Spironolactone 50mg / Furosemide 20mg capsules

AIMS: Several diuretic strategies, including furosemide i.v. boluses (FB) or continuous infusion (FC), are used in acute heart failure (AHF). METHODS AND RESULTS: We systematically searched phase 3 randomized clinical trials (RCTs) evaluating diuretic regimens in admitted AHF patients within 48 h and irrespective of clinical stabilization. We calculated the odds ratio (OR) of FC or FB plus another diuretic (sequential nephron blockade, SNB) compared to FB alone on 24 h weight loss (WL) and worsening renal function (WRF), with a random-effects model with inverse variance weighting. Urine output, hypokalaemia, hyponatremia, and all-cause mortality/rehospitalization were secondary endpoints. In 25 selected RCTs (7149 patients, mean age 68.9 ± 8.7 years, mean left ventricular ejection fraction 38.2 ± 10.7%), FC [OR 1.55 (95% confidence interval 1.39-1.63)], FB plus tolvaptan [OR 1.57 (1.39-1.77)], FB plus SGLT2i [OR 1.23 (1.06-1.42)], and FB plus thiazide [OR 1.63 (1.37-1.94)] were associated with greater WL than FB. FB plus SGLT2i [OR 1.52 (1.19-1.94)] and FB plus acetazolamide [OR 1.81 (1.31-2.49)] were associated with WRF. FB plus thiazide was associated with both WRF [OR 1.78 (1.43-2.21)] and hypokalaemia [OR 1.69 (1.32-2.16)]. Results were consistent in sensitivity analyses considering urine output, RCTs protocol-established furosemide doses, or daily furosemide dose. Congestion/decongestion scores and clinical outcomes were reported in around 50% of RCTs. In an underpowered exploratory analysis, mortality/rehospitalization was non-significantly lower with SGLT2i [OR 0.45 (0.19-1.07)]. CONCLUSION: FC and SNB improve surrogates of response to FB in AHF. SNB is also connoted by WRF and may induce hypokalaemia. The endpoints of diuretic RCTs should be revised and harmonized.

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Thiamin is a water-soluble vitamin essential for energy metabolism. Patients on long-term diuretics, particularly those with heart disease, are at risk of thiamin deficiency (TD) due to increased urinary loss, which may impact cardiac function. We evaluated changes in thiamin pyrophosphate effect (TPPE) values after 4 weeks of thiamin supplementation compared to placebo in pediatric heart disease patients receiving diuretics. The secondary objectives included assessing changes in left ventricular ejection fraction (LVEF) and identifying factors associated with TPPE changes. In this triple-blinded, randomized controlled trial, we recruited 45 children (aged 1 month to 15 years) with heart disease with increased pulmonary blood flow or congestive heart failure, all on diuretics for ≥ 1 month. Participants were randomly allocated to receive thiamin 25 mg/day, thiamin 50 mg/day, or placebo for 4 weeks. TD was defined as TPPE values ≥ 15%. At baseline, 9 of 45 participants (20%) had TD. After 4 weeks, no significant differences in changes in TPPE values (p = 0.540) or LVEF (p = 0.441) were observed among the three groups. Multiple linear regression showed that furosemide dosage was independently associated with TPPE changes (β: +0.36, p = 0.015), indicating a dose-dependent association with thiamin status. Thiamin supplementation at 25 mg/day or 50 mg/day did not significantly improve TPPE values or LVEF. However, furosemide dosage correlated with TPPE changes, indicating a need for tailored thiamin supplementation strategies in pediatric heart disease patients on diuretics. For those with TD, doses exceeding 50 mg/day may be necessary.Trial registration NCT03989700 (ClinicalTrials.gov). Date of registration: 18/06/2019.

