title: Combination of high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure.
abstract: OBJECTIVE
  We studied the synergism between high-dose furosemide and hydrochlorothiazide in patients with severe congestive heart failure and impaired renal function showing diuretic resistance to a daily dose of furosemide of at least 250 mg.
  
  
  METHODS
  An open study. A general hospital in The Netherlands.
  
  
  METHODS
  In 20 patients with severe congestive heart failure (stage III-IV according to the New York Heart Association) with an oedematous mass of more than 5 kg and a proven diuretic resistance to high-dose furosemide, hydrochlorothiazide (25-100 mg daily) was added to the medication for 3-12 days, leaving the other medication unchanged. After correction of the hydration state, hydrochlorothiazide was withdrawn. Variables included body weight, serum electrolytes, renal function and natriuresis.
  
  
  RESULTS
  Addition of hydrochlorothiazide resulted in a mean (+/-standard deviation) body weight reduction of 6.7 +/- 3.3 kg per patient. Mean daily urine volume increased from 1899 +/- 958 ml to 3065 +/- 925 ml (P < 0.001). Fractional sodium excretion increased significantly from 3.5 +/- 3.2% to 11.5 +/- 9.0% (P < 0.001). The most important side effect of this combination therapy appeared to be hypokalaemia. Mean endogenous creatinine clearance decreased (not significantly) from 32.7 +/- 22.5 ml. min-1.1.73 m-2 to 27.6 +/- 22.5 ml. min-1.1.73 m-2.
  
  
  CONCLUSIONS
  Addition of hydrochlorothiazide to high-dose furosemide is a powerful diuretic tool, even in patients with a significantly reduced renal function. Because of its potentially dangerous side effects (hypokalaemia), it should be used in a carefully controlled setting.
authors.affiliation: Department of Internal Medicine, University Hospital, Nijmegen, The Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: Dormans
authors.forename: P G
authors.initials: PG
authors.lastname: Gerlag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D005665:Furosemide