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 re nal haemodynamic and tubular abnormalities observed in cirrhosis, Low- dose theophylline is an adenosine antagonist and recent studies have s hown that this drug can improve renal blood now and sodium excretion i n cirrhotic patients, Methods: Fifteen patients with newly diagnosed c irrhotic ascites were randomized to receive either 100 mg spironolacto ne daily for 7 days or 250 mg theophylline on days 1, 2, 4 and 6. Base line clinical and urinary and serum biochemical data were collected an d compared following therapy. Results: After 7 days of spironolactone there were increases in urinary sodium excretion (43.5 +/- 15.6 vs. 10 6.8 +/- 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' weigh t, creatinine clearance or serum electrolytes were observed. No change was detected in any of these parameters following theophylline therap y, Conclusion: Adenosine antagonism in the form of low-dose theophylli ne is less efficacious than spironolactone in the management of cirrho tic ascites.