Naranjo C A, Pontigo E, Valdenegro C, González G, Ruiz I, Busto U
Clin Pharmacol Ther. 1979 Feb;25(2):154-60. doi: 10.1002/cpt1979252154.
Furosemide is frequently used for ascites and causes adverse reactions (AR). In an intensive prospective drug monitoring study of 1,920 patients, 172 (8.9%) had cirrhosis of the liver and received furosemide. Mean age was 53 years, and 66.3% were male; and 87% had alcoholic cirrhosis. Eighty-eight (51.2%) had 221 events that by consensus of the monitoring team and attending physicians were either definitely of probably related to furosemide. No AR was fatal but 24% of patients had severe reactions. Almost all reactions were dose-related (96%). The most common were electrolyte disturbances (23.3% of patients) and volume depletion (14%). Furosemide-induced coma occurred in 20 (11.6%) patients and was more frequent in patients with prior hepatic encephalopathy (p less than 0.0005). Higher total doses (p less than 0.001), hyerbilirubinemia (p less than 0.05), prolonged prothrombin time (p less than 0.02), and longer hospital stay (p less than 0.001) were associated with higher frequencies of AR to furosemide. The frequency of hypokalemia did not decrease when potassium chloride or potassium-sparing diuretics were added to furosemide therapy. Frequdncy of AR did not correlate with age, sex, renal impairment, serum albumin, transaminase, or alkaline phosphatase.
呋塞米常用于治疗腹水，但会引起不良反应（AR）。在一项针对1920名患者的前瞻性强化药物监测研究中，172名（8.9%）患有肝硬化并接受了呋塞米治疗。平均年龄为53岁，66.3%为男性；87%患有酒精性肝硬化。88名患者（51.2%）发生了221起事件，经监测团队和主治医生一致认定，这些事件肯定或很可能与呋塞米有关。没有不良反应是致命的，但24%的患者出现了严重反应。几乎所有反应都与剂量相关（96%）。最常见的是电解质紊乱（占患者的23.3%）和血容量减少（14%）。20名（11.6%）患者发生了呋塞米诱发的昏迷，在既往有肝性脑病的患者中更为常见（p<0.0005）。更高的总剂量（p<0.001）、高胆红素血症（p<0.05）、凝血酶原时间延长（p<0.02）和更长的住院时间（p<0.001）与呋塞米不良反应的更高发生率相关。在呋塞米治疗中添加氯化钾或保钾利尿剂时，低钾血症的发生率并未降低。不良反应的发生率与年龄、性别、肾功能损害、血清白蛋白、转氨酶或碱性磷酸酶无关。
