Oral Metolazone Increases Urine Output Comparable to Chlorothiazide IV as an Adjunct to Loop Diuretics in HFrEF Patients with ADHF
Thiazide diuretics are often utilized to overcome loop diuretic resistance when treating ADHF. In addition to a large cost advantage, several pharmacokinetic advantages exist when administering oral metolazone (MT) compared to IV chlorothiazide (CT); yet many providers are reluctant to utilize an oral formulation to treat ADHF. Several studies have found no difference in efficacy between the agents, however these studies had limited patients, utilized net UOP which can be misleading if patients are intubated or fluid restricted, and included HFpEF patients which may not have comparable UOP goals to HFrEF patients. (Source:...
Source: Journal of Cardiac Failure - August 1, 2017 Category: Cardiology Authors: Jerrica E. Shuster, Brian Bohn, Rim Hadgu, Hannah Pope Source Type: research
The Increased Mortality Risk Associated with Metolazone in Acute Heart Failure is Mediated by Worsening Renal Function and Electrolyte Disturbances
Background: Current guidelines recommend the addition of a thiazide when diuresis is inadequate during acute decompensated HF (ADHF) treatment; however this is based on limited data. Given that dual segmental nephron blockade may have harmful effects, we set out to determine the relationship between metolazone use during ADHF and mortality utilizing propensity score adjustment. Methods: Patients admitted to 3 hospitals employing a common EMR with a discharge diagnosis of HF and who received IV diuretics within the first 7 days were studied. (Source: Journal of Cardiac Failure)
Source: Journal of Cardiac Failure - August 1, 2017 Category: Cardiology Authors: Meredith A. Brisco-Bacik, Jozine M. ter Maaten, Natasha A. Vedage, F. Perry Wilson, Jeffrey M. Testani Source Type: research
Combined aquaretic and diuretic therapy in acute heart failure.
CONCLUSION: Our strategy of treating AHF by achieving high UOP, while maintaining stable electrolytes and creatinine in a short period to euvolemic state, is safe.
PMID: 28652798 [PubMed - in process] (Source: International Journal of Nephrology and Renovascular Disease)
Source: International Journal of Nephrology and Renovascular Disease - June 29, 2017 Category: Urology & Nephrology Tags: Int J Nephrol Renovasc Dis Source Type: research
Intravenous Chlorothiazide Versus Enteral Metolazone to Augment Loop Diuretic Therapy in the Intensive Care Unit.
CONCLUSION: Both CTZ and MET induced significant increases in UOP. CTZ induced a greater and more rapid change and was associated with higher cost and greater need for potassium replacement. Randomized controlled trials are needed to establish whether a preferable thiazide diuretic exists in this setting.
PMID: 28228057 [PubMed - in process] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - February 24, 2017 Category: Drugs & Pharmacology Authors: Michaud CJ, Mintus KC Tags: Ann Pharmacother Source Type: research
Efficacy and Safety of Intravenous Chlorothiazide versus Oral Metolazone in Patients with Acute Decompensated Heart Failure and Loop Diuretic Resistance
ConclusionOral metolazone was noninferior to intravenous chlorothiazide for enhancing net urine output in patients with ADHF and loop diuretic resistance and was similarly safe with regard to renal function and electrolyte abnormalities. Given the significant cost disparity between the two agents, these findings suggest that oral metolazone may be considered a first‐line option in this patient population.This article is protected by copyright. All rights reserved. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - July 8, 2016 Category: Drugs & Pharmacology Authors: Christine E. Shulenberger, Anthony Jiang, Sandeep Devabhakthuni, Vijay Ivaturi, Tao Liu, Brent N. Reed Tags: Original Research Article Source Type: research
31. Differential effects of intravenous bolus furosemide and continuous furosemide infusion on in-hospital management and outcomes among patients admitted with acute decompensated heart failure
Publication date: July 2016 Source:Journal of the Saudi Heart Association, Volume 28, Issue 3 Author(s): N. Alsuhebany, R. Aqel, H. Alballa, F. Al-Ayoubi, G. Bawazeer, K. Alhabib, H. AlFaleh, A. Hersi, A. Ullah, T. Kashour Loop diuretics are a cornerstone in the management of Acute Decompensated Heart Failure (ADHF). However, the best therapeutic strategy in terms of intermittent boluses versus continuous infusion is still unclear.We set to examine the differences in hospital management and short-term and long-term mortality of patient receiving furosemide bolus or infusion treatment for ADHF.This i...
Source: Journal of the Saudi Heart Association - June 10, 2016 Category: Cardiology Source Type: research
Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone
ConclusionThe addition of intravenous chlorothiazide did not result in improved diuresis in patients with ADHF determined to be refractory to loop diuretics and adjunctive oral metolazone.This article is protected by copyright. All rights reserved. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - April 30, 2016 Category: Drugs & Pharmacology Authors: Maria Cardinale, Jerry Altshuler, Jeffrey M. Testani Tags: Original Research Article Source Type: research
Preparation of a New Chiral Stationary Phase Based on Macrocyclic Amide Chiral Selector for the Liquid Chromatographic Chiral Separations.
