ADVANTAGES OF THE NEW LOOP DIURETIC TORASEMIDE OVER FUROSEMIDE IN PATIENTS WITH CIRRHOSIS AND ASCITES - A RANDOMIZED, DOUBLE-BLIND CROSS-OVER TRIAL

Torasemide is a new loop diuretic with a longer half-life and longer a ction than furosemide in healthy subjects. In order to evaluate the ph armacodynamic effects, single oral doses of furosemide (80 mg) and tor asemide (20 mg), which were equipotent in healthy subjects, were given to 14 patients with cirrhosis and ascites. Before the study patients underwent an equilibration period of 4 days without diuretics. The dru gs were alternated following a randomized double-blind cross-over desi gn after a wash-out period of at least 2 days. Urine was collected at defined intervals for 24 h after drug administration and blood samples were taken before, 6 h and 24 h after medication. Torasemide induced greater cumulative 24 h diuresis (2863 +/- 343 vs. 2111 +/- 184 ml, p < 0.01) than furosemide. Torasemide did not differ from furosemide for cumulative 0-6 h sodium excretion (96 +/- 17 vs. 92 +/- 23 mmol sodiu m) but caused a more pronounced cumulative 6-24 h natriuresis (38 +/- 11 vs. 17 +/- 4 mmol, p < 0.05). Five patients exhibited a weak respon se to furosemide (0-36 mmol sodium/24 h. median 24 mmol; 690-1460 ml u rinary volume/24 h, median 1325 ml). These patients showed significant ly higher natriuresis and diuresis following torasemide (26-136 mmol s odium/24 h, median 78 mmol, p < 0.05; 1670-3610 ml urinary volume/24 h , median 2200 ml, p < 0.05). Twenty-four hours after administration of both drugs there were no significant changes in hemodynamic, renal or hormonal parameters. No adverse effects were noted with either treatm ent. These findings suggest that torasemide might be more advantageous than furosemide in the treatment of ascites due to cirrhosis.