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CARDIOVASCULAR SYSTEM › DIURETICS › HIGH-CEILING DIURETICS › Sulfonamides, plain
piretanide
C03CA03
Forms & Strengths
- Oral tablets: 6 mg
- Oral tablets: 3 mg
Adult Dosing
- Hypertension: 3 mg to 6 mg once daily in the morning
- Edema (cardiac, hepatic, or renal origin): 6 mg once daily, adjusted up to 12 mg daily if necessary
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Hypertension
- Edema associated with congestive heart failure, liver cirrhosis, and renal disease
Mechanism of Action
- Loop diuretic that inhibits the Na+/K+/2Cl- cotransporter in the thick ascending limb of the loop of Henle
- Increases excretion of sodium, chloride, potassium, and water, thereby reducing blood volume and peripheral resistance
Contraindications
- Hypersensitivity to piretanide or sulfonamide-derived drugs
- Anuria or severe renal failure
- Severe hypokalemia, hyponatremia, or hypovolemia
- Hepatic coma or pre-comatose states
- Breastfeeding
Adverse Reactions
- Electrolyte disturbances (hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia)
- Dehydration and hypovolemia leading to hypotension and dizziness
- Hyperuricemia and gout
- Hyperglycemia
- Ototoxicity (tinnitus, hearing loss, particularly with rapid IV administration or high doses)
- Paresthesias, gastrointestinal distress, and muscle cramps
Drug Interactions
- Lithium: Decreases renal clearance of lithium, increasing risk of lithium toxicity
- NSAIDs: May attenuate the diuretic, natriuretic, and antihypertensive effects
- ACE inhibitors or ARBs: Can cause severe first-dose hypotension and worsening renal function
- Other diuretics or antihypertensives: Synergistic hypotensive and electrolyte-depleting effects
- Corticosteroids or amphotericin B: Increases risk of severe hypokalemia
- Nondepolarizing neuromuscular blockers: Effects may be potentiated by hypokalemia
Curated Content: Needs Vetting Before Put to Clinical Use