title: Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions.
abstract: The efficacy and side effects of the combination therapy of thiazide and furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients were hospitalized during the years 1985-1991. Left heart failure (left ventricular ejection fraction (LVEF = 22.4% +/- 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, cirrhosis and bilateral pleural effusion were present each in one patient. Chlorothiazide 0.5 g daily was added to conventional therapy. Patients were monitored closely during hospitalization and later as outpatients. During hospitalization, addition of chlorothiazide caused a reduction of 4.8 +/- 4.0 kg in patients' weight, serum potassium decreased from 4.4 +/- 0.6 to 4.0 +/- 0.5 mmol/l (P < 0.005) and serum sodium from 139.0 +/- 4.7 to 136.8 +/- 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 +/- 19.1 months. Thirteen patients had short treatment (1.6 +/- 0.8 months) and 19 patients had prolonged treatment (26.5 +/- 19.0 months). No specific characteristics distinguished patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated for the prolonged period had thiazides to be discontinued because of side effects. Addition of thiazides to furosemide is efficacious in severe heart failure. The combination should be started during hospitalization. Many patients can be maintained on this combination for a prolonged period of time on an ambulatory basis.
authors.affiliation: Department of Medicine E, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Mouallem
authors.forename: I
authors.initials: I
authors.lastname: Brif
authors.forename: H
authors.initials: H
authors.lastname: Mayan
authors.forename: Z
authors.initials: Z
authors.lastname: Farfel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy / Q000503:physiopathology; D002740:Chlorothiazide / Q000008:administration & dosage* / Q000009:adverse effects; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D011188:Potassium / Q000097:blood; D012214:Rheumatic Heart Disease / Q000188:drug therapy / Q000503:physiopathology; D012964:Sodium / Q000097:blood; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
chemical_list: D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D002740:Chlorothiazide; D005665:Furosemide; D012964:Sodium; D011188:Potassium