Piretanide

Registered South African indications:

• Oedema
• Hypertension

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to sulphonamide derivatives
• Pregnancy
• Breastfeeding
• Renal failure with anuria
• Hepatic failure associated with clouding of consciousness
• Serious potassium deficiency
• Serious sodium deficiency and/or diminished blood volume with or without concurrent lowering of blood pressure
• Should not be used in children

Cautions

• Metabolic alkalosis
• Diabetes mellitus
• Gout
• Prostatic hypertrophy 
• Abnormalities of bladder emptying

Forms avail. in SA and covered in this monograph: tab

Oedema

• Oral (tab): Initial: 6mg, dly; Maintenance: 3-6mg, dly

Hypertension - mild to moderate 

• Oral (tab): Initial: 6mg, dly; Titrate at intervals of 2-4 weeks; Max: 12mg/24hrs

Advise diet rich in potassium and restrict salt intake

Not established for use in children (see Contraindications) 

Pregnancy

• FDA Pregnancy Category Not Rated (NR)

Breastfeeding

• Contraindicated

Renal Impairment

• Severe: Contraindicated

Hepatic Impairment

• Severe: Contraindicated

Elderly

• No dose adjustment recommended

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

• Hypovolaemia
• Hypotension
• Vasculitis

Gastrointestinal Disorders

• Nausea and vomiting
• Digestive disorders
• Diarrhoea
• Dry mouth

Genitourinary Disorders

• Dehydration
• Impotence
• Urinary outflow obstruction
• Increased serum urea
• Increased serum creatinine

Endocrine and Metabolic Disorders

• Hypokalaemia
• Hyponatraemia
• Metabolic alkalosis
• Hypocalcaemia
• Hypomagnesemia
• Impaired glucose tolerance
• Latent diabetes mellitus

Musculoskeletal Disorders

• Gout

Skin and Subcutaneous Tissue Disorders

• Photosensitivity
• Allergic reactions

Immune, Blood and Lymphatic System Disorders

• Thrombophilia
• Thrombocytopaenia

Sensory Disorders

• Visual disturbances

• Nephrotoxic agents
• Digoxin
• Corticosteroids
• Laxatives
• Carbenoxolone
• Liquorice
• Antihypertensive agents
• Antidiabetic agents
• Salicylates
• Muscle relaxants
• Pressor amines
• Lithium
• Probenecid
• Non-steroidal anti-inflammatory drugs

None routine. Specific cases may require

• Renal function
• Electrolytes

Piretanide inhibits the reabsorption of sodium, mainly from the Loop of Henle but also from the proximal convoluted tubule. Active chloride transport is inhibited in the Loop of Henle.

Tablet 6mg

• Arelix (Sanofi) originator