Sica Domenic A
Department of Medicine, Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298-0160, USA.
Congest Heart Fail. 2003 Sep-Oct;9(5):287-92. doi: 10.1111/j.1527-5299.2003.02399.x.
Congestive heart failure is a disease state distinguished by the regular presence of both renal and hepatic abnormalities in drug handling. One such abnormality involves flaws in the process of drug absorption. In most instances, congestive heart failure-related abnormalities in drug absorption are of inconsequential significance. However, this is not the case with loop diuretics. Loop diuretic action ordinarily tracks the rate and extent of absorption if a sufficient amount of diuretic has been given to exceed the threshold for diuretic effect. In congestive heart failure, both the rate and absolute amount of loop diuretic absorbed can be reduced as a function of the heart failure state itself. In this setting, drug dissolution characteristics can assume added significance. Furosemide is the loop diuretic with the widest intra- and interpatient variability of absorption. Alternatively, the loop diuretic torsemide is rapidly and fairly completely absorbed independent of the heart failure state. This pattern of absorption establishes it as the preferred loop diuretic in the otherwise diuretic-resistant heart failure patient. However, the exact role of torsemide in the outpatient management of congestive heart failure remains to be determined.
充血性心力衰竭是一种疾病状态，其特征是在药物处理过程中经常出现肾脏和肝脏异常。其中一种异常涉及药物吸收过程中的缺陷。在大多数情况下，充血性心力衰竭相关的药物吸收异常意义不大。然而，袢利尿剂并非如此。如果给予足够量的利尿剂以超过利尿效应阈值，袢利尿剂的作用通常会跟踪吸收的速率和程度。在充血性心力衰竭中，袢利尿剂吸收的速率和绝对量均可作为心力衰竭状态本身的函数而降低。在这种情况下，药物溶解特性可能具有额外的重要性。呋塞米是吸收的患者内和患者间变异性最广的袢利尿剂。相比之下，托拉塞米这种袢利尿剂的吸收迅速且相当完全，与心力衰竭状态无关。这种吸收模式使其成为在其他情况下对利尿剂耐药的心力衰竭患者首选的袢利尿剂。然而，托拉塞米在充血性心力衰竭门诊管理中的确切作用仍有待确定。
