of action. Use of a potassium sparing diuretic can usually avoid the need for potassium supplement.
|
| |
| 2.2.1 Thiazides and related diuretics |
| GREEN Bendroflumethiazide tablets 2.5mg |
| GREEN Indapamide |
| tablets 2.5mg |
| tablets MR 1.5mg |
| N.B. Where Bendroflumethiazide is to be used for oedema or where an alternative to Metolazone (discontinued by |
| manufacturer) is needed, Bendroflumethiazide 5mg tablets would be suitable. |
| |
| 2.2.2 Thiazides Loop Diuretics |
First line treatment
|
GREEN Furosemide
|
tablets 20mg, 40mg
|
liquid 50mg in 5mL
|
AMBER Furosemide tablets 500mg
|
RED Furosemide injection 20mg/2mL, 50mg/5mL, 250mg/25mL
|
| |
Second line treatment - Only if poor response to furosemide
|
GREEN Bumetanide
|
| tablets 1mg, tablets 5mg |
| liquid 1mg/5mL |
| |
Metolazone –an unlicensed tablet is available and is approved for inclusion in formulary for secondary care use only.
|
| RED Metolazone tablets (unlicensed secondary care only) |
| |
| 2.2.3 Potassium-sparing diuretics and aldosterone antagonists |
| Amiloride on its own is a weak diuretic. It causes retention of potassium and is used as a more effective alternative |
| to giving potassium supplements with thiazide or loop diuretics. |
| Spironolactone is licensed only for congestive cardiac failure, hepatic cirrhosis with ascites and oedema, malignant |
| ascites, nephrotic syndrome and the diagnosis and treatment of primary aldosteronism. |
| Both of these drugs have the potential to cause hyperkalaemia with drugs acting on the renin-angiotensin system. |
| |
| GREEN Amiloride |
| tablets 5mg |
| liquid 5mg/5mL |
| GREEN Spironolactone |
| tablets 25mg, 100mg |
| RED Spironolactone |
| liquid 5mg/5mL, 10mg/5mL, 25mg/5mL, 50mg/5ml, 100mg/5mL |
| for NICU use only |
| |
| Finerenone for treating chronic kidney disease in type 2 diabetes ICS Commissioned |
| NICE TA877 Finerenone is recommended as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with |
| Type 2 diabetes in adults. It is only recommended if: |
| > it is an add-on to optimised standard care; this should include, unless they are unsuitable, the highest tolerated licensed doses of: |
| > angiotensin - converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and |
| > sodium–glucose cotransporter‑2 (SGLT2) inhibitors and |
| > the person has an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 or more. |
| |
| Eplerenone |
| For patients with symptoms and/or signs of heart failure and left ventricular systolic dysfunction (LVSD), initiate |
| treatment with eplerenone, an aldosterone antagonist. Eplerenone is licensed for post-MI treatment within 3–14 days |
| of the MI, preferably after ACE inhibitor therapy. For patients with clinical heart failure and LVSD already being |
| treated with an aldosterone antagonist for a concomitant condition (e.g. spironolactone), continue with the |
| aldosterone antagonist or an alternative, licensed for early post-MI treatment. |
| |
| Assessment/monitoring |
| Monitor renal function and serum potassium before and during treatment. If hyperkalaemia is a problem, |
| halve the dose or stop the treatment. |
| AMBER Eplerenone |
| tablets 25mg, 50mg |
| |
| 2.2.4 Potassium-sparing diuretics with other diuretics |
| Fixed dose combinations may be justified where compliance is a problem. |
| GREEN Co-amilofruse (amiloride, furosemide) |
| tablets 2.5/20, 5/40 |
| |
| 2.2.5 Osmotic diuretics |
| RED Mannitol intravenous infusion 10%, 20% |
| |
