Usual Adult Dose for Ascites

Initial dose: 100 mg orally 2 times a day after meals
Maximum dose: 300 mg/day

Comments:

• The dosage should be titrated to the needs of the individual patient.
• The maximum therapeutic effect may not be seen for several days.
• When this drug is used concomitantly with another diuretic or antihypertensive agent, the total daily dose of each agent should be lowered initially and then adjusted according to patient need.

Use: To reduce edema in cardiac failure, cirrhosis of the liver or nephrotic syndrome, and in that associated with corticosteroid treatment

Usual Adult Dose for Edema

Initial dose: 100 mg orally 2 times a day after meals
Maximum dose: 300 mg/day

Comments:

• The dosage should be titrated to the needs of the individual patient.
• The maximum therapeutic effect may not be seen for several days.
• When this drug is used concomitantly with another diuretic or antihypertensive agent, the total daily dose of each agent should be lowered initially and then adjusted according to patient need.

Use: To reduce edema in cardiac failure, cirrhosis of the liver or nephrotic syndrome, and in that associated with corticosteroid treatment

Renal Dose Adjustments

• Mild to moderate renal dysfunction: Data not available
• Severe or progressive renal failure (with the possible exception of nephrosis): Contraindicated

Liver Dose Adjustments

Severe or progressive hepatic disease: Contraindicated

Dose Adjustments

• This drug can cause mild nitrogen retention, which is reversible upon withdrawal of therapy, and is seldom observed with intermittent (every-other-day) therapy.
• Reducing the dose of this drug may be necessary in the presence of electrolyte imbalance and in geriatric patients.
• When administering this drug with another diuretic, the doses of both drugs should be reduced.

Precautions

US BOXED WARNINGS:

• Abnormal elevation of serum potassium levels (greater than or equal to 5.5 mEq/L) can occur with potassium-sparing agents. Hyperkalemia occurs more often in patients with renal impairment and diabetes (even without evidence of renal impairment), and in the elderly or severely ill. Since uncorrected hyperkalemia may be fatal, serum potassium levels should be monitored at frequent intervals especially when dosages are changed or with any illness that may influence renal function.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

• Although this drug is 67% protein-bound, there may be some benefit to dialysis in cases of overdosage.
• Excess potassium can be removed by dialysis.

Other Comments

Administration advice:

• Take with meals.