Abstract licence: CC BY-NC-ND

Background: Cardiovascular polypharmacy inherently amplifies the risk of drug–drug interactions (DDIs), yet most studies remain limited to isolated drug pairs or predefined high-risk classes, without mapping the systemic architecture through which interactions accumulate. Objectives: To characterize the burden, severity, and network structure of potential DDIs in a real-world cohort of hospitalized cardiovascular patients using interaction profiling combined with graph-theoretic network analysis. Methods: This retrospective observational study included 250 hospitalized cardiovascular patients. All home medications at admission were analyzed using the Drugs.com interaction database, and a drug interaction network was constructed to compute topological metrics (i.e., degree, betweenness, and eigenvector centrality). Results: Polypharmacy was highly prevalent, with a mean of 7.7 drugs per patient, and 98.4% of patients exhibited at least one potential DDI. A total of 4353 interactions were identified, of which 12.1% were classified as major, and 35.2% of patients presented high-risk profiles with ≥3 major interactions. Interaction burden showed a strong correlation with medication count (r = 0.929). Network analysis revealed a limited cluster of hub medications, particularly pantoprazole, furosemide, spironolactone, amiodarone, and perindopril, that disproportionately governed both interaction density and high-severity risk. Conclusions: These findings move beyond conventional pairwise screening by demonstrating how interaction risk propagates through interconnected therapeutic networks. The study supports the integration of hub-focused deprescribing, targeted monitoring strategies, and network-informed clinical decision support to mitigate DDI risk in cardiovascular polypharmacy. Future studies should link potential DDIs to clinical outcomes and validate network-based prediction models in prospective settings.

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BACKGROUND: While male breast cancer incidence is rare, veteran status is found to be associated with increased risk, for incidence, a higher prevalence of male breast cancer patients was observed among male veteran prostate cancer survivors. This study leveraged the existing large-scale Veterans Affairs (VA) Prostate Cancer Data Core and examined factors associated with increased risk of male breast cancer incidence in veterans with prior prostate cancer diagnoses. METHODS: A retrospective cohort study of 1.3 million male veterans treated for prostate cancer at VA hospitals was conducted using the VA Prostate Cancer Data Core. Of these, 11,327 (0.86%) were newly diagnosed with male breast cancer on average 5.4 years post prostate cancer diagnosis. RESULTS: Multivariate Cox and competing risk model results found that younger onset age of prostate cancer (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.97-0.98), metastasized prostate cancer (HR 2.03, 95% CI 1.90-2.17), being Non-Hispanic (N-H) Black (HR 1.10, 95% CI: 1.05-1.15), radiation (HR 1.06, 95% CI: 1.02-1.11) and androgen deprivation therapy (ADT; HR 1.24, 95% CI 1.17-1.32) were associated with significantly increased risk of male breast cancer diagnosis. Prolonged use of cardiovascular disease (CVD) medications, furosemide (HR 1.51, 95% CI 1.39-1.63), spironolactone (HR 1.36; 95% CI 1.15-1.61), and digoxin (HR 1.50, 95% CI: 1.29-1.72), significantly increased risk for male breast cancer incidence. CONCLUSIONS: Younger age onset of prostate cancer, metastasized prostate cancer, prolonged use of CVD medications, radiation, and ADT cancer treatment were factors significantly associated with increased risk of being diagnosed with male breast cancer among male veteran prostate cancer survivors. The study findings may shed insights in cardio-oncology specific risk factors for male breast cancer among prostate cancer survivors.

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Although congestion is present in the large majority of patients hospitalized with acute heart failure (AHF), the pharmacological options to treat it remain poorly studied, with heterogeneity in real-world practices and outcomes. The best available evidence supports that patients with AHF and congestion should be initially treated with i.v. loop diuretics with their dose tailored to early (within 2-6 h) diuretic response, as assessed by spot urine sodium and/or hourly urine output. If diuretic response is sub-optimal, the next best steps seem to be increases in i.v. loop diuretics and addition of a thiazide and/or i.v. acetazolamide. Irrespective of the above, sodium-glucose co-transporter-2 inhibitors and spironolactone should be started in all patients with AHF as early as possible. Changes in serum creatinine in this scenario do not typically represent true worsening in renal function and should, thus, not lead to de-escalation of decongestion therapy.

