Uremide

Uremide - Interactions | Dose | Side Effects

Uremide is a drug that contains active substance known as furosemide. Uremide is a medicine that belongs to a family of medicines known as the Henle's loop diuretics. Chemically, Uremide is an anthranilic acid derivative. Mechanism of action of Uremide is based on inhibition of water, sodium and chlorine reabsorption in the Henle's loop, but also in the distal and proximal tubules of the kidneys. Such an effect leads to increased excretion of water from the body, and Uremide is therefore used in the treatment of high blood pressure and edema (swelling). Uremide is most commonly used in edema that is caused by congestive heart failure, liver cirrhosis, or nephrotic syndrome. In the treatment of hypertension, Uremide is most commonly used in patients in whom the use of weaker diuretics (known as thiazides) has not yielded adequate therapeutic results.

Uremide is thought to be one of the least toxic and most potent diuretics.

Pharmacokinetics

Most of the drug is metabolized to furosemide glucuronide and as such is excreted via bile. A large portion of the drug binds to plasma proteins (97.6%), while the elimination half-life of this drug in healthy individuals is 0.33-1.17 hours. The elimination half-life is significantly prolonged in people who are suffering from liver cirrhosis (more than 10 hours), and Uremide must be cautiously administered in patients who have severe liver damage. The elimination half-life can also be prolonged in patients with kidney damage (5-9 hours) and this drug should be used with extra precaution in patients with severe renal impairment.

The small portion of the drug (only 10%) is removed by hemodialysis.

Increased urine output occurs within one hour of administration and the maximum effect is achieved after 1-2 hours.

Precautions

When used in the treatment of edema associated with liver cirrhosis, Uremide should be administered only in hospitals and patients should be carefully monitored. The use of Uremide in patients with liver cirrhosis can lead to severe electrolyte imbalance and hepatic coma - permanent damage to the liver leading to neurological disorders and to coma.

Uremide should be discontinued in patients who are experiencing a decreased urine output (less than 400 ml per day) or an increase in creatinine and nitrogen levels in the urine.

Uremide belongs to a group of ototoxic drugs - medicines that can cause loss of hearing. If you are experiencing ringing in your ears or other signs of hearing impairment, contact your doctor immediately. People with impaired renal function and people taking other ototoxic drugs (aminoglycoside antibiotics, such as streptomycin, amikacin, kanamycin, gentamicin, and tobramycin) have a higher risk of hearing loss.

Since Uremide exhibits a diuretic effect, it can lead to dehydration and consequently to electrolyte imbalance (hypokalemia, hypomagnesaemia, hypocalcaemia, hyponatraemia and hypochloremia). The risk of electrolyte imbalance is higher in patients who do not get adequate amounts of minerals through diet. Uremide increases the potassium excretion and may lead to hypokalaemia - low blood potassium, which can cause irregular heartbeat (arrhythmia). The use of cardiotonic glycosides (such as digitalis preparations) can further aggravate the cardiac function. For this reason, caution should be exercised if Uremide is used concurrently with digitalis preparations (such as digoxin).

If you are experiencing symptoms of electrolyte imbalance, such as: nausea, vomiting, irregular heartbeat, rapid heartbeat, muscle cramps, weakness, lethargy, nausea, increased thirst or dry mouth, contact your doctor immediately.

Uremide may cause urinary retention, and should not be used in patients with enlarged prostate.

Patients suffering from nephrotic syndrome (Uremide is used to treat edema caused by nephrotic syndrome) often have a low concentration of protein in the blood. Such patients have an increased risk of hearing loss.

Patients who are allergic to sulfonamides, such as: sulfamethoxazole (one of the active ingredients of medicine called Bactrim - used in the treatment of urinary infections), sulfisoxazole, sulfadiazine, sulfamoxole, and others, should not use Uremide because there are few reported cases of cross-allergic reactions between these drugs.

Patients with diabetes should use Uremide cautiously because this drug may increase blood sugar levels.

Dosage

Treatment of Edema

The usual dose in edema treatment is 20-80 mg once a day, in the morning. Uremide should not be used at night, before bedtime, as you will probably have the frequent urge to use the restroom at night, which can be disruptive to your sleep. Daily dose can also be divided into two doses (first dose should be taken in the morning (about 8-9AM) and the second dose should be taken about 2-3PM).

Your doctor will determine right dose for you.

The maximum daily dose in the treatment of edema is 600 mg.

Treatment of Hypertension

The usual dose in the treatment of hypertension is 40 mg twice a day. The dose should be adjusted based on the antihypertensive effects. Your doctor will determine right dose for you.

Uremide, Pregnancy and Breastfeeding

According to the FDA, Uremide belongs to group C because animal studies have shown that it exhibits fetotoxic effects. For this reason, Uremide should be used during pregnancy only if the benefit to the mother outweighs the risk to the child.

Uremide passes into breast milk and should not be used during breastfeeding.

Interactions

Uremide should not be used concurrently with the following medicines:

  • Antipsychotics, such as: lithium, pimozide, haloperidol, ziprasidone, and droperidol.
  • Antibiotics from the group of aminoglycosides, such as: amikacin, tobramycin, streptomycin, kanamycin, gentamicin, and others.
  • Medicines used to treat gastroesophageal reflux, such as cisapride.
  • Medicines used to treat arrhythmias, such as: dronedarone and amiodarone.
  • Corticosteroids, such as: dexamethasone, methylprednisolone, prednisolone, and others.
  • Cyclosporine - an immunosuppressive drug.
  • Non-steroidal anti-inflammatory drugs, such as: indomethacin and Aspirin.
  • Cisplatin and methotrexate - medicines used in the treatment of cancer.
  • Probenecid - medicine used to treat gout.

Tell your doctor about all the medicines you are taking.

Side Effects

Uremide may cause the following side effects:

  • Decrease in sodium concentration in the blood.
  • Decrease in potassium concentration in the blood.
  • Decrease in magnesium concentration in the blood.
  • Decrease in chlorine concentration in the blood.
  • Decrease in calcium concentration in the blood.
  • Increase in glucose concentration in the blood.
  • Increase in urea concentration in the blood.
  • Increase in creatinine concentration in the urine.
  • Increase in glucose concentration in the urine.
  • Low blood pressure.
  • Urinary retention.
  • Nausea.
  • Diarrhea.
  • Acute pancreatitis.
  • Ringing in the ears.
  • Loss of hearing which can be transient or permanent.
  • Low white blood cell count.
  • Low platelet count.
  • Allergic reactions.

Tell your doctor if you are experiencing any side effects.

References

  1. FDA
  2. springer
  3. NCBI

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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.