Combined Therapy with Thiazide-Type and Loop Diuretic Agents for Resistant Sodium Retention

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Editorials1 September 1983Combined Therapy with Thiazide-Type and Loop Diuretic Agents for Resistant Sodium RetentionJAMES R. OSTER, M.D., MURRAY EPSTEIN, M.D., SCOTT SMOLLER, M.D.JAMES R. OSTER, M.D., MURRAY EPSTEIN, M.D., SCOTT SMOLLER, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-99-3-405 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTrue resistance to a loop-type diuretic agent such as furosemide is relatively uncommon, and treatment failures can often be attributed to noncompliance either with medication or diet (1). When patients have refractory edema due to nephrotic syndrome or hepatic cirrhosis, vigorous attempts to mobilize the excess fluid with diuretic agents are often inappropriate. Conversely, in patients with end-stage congestive heart failure or uncontrolled severe hypertension, sodium retention may be life threatening and warrant aggressive therapy. In the case of hypertension, the administration of a vasodilator or inhibitor of the sympathetic nervous system not only may contribute to the sodium retention...References1. EPSTEIN M, LEPP B, HOFFMAN D, and LEVINSON R. Potentiation of furosemide by metolazone in refractory edema. Curr Ther Res. 1977;21:656-67. Google Scholar2. WOLLAM G, TARAZI R, BRAVO E, and DUSTAN H. Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia. Am J Med. 1982;72:929-36. CrossrefMedlineGoogle Scholar3. BAMFORD J. Synergistic action of metolazone with "loop" diuretics [Letter]. Br Med J. 1981;283:618. CrossrefMedlineGoogle Scholar4. BROWN E and MACGREGOR G. Synergistic action of metolazone and frusemide [Letter]. Br Med J. 1981;283:1611. CrossrefMedlineGoogle Scholar5. GHOSE R and GUPTA S. Synergistic action of metolazone with "loop" diuretics. Br Med J. 1981;282:1432-3. CrossrefMedlineGoogle Scholar6. BLACK W, SHINER P, and ROMAN J. 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OSTER, M.D.; MURRAY EPSTEIN, M.D.; SCOTT SMOLLER, M.D.Affiliations: Veterans Administration Medical Service University of Miami School of Medicine Miami, Florida PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPharmacologic InteractionsCompensatory Distal Reabsorption Drives Diuretic Resistance in Human Heart FailureKorean Guidelines for Diagnosis and Management of Chronic Heart FailureA ceiling dose with furosemide in systolic heart failure: A myth or a pertinent clinical consideration?Edema in Renal Diseases – Current View on PathogenesisPathogenesis and treatment of the cardiorenal syndrome: Implications of L-arginine-nitric oxide pathway impairmentOutpatient management of chronic heart failureDigoxin, Diuretics, and Vasodilators in Patients with Heart FailureAcute Heart Failure and Pulmonary EdemaLe syndrome cardiorénal : diagnostic, physiopathologie et prise en chargeInsuficiencia cardíacaManagement of oral chronic pharmacotherapy in patients hospitalized for acute decompensated heart failureAldosterone and Volume Management in Hypertensive Heart DiseaseNovel Diuretic Strategies for the Treatment of Heart Failure in Japan2013 ACCF/AHA Guideline for the Management of Heart Failure2013 ACCF/AHA Guideline for the Management of Heart FailureApproaches to Decongestion in Patients with Acute Decompensated Heart FailureManagement of the patient with resistant edemaFluid and Diuretic Therapy in Heart FailureNonsurgical Therapy for Heart FailureChronic kidney disease and congestive heart failure management: cardionephrologist's roleDiuretics, digitalis, and electrolytesTherapeutic Options for the Management of the Cardiorenal SyndromeCombination of Loop Diuretics With Thiazide-Type Diuretics in Heart FailurePharmacologic Interactions in the CICUManagement of loop diuretic resistance in the intensive care unitTorasemide significantly reduces thiazide-induced potassium and magnesium loss despite supra-additive natriuresis2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in AdultsRational use of diuretics in acute decompensated heart failureDiuretic Use in Edema and the Problem of ResistanceDiuretics: Still the mainstay of treatmentDiureticsFluid and Diuretic Therapy in Heart FailureACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the AdultACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the AdultThe rational use of diuretics in heart failureMetolazone and Its Role in Edema ManagementLoop diuretics: from the Na-K-2Cl transporter to clinical useBalancing Diuretic Therapy in Heart Failure: Loop Diuretics, Thiazides, and Aldosterone AntagonistsPOLYPHARMACY OF HEART FAILUREMedical management of mild-to-moderate heart failure before the advent of beta blockersTherapy of heart failureTreatment of Edematous Disorders with DiureticsPharmacology of DiureticsTreatment of Edematous Disorders with DiureticsPharmacology of DiureticsPharmacologic Management of Chronic Heart Failure: A ReviewDiuretic TherapyEdematous StatesSequential Nephron Blockade Breaks Resistance to Diuretics in Edematous StatesIntensive Diuretic TherapyThe Use of Diuretics in the Treatment of Ascites and Edema in Hepatic CirrhosisChapter 30 The physiologic basis of diuretic drug action and synergismGuidelines for the Evaluation and Management of Heart FailureHigh-dose frusemide for cardiac failureProlonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditionsDosing of Antihypertensive Medications in Patients with Renal InsufficiencyThiazide DiureticsCoadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failureDiuretic Drugs and the Treatment of Edema: From Clinic to Bench and Back AgainApproaches to Diuretic Therapy and Electrolyte Imbalance in Congestive Heart FailureClinical trials of diuretic therapy in heart failure: Research directions and clinical considerationsLow-dose segmental blockade of the nephron rather than high-dose diuretic monotherapyNephrotic syndrome in adultsThe Physiologic Basis of Diuretic Synergism: Its Role in Treating Diuretic ResistanceDavid H. 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WARE, M.D.Furosemide and Vitamin EClinical pharmacologic implications in diuretic selectionHyperosmolar non-ketotic diabetes mellitus associated with metolazone.Diuretic-induced hypokalemiaDiurétiques et vasodilatateurs 1 September 1983Volume 99, Issue 3Page: 405-406KeywordsCirrhosisDietDiureticsEdemaHeart failureHypertensionSodiumSympathetic nervous systemVasodilators ePublished: 1 December 2008 Issue Published: 1 September 1983 PDF downloadLoading ...