Comparison between theophylline and spironolactone in the management of cirrhotic ascites: a randomized controlled study.
BACKGROUND
It has been suggested that adenosine is involved in the renal haemodynamic and tubular abnormalities observed in cirrhosis. Low-dose theophylline is an adenosine antagonist and recent studies have shown that this drug can improve renal blood flow and sodium excretion in cirrhotic patients.


METHODS
Fifteen patients with newly diagnosed cirrhotic ascites were randomized to receive either 100 mg spironolactone daily for 7 days or 250 mg theophylline on days 1, 2, 4 and 6. Baseline clinical and urinary and serum biochemical data were collected and compared following therapy.


RESULTS
After 7 days of spironolactone there were increases in urinary sodium excretion (43.5 +/- 15.6 vs. 106.8 +/- 34.7 mmol/day; P < 0.05) and urine volume (769.1 +/- 206.5 vs. 1541.6 +/- 342.6 mL/day; P < 0.05). No changes in the patients' weight, creatinine clearance or serum electrolytes were observed. No change was detected in any of these parameters following theophylline therapy.


CONCLUSIONS
Adenosine antagonism in the form of low-dose theophylline is less efficacious than spironolactone in the management of cirrhotic ascites.
Stanley
A J
AJ
Department of Medicine, Royal Infirmary of Edinburgh, UK.
Forrest
E H
EH
Dabos
K J
KJ
MacGilchrist
A J
AJ
Hayes
P C
PC
D000241:Adenosine / Q000037:antagonists & inhibitors; D000368:Aged; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use*; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology
D000451:Mineralocorticoid Receptor Antagonists; D010726:Phosphodiesterase Inhibitors; D013148:Spironolactone; D013806:Theophylline; D000241:Adenosine