Furotone Tablet

Introduction

Furosemide and Spironolactone are diuretics often combined to treat conditions related to fluid overload, such as hypertension and edema. Furosemide is a loop diuretic, while Spironolactone is a potassium-sparing diuretic. Together, they help manage fluid balance and blood pressure.

Uses

The combination of Furosemide and Spironolactone is used for:

Treating edema associated with congestive heart failure, liver cirrhosis, or kidney disorders
Managing hypertension, particularly in patients who require multiple diuretic effects
Reducing the risk of hypokalemia (low potassium levels) induced by loop diuretics

Brand Name	Furotone
Type	Tablet
Weight	20 mg+50 mg
Generic	Furosemide + Spironolactone
Manufacturer	Novo Healthcare and Pharma Ltd.
Available in	English বাংলা

Mechanism of Action

Furosemide acts as a loop diuretic by inhibiting the sodium-potassium-chloride cotransporter in the ascending loop of Henle in the kidney, which increases sodium, potassium, and chloride excretion. Spironolactone is a potassium-sparing diuretic that works by antagonizing aldosterone in the distal convoluted tubule and collecting ducts, promoting sodium and water excretion while retaining potassium.

How Long Does It Take to Work?

Furosemide typically begins to act within 1 hour of oral administration, with peak effects occurring in 1 to 2 hours. Spironolactone takes longer, usually 2 to 4 days to achieve its full effect. When used together, the diuretic effects are often noticed within a few hours, but the combined benefits may take a few days to become fully apparent.

Absorption

Furosemide is well absorbed from the gastrointestinal tract with a bioavailability of about 50% to 70%. Spironolactone is also well absorbed, with a bioavailability of about 90%. Food can affect the absorption rate, but not significantly.

Route of Elimination

Furosemide is primarily eliminated via the kidneys, with approximately 60% to 90% of the drug excreted unchanged in the urine. Spironolactone is metabolized in the liver to active metabolites and then excreted mainly via the kidneys. A small amount is also excreted in the feces.

Dosage

Furosemide 20 and spironolactone 50 mg: 1 to 4 tablets daily (20 to 80 mg of Furosemide and 50 to 200 mg of spironolactone) according to the patient’s response.

Furosemide 40 and spironolactone 50 mg: For previously stabilized patients requiring a higher dosage of spironolactone and Furosemide, This tablet can be used at a dose of one to two tablets daily (Furosemide 40 to 80 mg and spironolactone 50 to 100 mg).

Use in children: Spironolactone and Furosemide is not suitable for use in children. Spironolactone and Furosemide may both be excreted more slowly in the elderly.

The dosage for the combination of Furosemide and Spironolactone can vary based on the condition being treated:

Edema: Furosemide 20-80 mg once daily and Spironolactone 25-100 mg once daily
Hypertension: Furosemide 20-40 mg once daily and Spironolactone 25-50 mg once daily

Dosages should be adjusted according to patient response and tolerance.

Administration

Both Furosemide and Spironolactone are usually administered orally in tablet form. They should be taken with or after meals to minimize gastrointestinal irritation. Consistent dosing times each day are recommended to maintain effective diuretic action.

Side Effects

Common side effects include:

Electrolyte imbalances such as hypokalemia or hyperkalemia
Dehydration and hypotension
Gastrointestinal disturbances such as nausea and diarrhea
Headache and dizziness

Serious side effects may include severe electrolyte disturbances, renal dysfunction, or anaphylactic reactions.

Toxicity

Toxicity can occur with excessive doses or in patients with compromised renal function. Symptoms of toxicity may include severe electrolyte imbalances, profound dehydration, or kidney damage. Immediate medical attention is required in such cases.

Precautions

Precautions should be observed in patients with:

Pre-existing renal or hepatic impairment
Diabetes mellitus, as both drugs can affect blood glucose levels
Gout, due to potential exacerbation of hyperuricemia

Regular monitoring of electrolytes and renal function is advised during treatment.

Interaction

Interactions may include:

Potassium supplements: Use with caution as Spironolactone can increase potassium levels
Nonsteroidal anti-inflammatory drugs (NSAIDs): Can reduce the efficacy of Furosemide

Patients should inform their healthcare provider of all medications they are taking to avoid adverse interactions.

Disease Interaction

Interactions with diseases may include:

Heart failure: May require careful monitoring to avoid excessive diuresis
Renal impairment: Dose adjustments may be necessary to avoid further renal damage

Patients with these conditions should be monitored closely.

Drug Interaction

Drug interactions include:

ACE inhibitors: Combined use may lead to increased risk of hyperkalemia
Lithium: Furosemide can increase lithium levels and risk of toxicity

Regular monitoring is essential when using these drugs concurrently.

Food Interactions

No significant food interactions have been reported with Furosemide and Spironolactone. However, maintaining a balanced diet and monitoring potassium intake is important during treatment.

Pregnancy Use

Furosemide and Spironolactone are classified as category C drugs for pregnancy. They should only be used if the benefits outweigh the risks. Both medications can affect fetal electrolyte balance and renal function.

Lactation Use

Both Furosemide and Spironolactone are excreted in breast milk. Use during lactation should be avoided or used with caution, depending on the clinical need. The potential effects on the infant should be considered.

Acute Overdose

Acute overdose can result in severe electrolyte imbalances, dehydration, hypotension, and renal failure. Treatment involves symptomatic management, electrolyte replacement, and supportive care. Immediate medical attention is crucial.

Contraindication

Contraindications include:

Severe renal impairment or anuria
Hyperkalemia (high potassium levels)
Severe hepatic impairment

These conditions may be exacerbated by the combined use of these diuretics.

Use Direction

Take Furosemide and Spironolactone exactly as prescribed. Follow dosing instructions and frequency as directed by the healthcare provider. Regular monitoring of electrolytes and renal function is necessary.

Storage Conditions

Store Furosemide and Spironolactone at room temperature, away from light and moisture. Keep the medications tightly closed and out of reach of children.

Volume of Distribution

The volume of distribution for Furosemide is approximately 0.1 to 0.2 L/kg, while for Spironolactone, it is about 0.4 to 0.7 L/kg. This indicates the extent to which the drugs are distributed throughout body tissues.

Half Life

The half-life of Furosemide is approximately 1 to 2 hours, while Spironolactone has a half-life of 1.4 to 2 hours. The active metabolites of Spironolactone have a longer half-life, contributing to the prolonged effect.

Clearance

Furosemide is cleared primarily by the kidneys with a clearance rate of 100 to 150 mL/min. Spironolactone is also cleared through renal excretion, with its active metabolites having a slower clearance rate, contributing to its extended duration of action.

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