EGY RÉGI DIURETIKUM UJ ARCA: A SPIRONOLACTONRADÓ JÁNOS

Spironolactone: An Old Friend Rediscovered

Domenic A. Sica MD

The Journal of Clinical HypertensionVolume 8, Issue 7, pages 467–469, July 2006

ALDOSTERONE ANTAGONISTS — LAST MAN STANDING?PAUL W. ARMSTRONG, M.D.

NOVEMBER14, 2010, AT NEJM.

FOUR CARDIAC MEDICINES DEVELOPEDBEFORE 1960 THAT SURVIVED THE TURNOF THE MILLENNIUM ARE ASPIRIN, DIGOXIN, WARFARIN, AND

SPIRONOLACTONE.

A MAGAS SZÉRUM KÁLIUM EREDETE ÉS KÖVETKEZMÉNYEI 14DNN 2008

Table .  Comparison of the Package Labels for Spironolactone and Eplerenone

EPLERENONE SPIRONOLACTONE

Contraindicated with a serum potassium of >5.5 mEq/L

Spironolactone is contraindicated in patients with hyperkalemia with no statement as to what qualifies as hyperkalemia.

CONTRAINDICATED IN TYPE 2 DIABETES WITH MICROALBUMINURIA

No comment

Contraindicated with a serum creatinine of >2.0 mg/dL in men or 1.8 mg/dL in women

Spironolactone is contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function with no qualification as to the specific level of renal function where it would be contraindicated.

Contraindicated with a creatinine clearance of <50 mL/min

Spironolactone is contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function with no qualification as to the specific level of renal function where it would be contraindicated.

Contraindicated in patients treated concomitantly with potassium supplements or other potassium-sparing diuretics

The following is provided as a “Warning” but not a contraindication: potassium supplementation, either in the form of medication or a diet rich in potassium, should not ordinarily be given in association with spironolactone. Spironolactone should not be administered concurrently with other potassium-sparing diuretics.

Contraindicated with strong inhibitors of CYP450 3A4 such as ketoconazole or itraconazole

Not dependent on the CYP450 system for metabolism

Megegyeznek a szerzők, hogy van egy „mentsvár” a hyperkalaemiás komplikációk lehetséges elkerülésére (már akkor, ha a szabályokat egyébként betartják, és például lehetőleg elkerülik, hogy 45 ml/min GFR alatt adjanak AA-t a betegnek), és

ez a diuretikum bevétele a kombinációba.

Conclusions

BLOCKADE OF ALDOSTERONE RECEPTORS BY SPIRONOLACTONE, IN ADDITION TO STANDARD THERAPY SUBSTANTIALLY REDUCES THE RISK OF BOTH MORBIDITY AND DEATH AMONG PATIENTS WITH SEVERE HEART FAILURE. (N Engl J Med 1999:341:709-17.)

SPIRONOLACTONE (12.5–50 mg/d) was added to a regimen including a diuretic, an ACE inhibitor, or an ARB. A mean decrease in blood pressure of 21±20 mm Hg/10±14 mm Hg and 25±20 mm Hg/12±12 mm Hg was observed at 6 weeks and 6 months of therapy, respectively.

THE GENERAL BENEFIT OF ALDOSTERONE RECEPTOR ANTAGONISTS (ARAS) IN PATIENTS WITH RESISTANT HYPERTENSION SUGGESTS THAT ALDOSTERONE MAY BE A MORE COMMON DETERMINANT OF RESISTANT HYPERTENSION THAN WAS FIRST BELIEVED.

Nephrol Dial Transplant (2009) 1 of 11doi: 10.1093/ndt/gfp371

INCREASED RENOPROTECTION WITH ACE INHIBITOR PLUS ALDOSTERONE ANTAGONIST AS COMPARED TO MONOTHERAPIES—THE EFFECT ON PODOCYTESZalan Nemeth, Gabor Kokeny, Maria Godo, Miklos Mozes, Laszlo Rosivall,Marie-Luise Gross, Eberhard Ritz and Peter Hamar

Nephrol Dial Transplant (2009) 1 of 6doi: 10.1093/ndt/gfp511

THE IMPACT OF

STOPPING INHIBITORS OF THE RENIN–ANGIOTENSIN SYSTEM IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASEAimun K. Ahmed, Neetha S. Kamath, Mohsen El Kossi and A. Meguid El NahasSheffield Kidney Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

NDT Plus (2011) 4: 99–100doi: 10.1093/ndtplus/sfq218Advance Access publication 21 February 2011Case Report

Idiopathic or iatrogenic membranous glomerulonephritis? A case ofspironolactone-induced membranous glomerulonephritisAkimichi Inaba, Milind Nikam, Colin Short and Michael VenningDepartment of Renal Medicine, Manchester Royal Infirmary, Manchester, UK

Spironolacton által okozott nephrosis szindróma

A MAGAS SZÉRUM KÁLIUM EREDETE ÉS KÖVETKEZMÉNYEI 29DNN 2008

  e-mail this to a colleague

NAPI 30 TBL KÁLIUM-R EGÉSZSÉGESEKNEK

©2008 UpToDate® • www.uptodate.com Licensed to UpToDate Guest Pass

SupportTag: [ecapp0503p.utd.com-78.92.80.239-48A9C99DEF-2579]