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PURPOSE: Anticoagulation therapy is required to prevent thromboembolic complications in patients with heart valve surgery (HVS). However, caution must be taken due to the risk of bleeding. This study aimed to identify bleeding risk factors in patients with stable warfarin therapy and develop a predictive tool for high-risk patients. METHODS: This study is a nested case-control design using the Korean National Health Insurance Service-National Sample Cohort Data. We identified patients who underwent HVS and were prescribed warfarin within 1 week after the procedure. Of these, patients with the last two identical warfarin prescriptions within 6 months before the bleeding events were defined as the case group, while patients with no bleeding events within 6 months after HVS and two consecutive identical warfarin prescriptions were defined as the control group. Three machine learning models-logistic regression, support vector machine, and random forest-were trained and scored by fivefold validation to validate our feature selection processes. We developed a risk scoring system using adjusted odds ratios from multivariate logistic regression. RESULTS: Of 1 137 861 subjects, 1093 patients were eligible for the study cohort; 173 and 298 were selected as the case and control groups, respectively. After a series of machine learning processes, eight features were identified as significant risk factors for bleeding events. CONCLUSION: Our finding suggests that furosemide, spironolactone, lacrimal system disorders, ursodeoxycholic acid, captopril, chronic kidney disease, zolpidem, and valsartan are the most important features for predicting bleeding events in patients taking a stable warfarin dose after HVS.

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ABSTRACT: "Diuretics," like spirolactone and furosemide, help the kidneys eliminate excess water. It also reduces fluid-induced hypertension and maintains blood potassium levels. Both Furosemide (FRU) and Spironolactone (SPL) can be measured at the same time with the help of HPTLC chromatographic method that have been shown to be very selective and accurate. There are a number of causes of edema, and FRU can help with all of them, including hepatic cirrhosis, chronic congestive heart failure, and excessive blood pressure. Heart failure and ascites caused by hepatic diseases are commonly treated with spironolactone due to its properties as an aldosterone antagonist and potassium-sparing diuretic. HPTLC methods were developed in this research to determine FRU and SPL simultaneously without using the solvents generally needed in chromatographic procedures. The proposed HPTLC approach stood out as an analytical method for quality control laboratories due to its speed, low cost, and ability to concurrently determine the target chemicals with a small number of solvents. The selectivity, accuracy, and reproducibility of the procedures for the simultaneous determination of the pure and mixed drug forms studied were further confirmed by statistical analysis.

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Background/Objectives: Diuretics are recommended for hemodynamically stable patients with COVID-19-associated acute respiratory distress syndrome (ARDS) who have a positive fluid balance. However, furosemide use may be limited by hypokalemia in this population. We aimed to evaluate the clinical and biochemical effects of spironolactone in critically ill patients with COVID-19-associated ARDS. Methods: In this retrospective cohort study, 60 patients with COVID-19-associated ARDS admitted to the intensive care unit (ICU) between March and May 2020 were grouped according to diuretic therapy (furosemide vs. spironolactone). Patients were followed for five days (T0–T4). Demographic characteristics and clinical/laboratory parameters were recorded. A two-sided p value < 0.05 was considered statistically significant. Results: Thirty-one patients received furosemide (F group) and 29 received spironolactone (S group). On day 5, in the F group, cumulative fluid balance and serum sodium increased significantly over time (p < 0.05). Lactate increased significantly over time in both groups (p < 0.05). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels increased significantly from T0 to T4 in the F group (p < 0.05). Conclusions: Spironolactone use was associated with a more favorable trajectory of organ dysfunction and improved volume, electrolyte, and cardiac stress marker dynamics compared with furosemide in patients with COVID-19-associated ARDS. Although confirmation in larger prospective studies is needed, spironolactone may be considered a reasonable diuretic alternative in selected patients, particularly when potassium preservation and avoidance of hypernatremia are clinical priorities.

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