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Drug Interactions between furosemide and probenecid

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Minor

probenecid furosemide

Applies to: probenecid and furosemide

Some investigators suggest that probenecid may acutely decrease the pharmacologic effects of loop diuretics by competitively inhibiting their renal secretion in the proximal tubule. A marked increase in diuresis and natriuresis may then follow due to increased amount of diuretic available at renal acceptor sites once probenecid has been cleared from the urine. In a study of eight normal volunteers, pretreatment with probenecid led to an overall increased response to a 40 mg dose of furosemide, as indicated by a 37% increase in sodium excretion and a 28% increase in urine volume over an eight-hour period. However, others have not corroborated these findings. One study reported no effect of probenecid on either cumulative response or time course of response of bumetanide, while another reported an increase in initial diuretic efficiency of furosemide but no change in cumulative urinary sodium excretion over five hours. No particular intervention is necessary during concomitant therapy with these agents, but clinicians should be aware of the potential for interaction.

References

  1. Brater DC, Fox WR, Chennavasin P (1981) "Interaction studies with bumetanide and furosemide: effects of probenecid and of indomethacin on response to bumetanide in man." J Clin Pharmacol, 21, p. 647-53
  2. Brater DC, Chennavasin P (1981) "Effect of probenecid on response to bumetanide in man." J Clin Pharmacol, 21, p. 311-5
  3. Honari J, Blair AD, Cutler RE (1977) "Effects of probenecid on furosemide kinetics and natriuresis in man." Clin Pharmacol Ther, 22, p. 395-401
  4. Chennavasin P, Seiwell R, Brater DC, Liang WM (1979) "Pharmacodynamic analysis of the furosemide-probenecid interaction in man." Kidney Int, 16, p. 187-95
  5. Odlind B, Beermann B (1980) "Renal tubular secretion and effects of furosemide." Clin Pharmacol Ther, 27, p. 784-90
  6. Velasquez MT, Wan SH, Barr JW, Maronde RF (1981) "Effect of probenecid on the natriuresis and renin release induced by bumetanide in man." J Clin Pharmacol, 21, p. 657-62
  7. Brater DC (1978) "Effects of probenecid on furosemide response." Clin Pharmacol Ther, 24, p. 548-54
  8. Homeida M, Roberts C, Branch RA (1977) "Influence of probenecid and spironolactone on furosemide kinetics and dynamics in man." Clin Pharmacol Ther, 22, p. 402-9
  9. Sommers DK, Meyer EC, Moncrieff J (1991) "The influence of co-administered organic acids on the kinetics and dynamics of frusemide." Br J Clin Pharmacol, 32, p. 489-93
  10. Brater DC, Leinfelder J, Anderson SA (1987) "Clinical pharmacology of torasemide, a new loop diuretic." Clin Pharmacol Ther, 42, p. 187-92
  11. Vree TB, van den Biggelaar-Martea M, Verwey-van Wissen CP (1995) "Probenecid inhibits the renal clearance of frusemide and its acyl glucuronide." Br J Clin Pharmacol, 39, p. 692-5
  12. Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
View all 12 references

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Drug and food interactions

Moderate

furosemide food

Applies to: furosemide

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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