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Drugs to Control Sodium and Water Retention Diuretics Drugs which increase urine formation are useful in CHF. Furosemide It is a very potent drug used orally and intravenously to treat severe CHF and oedema in lungs due to Left Heart Failure. Usual dose is 40 to 80 mg per day. Drug causes loss of electrolytes, particularly potassium. Therefore, it is necessary to get extra potassium (as potassium chloride) during its regular use. One way to obviate loss of potassium is by giving another variety of drug along with furosemide. These drugs are called as Potassium-Sparing diuretics. These counteract the loss of potassium. Such drugs are: Spironolactone is a combination of furosemide 20 mg and spironolactone 50 mg. Triamterene (Frusemene) is a combination of furosemide 20 mg and triamterene 50 mg. Torasemide (Dytor 10 mg). It is another potent diuretic. Thiazides For mild to moderate CHF, thiazides act as good diuretics allowing loss of sodium, potassium and water in urine. The same problem exists with their use and therefore potassium supplementation is necessary. Addition of a potassium-sparing diuretic along with a thiazide is quite common practice to reduce potassium loss for example ALDACTIDE which is a combination of hydroflumethiozide 25 mg and spironolactone 25 mg. BIDURET which is a combination of hydrochlorothiazide 50 mg and amiloride 5 mg. In some cases longer use of thiazide may cause impotency, poor control of diabetes, rise in blood levels of uric acid (gouty pains may occur) and lipids. Allergy may occur, occasionally. Drugs that Provide Long Term Benefits In CHF ACE-inhibitors Captopril, (Capoten) Enalapril (Enace), Lisinopril (Listril), Ramipril (Ramace) are the drugs which decrease formation of chemicals aldosterone and angiotensin-II which are responsible for causing structural changes in the heart with CHF. Therefore, their use in low doses for a longer period alters the course of disease (unfortunately digoxin could not do so!). The size and thickness of heart muscles revert back to normal and pumping capacity improves without significant adverse effects. This has been proved in multicentric drug trails which show prolongation of a 'good quality' life in CHF. The chances of sudden death are reduced and episodes of CHF recurrences are less. Obviously, they are increasingly used nowadays. Patients who are unable tolerate ACE-inhibitors due to dry hacking cough, losartan, candesartan or valsartan is given. Role of Beta-blockers: It is a parodox that a drug which worsens CHF has shown to be beneficial in long term for the same disorder, provided CHF is treated beforehand with the above drug in the absence of breathlessness and very low doses of metoprolol, carvedilol and bisoprolol are used. After 2 to 3 months the pumping capacity of heart increases and episodes of hospitalisation reduce. The only caveat is that use should be judicious and systolic dysfunction (poor heart contractions) is the underlying problems and the patient has mild to moderate CHF treated or compensated with routine drugs only. Role of Other Drugs: Spironolactone acts as a mild diuretic but more importantly prevents heart muscle damage (fibrotic changes) when added to ACE-inhibitors in low doses of 12.5 to 25 mg per day. Its benefits are slow but steady. It should never be taken if there is kidney damage. In poor relaxation (diastolic phase) of heart, calcium channel blockers are effective.
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