Frusemide + Spironolactone

Frusemide + Spironolactone is a diuretic combination (loop diuretic + potassium-sparing diuretic) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Liver cirrhosis with ascites — fluid in the abdomen, where this combination is particularly preferred
• Chronic heart failure — persistent swelling and breathlessness needing both fluid removal and potassium balance
• Resistant oedema — swelling not adequately controlled by a single diuretic
• Oedema with low potassium risk — patients who developed hypokalaemia on a loop diuretic alone

Your doctor will set the dose of Frusemide + Spironolactone based on your condition, daily weight record, kidney function and electrolyte reports, and will adjust it as the fluid comes under control.

• Take it in the morning, after food, so the extra urination happens during the day and not at night.
• Weigh yourself each morning if advised, and keep the record for follow-up visits.
• If you miss a dose, take it when you remember the same day; skip it if evening has come — never take a double dose.

Never stop or adjust Frusemide + Spironolactone on your own — fluid can rebuild quickly in heart failure or cirrhosis, and the potassium balance this combination maintains needs regular blood-test monitoring by your doctor.

Possible side effects include:

• Increased urination after the dose (expected)
• Dizziness, light-headedness, thirst or dry mouth
• Stomach upset, nausea, diarrhoea
• Potassium disturbances either way — too low (cramps, weakness) or too high (muscle weakness, slow/irregular heartbeat), depending on kidney function
• Low sodium — confusion, lethargy in severe cases
• From spironolactone: breast tenderness or enlargement in men (gynaecomastia), menstrual irregularity
• Raised uric acid (gout) or blood sugar changes
• Serious: fainting, very reduced urine, severe muscle weakness or palpitations — seek medical help promptly

• Regular blood tests for potassium, sodium and kidney function are essential — never skip them.
• Do not take potassium supplements or potassium-rich salt substitutes unless your doctor specifically prescribes them — the spironolactone part already retains potassium.
• Weigh yourself as advised and report rapid weight gain or loss.
• In diarrhoea, vomiting or very hot weather, dehydration and electrolyte upset develop fast — contact your doctor.
• Rise slowly to avoid dizziness and falls, especially if elderly.
• Tell your doctor about diabetes, gout, kidney impairment or difficulty passing urine.
• Men noticing breast tenderness should inform the doctor — adjusting the dose usually helps.

• ACE inhibitors and ARBs (ramipril, losartan, telmisartan): useful together in heart failure but raise the high-potassium risk — needs monitoring
• Potassium supplements and other potassium-sparing diuretics: dangerous potassium rise — avoid unless prescribed
• NSAID painkillers (ibuprofen, diclofenac): blunt the diuretic effect, strain kidneys and raise potassium
• Digoxin: spironolactone can raise digoxin levels and potassium shifts alter its safety
• Lithium: levels can rise to toxic range
• Trimethoprim/co-trimoxazole: adds to potassium retention
• Other blood pressure medicines: additive pressure drop

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to frusemide, spironolactone or sulphonamide-derived medicines
• High blood potassium (hyperkalaemia)
• Severe kidney failure or inability to pass urine (anuria)
• Addison's disease (adrenal insufficiency)
• Severe dehydration or uncorrected low sodium
• Hepatic coma or pre-coma (specialist care only)
• Combined use with other potassium-sparing diuretics or potassium supplements without supervision

Pregnancy: This combination is generally avoided in pregnancy. Frusemide is used only for specific medical emergencies under specialist care, and spironolactone is usually avoided because its hormone-blocking action could theoretically affect a male baby's development. Tell your doctor immediately if you are or may be pregnant.

Lactation: Both components pass into breast milk in small amounts, and frusemide may reduce milk production. Breastfeeding during treatment is generally not recommended unless the doctor judges it necessary and monitors the baby.

Store below 30°C in a cool, dry place, protected from light and moisture. Keep the tablets in the original pack until use, and keep out of the reach of children. Do not use after the expiry date.