Summary
The pharmacokinetics of piretanide, a new loop diuretic, were studied in seven patients with severe liver disease before and after resolution of ascites. The time to maximum concentration was significantly prolonged by the presence of ascites. Tmax after relief of ascites was similar to that seen for normal volunteers. Area under the curves, bioavailability, volumes of distribution and elimination half-lives did not change after resolution of the ascites: two patients in whom diuretic resistant ascites occurred showed similar pharmacokinetics to that of the diuretic responders. Reduced responsiveness to piretanide therapy in patients with gross ascites does not appear to be the result of decreased bioavailability.
Similar content being viewed by others
References
Allgulander C, Beerman B, Sjögren A (1980) Frusemide pharmacokinetics in patients with liver disease. Clin Pharmacokinet 5: 570–575
Anonymous (1979) Diuretic resistance? Lancet 1: 253–254
Arroya U, Bosch J, Casamitjana R, Rivera F, Rodes J (1980) Use of piretanide, a new loop diuretic in cirrhosis with ascites. Gut 21: 855–859
Benet LZ, Greither A, Meister W (1976) Gastrointestinal absorption of drugs in patients with cardiac failure. In: Benet LZ (ed) The effect of disease states on drug pharmacokinetics. American Pharmacological Association, Washington, pp 33–52
Brater DC, Chennanasis P, Seiwell MS, Beck J (1980) Frusemide in patients with heart failure; shift and dose-response curves. Clin Pharmacol Ther 28: 182–186
Brater DC, Seiwell R, Anderson S, Burdett A, Dehmer GJ, Chennanasis P (1982) Absorption and disposition of furosemide in congestive cardiac failure. Kidney Int 22: 171–176
Brater DC, Anderson S, Baird B, Kaojarern S (1983) Effects of piretanide in normal subjects. Clin Pharmacol Ther 34 (3): 324–330
Flamenbaum W, Friedman R (1982) Pharmacology, therapeutic efficacy and adverse effects of bumetanide, a new “Loop” diuretic. Pharmacotherapy 2: 213–222
Greither A, Goldman JS, Edelan JS, Benet LZ, Cohn K (1979) Pharmacokinetics of furosemide in patients with congestive heart failure. Pharmacology 19: 121–131
Kaojarern S, Day B, Brater DS (1982) The time course of delivery of frusemide into urine: an independent determinant of overall response. Kidney Int 22: 69–74
Kondo T, Nagashima H, Nakashima M (1981) The diuretic effects and safety of piretanide in liver cirrhosis: a double blind intergroup comparison study. Rinsyo Yakuri 12 (1): 73–74
Lawrence JR, Ansari AF, Elliot HL, Sumner DJ, Brunton GF, Whiting B, Whitesmith R (1978) Kinetic and dynamic composition of piretanide and frusemide. Clin Pharmacol Ther 23: 558–565
Odlind BOG, Beerman B (1980) Diuretic resistance; reduced bioavailability and effect of oral frusemide. Br Med J 1: 1577
Scarpioni L, Crippa G, Zanazzi MA (1982) The use of piretanide in the treatment of urinary sodium retention in patients suffering from cirrhosis of the liver. Clin Med 63 (1): 57–76
Smith DE, Lin ET, Benet LZ (1980) Absorption of frusemide in healthy volunteers with a metabolic specific assay. Drug Metab Dispos 8: 337–342
Tilstone W, Fine A (1978) Frusemide pharmacokinetics in renal failure. Clin Pharmacol Ther 23: 644–650
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shepherd, A.N., Bouchier, I.A.D. The influence of ascites on the pharmacokinetics of piretanide in cirrhotic patients. Eur J Clin Pharmacol 28, 581–583 (1985). https://doi.org/10.1007/BF00544070
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00544070