuretics

Synonym(s): potassium sparing; loop diuretic; aldosterone antagonist

Contributor(s): Fraser Broadfoot, Jonathon Elliot, Linda Horspool, Lauren Trepanier, Gary Coxon

Furosemide

  • Formerly known as frusemide Furosemide.
  • Potent loop diuretic.
  • Blocks active chloride, sodium, and potassium co-transport in thick ascending limb of the loop of Henle.
  • Leads to loss of sodium, chloride, potassium, calcium and magnesium and water in urine.
  • Used as part of standard therapy (with ACE inhibitors) of congestive heart failure Heart: congestive heart failure.
  • Activates the renin-angiotensin-aldosterone system (RAAS) and should therefore always be used in combination with inhibitors of RAAS such as ACE inhibitors ACE inhibitor: overview. Pimobendan Pimobendan has no effects on RAAS.
  • After IV administration, increases venous capacitance and decreases pre-load via a prostaglandin-dependent mechanism.
    • Therefore, when possible, IV administration is preferred for fulminate congestive heart failure.
  • Pre-renal azotemia Pre-renal azotemia and metabolic alkalosis Acid base imbalance , due to hypochloremia Hypochloremia and hypokalemia Hypokalemia , is common after moderate to high dosage.
  • Hypokalemia Hypokalemia and hypomagnesemia Hypomagnesemia is seen with chronic or high dosages in dogs.
  • Both hypokalemia and hypomagnesemia may predispose to ventricular arrhythmias Ventricular fibrillation.
  • Induces calciuresis; can be used to treat hypercalcemia Hypercalcemia: overview of any etiology in a hydrated dog.
  • May potentiate ototoxicity and nephrotoxicity of aminoglycosides.
  • High dosages can be used to increase urine output in hydrated patients with oliguric renal failure Kidney: chronic kidney disease (CKD).

Torasemide

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Spironolactone

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Thiazide diuretics

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Mannitol

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Carbonic anhydrase inhibitors

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Hofmeister E H et al (2009) Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulmonary cerebral resuscitation at a university teaching hospital. JAVMA 235(1), 50-57 PubMed.
  • Sayer M B et al (2009) Acute effect of pimobendan and furosemide on the circulating renin-angiotensin-aldosterone system in healthy dogs. J Vet Intern Med 23(5), 1003-1006 PubMed.
  • Jeunesse E et al (2007) Effect of spironolactone on diuresis and urine sodium and potassium excretion in healthy dogs. J Vet Cardiol 9(2), 63-68 PubMed.
  • Thomason J D et al (2007) Influence of combined angiotensin-converting enzyme inhibitors and spironolactone on serum K+, Mg2+, and Na+ concentrations in small dogs with degenerative mitral valve disease. J Vet Cardiol 9(2), 103-108 PubMed.
  • Falk T et al (2006) Arteriosclerotic changes in the myocardium, lung and kidney in dogs with chronic congestive heart failure and myxomatous mitral valve disease. Cardiovasc Pathol 15, 185-193 PubMed.
  • Palmieri E A, Biondi B, Fazio S (2002) Aldosterone receptor blockade in the management of heart failure. Heart Fail Rev 7(2) 205-219 PubMed.
  • Gelatt K N, MacKay E O (2001) Changes in intraocular pressure associated with topical dorzolamide and oral methazolamide in glaucomatous dogs. Vet Ophthalmol 4(1) 61-67 PubMed.

Other sources of information

  • European Medicines Evaluation Agency. Prilactone Summary of Product Characteristics http://www.ema.europa.eu/.
  • Kochevar D (2009) Diuretics. In: Riviere J E, Papich M G. Veterinary Pharmacology and Therapeutics.9th edition. Chichester, Wiley-Blackwell pp. 647-670.
  • Miller M W, Adams R H (2009) Digitalis, Positive Inotropes, and Vasodilators. In: Riviere J E, Papich M G. Veterinary Pharmacology and Therapeutics. 9th edition. Chichester, Wiley-Blackwell pp. 541-574.
  • Falk T et al (2007) Correlation of cardiac pathology and clinical findings in dogs with naturally occurring congestive heart failure. ACVIM abstracts 233, 636.
  • Bonagura J D, Lehmkuhl L B, de Morais H A (2002) Fluid and diuretic therapy in heart failure. In: DiBartola S P Fluid Therapy in Small Animal Practice. 2nd edition, Philadelphia: WB Saunders, pp 387-409.
  • Jackson E K (1996)Diuretics.In: Hardman J G, Limbard L E, Goodman & Gilman The Pharmacologic Basis of Therapeutics.9th edition, New York: McGraw Hill, pp 685-713.


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