Abstract
A new chiral stationary phase (CSP) based on macrocyclic amide receptor was prepared starting from (1R,2R)-1,2-diphenylethylenediamine. The new CSP was successfully applied to the resolution of various N-(substituted benzoyl)-α-amino amides with reasonably good separation factors and resolutions (α = 1.75 ~ 2.97 and RS = 2.89 ~ 6.82 for 16 analytes). The new CSP was also applied to the resolution of 3-substituted 1,4-benzodiazepin-2-ones and some diuretic chiral drugs including bendroflumethiazide and methylchlothiazide and metolazone. The resolution results for 3-substituted 1,...
Source: Chirality - January 4, 2016 Category: Molecular Biology Authors: Sung JY, Choi SH, Hyun MH Tags: Chirality Source Type: research
Predicting outcomes among patients with atrial fibrillation and heart failure receiving anticoagulation with warfarin.
In conclusion, we developed a HF severity model using easily available clinical characteristics that performed well to risk-stratify patients with HF who are receiving anticoagulation for AF with regard to major haemorrhage.
PMID: 25948532 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
Source: Thrombosis and Haemostasis - May 7, 2015 Category: Hematology Authors: Kim EJ, Ozonoff A, Hylek EM, Berlowitz DR, Ash AS, Miller DR, Zhao S, Reisman JI, Jasuja GK, Rose AJ Tags: Thromb Haemost Source Type: research
Thiazide Diuretics in Chronic Kidney Disease
Abstract
Widely prevalent in the general population, chronic kidney disease (CKD) is frequently complicated with hypertension. Control of hypertension in this high-risk population is a major modifiable cardiovascular and renal risk factor but often requires multiple medications. Although thiazides are an attractive agent, guidelines have previously recommended against thiazide use in stage 4 CKD. We review the updated guidelines on thiazide use in advanced CKD, the antihypertensive mechanism of thiazides, and the clinical studies of thiazides in CKD. Older uncontrolled studies have shown that metolazone...
Source: Current Hypertension Reports - March 7, 2015 Category: Primary Care Source Type: research
Comparison of metolazone versus chlorothiazide in acute decompensated heart failure with diuretic resistance
ConclusionSequential nephron blockade with either metolazone or chlorothiazide appears to be efficacious and safe in ADHF, renal dysfunction, and diuretic resistance. Given the considerable cost difference favoring oral metolazone, larger randomized studies are warranted to confirm our findings and to exclude the possibility of confounding by indication.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)
Source: Cardiovascular Therapeutics - February 1, 2015 Category: Cardiology Authors: Michael Moranville, Suji Choi, Jennifer Hogg, Allen Anderson, Jonathan Rich Tags: Original Research Article Source Type: research
Hypotension During Hospitalization for Acute Heart Failure Is Independently Associated With 30-Day Mortality: Findings From ASCEND-HF [Original Articles]
Conclusions—
Hypotension while hospitalized for acute decompensated heart failure is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies.
Clinical Trial Registration—
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852. (Source: Circulation: Heart Failure)
Source: Circulation: Heart Failure - November 18, 2014 Category: Cardiology Authors: Patel, P. A., Heizer, G., O'Connor, C. M., Schulte, P. J., Dickstein, K., Ezekowitz, J. A., Armstrong, P. W., Hasselblad, V., Mills, R. M., McMurray, J. J. V., Starling, R. C., Tang, W. H. W., Califf, R. M., Hernandez, A. F. Tags: Other heart failure Original Articles Source Type: research
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Discussion:
The nearest 24/7 PCI center is 20 minutes away, while a smaller community hospital (fibrinolysis only, but has an ICU, etc.) is “just around the corner.” What is your transport destination? (Source: EMS 12-Lead)
Source: EMS 12-Lead - September 28, 2014 Category: Cardiology Authors: Brooks Walsh MD Tags: 12 lead ecg Uncategorized Source Type: research
Thiazide-like diuretic drug metolazone activates human pregnane X receptor to induce cytochrome 3A4 and multidrug-resistance protein 1.
Abstract
Human pregnane X receptor (hPXR) regulates the expression of drug-metabolizing enzyme cytochrome P450 3A4 (CYP3A4) and drug transporters such as multidrug-resistance protein 1 (MDR1). PXR can be modulated by small molecules, including Federal Drug Administration (FDA)-approved drugs, thus altering drug metabolism and causing drug-drug interactions. To determine the role of FDA-approved drugs in PXR-mediated regulation of drug metabolism and clearance, we screened 1481 FDA-approved small-molecule drugs by using a luciferase reporter assay in HEK293T cells and identified the diuretic drug metolazone...
Source: Biochemical Pharmacology - August 30, 2014 Category: Drugs & Pharmacology Authors: Banerjee M, Chen T Tags: Biochem Pharmacol Source Type: research
Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension.
CONCLUSIONS: This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect. The mean blood pressure-lowering effect over the dose range 6.25 mg, 12.5 mg, 25 mg and 50 mg/day is 4/2 mmHg, 6/3 mmHg, 8/3 mmHg and 11/5 mmHg, respectively. For other thiazide drugs, the lowest doses studied lowered blood pressure maximally and higher doses did not lower it more. Due to the greater effect on systolic than on diastolic blood pressure, thiazides lower pulse pressure by 4 mmHg to 6 mmHg. This exceeds the mean 3 mmHg pulse pressure reduction achieved by ACE inhibitors, ARBs and renin inhibito...
Source: Cochrane Database of Systematic Reviews - June 3, 2014 Category: Journals (General) Authors: Musini VM, Nazer M, Bassett K, Wright JM Tags: Cochrane Database Syst Rev Source Type: research
