Medicines to Treat Ascites

Definition

By "ascites" s "means an effusion of fluid into the peritoneal cavity, the abdominal lining membrane; in other words, ascites appears in the space between the abdominal organs and the tissue lining the abdomen. Ascites is a of the most common complications of liver cirrhosis.

Causes

In addition to liver cirrhosis, many other diseases can predispose the patient to the onset of ascites: impaired intestinal absorption, colon and liver cancer, hepatitis, heart failure, portal hypertension (often associated with water and sodium retention from part of the body), severe malnutrition, pancreatitis, tuberculosis.

Symptoms

It is estimated that 33% of patients with ascites do not complain of any symptoms, and that fluid effusion into the abdominal cavity is diagnosed by chance. In some patients, ascites manifests itself with mental confusion, muscle weakness, difficulty breathing, abdominal pain and distention, encephalopathy, fever, gynaecomastia, loss of appetite, jaundice. In severe forms, ascites can induce coma.

The information on Ascites - Medicines for the Treatment of Ascites is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Ascites - Medicines for the Treatment of Ascites.

Medicines

Given the complex mechanism that is established in the context of ascites, before describing the treatments and drugs indicated for its treatment, a concise summary scheme is provided below, which describes how the transudation of liquids in the peritoneal cavity is reached starting from from liver disease:

Hepatic disorders → prevented blood from flowing normally in the liver → increased portal pressure → ↑↑ in the volume of the spleen (splenomegaly) → ↓ volume of circulating blood (hypovolaemia) → activation of the renin-angiotensin-aldosterone system and the sympathetic system → ↑ ↑ renal sodium, tachycardia → accumulation of fluid in the peritoneal cavity (ascites).

The goal of treatment for ascites is to cure the underlying disease; there are numerous intervention strategies. Here are the most frequent:

Behavioral modification: involves bed rest and sodium restriction to only 1.5-2 grams per day
Pharmacological therapy: involves the administration of diuretics to remove excess fluids (spironolactone and furosemide), albumin, antibiotics to be used in case of proven bacterial co-infection (eg cefotaxime, cefoxitin, amoxicillin and clavulanic acid)
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Evacuative paracentesis: it aims to eliminate the liquids accumulated in the abdominal cavity. The therapeutic practice makes use of the aid of a needle that is inserted directly into the abdomen, in order to favor the elimination of excess fluids by aspiration. In such situations, concomitant albumin infusion is recommended in order to promote re-expansion of plasma volume.
Liver transplant: reserved for those patients who do not report any appreciable benefit after taking drugs

The following are the classes of drugs most used in the therapy against ascites, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Diuretics for the treatment of uncomplicated ascites: by reducing the volume, these drugs are able to significantly reduce portal pressure.

Spironolactone (eg Aldactone, Uractone, Spirolang): this is a powerful diuretic drug (belonging to the potassium-sparing pharmacological class), used in therapy for the treatment of ascites at the initial dosage of 100 mg per day; subsequently, gradually increase the dose up to a maximum of 400 mg per day. Spironolactone is also available in association with hydrochlorothiazide (eg Aldactazide, Spiridazide), another potassium-sparing drug: in this case, it is recommended to start therapy by taking 4 tablets a day. day orally, formulated with 25 mg of spironolactone and with the same number of 25 mg of hydrochlorothiazide. The drug is also available in tablets of 50 + 50 mg: in this case, only two tablets a day are needed. If after 2-4 days, no appreciable improvement is observed, it is recommended to increase the dose gradually, every 2-3 days, up to a maximum of 200 + 200 mg. Long-term treatment with this drug - as well as its abuse - can lead to decreased sexual desire, impotence and gynecomastia.
Furosemide (eg Lasix, Spirofur): to be used in combination with spironolactone when monotherapy with this last drug does not bring the desired therapeutic results. The combination of spironolactone + furosemide is also recommended to avoid nocturia. Indicatively, for the treatment of ascites, it is recommended to start therapy with a minimum dose of the drug (40 mg); eventually, gradually increase the dose up to a maximum of 160 mg / day.
Bumetanide (eg. Bumex) drug of second choice for the treatment of ascites. The indicative dosage suggests taking 0.5-2 mg of drug per day, orally; alternatively, take the drug intravenously or intramuscularly at the dose of 1 mg per day The active ingredient can also be taken by continuous intravenous infusion: in this case, the indicative dosage is 1 mg / hour, for a maximum of 12 mg per day.
Torsemide or Torasemide (eg Demadex, Diuresix): the drug is a loop diuretic used in therapy for the treatment of ascites; it is not a first choice drug as furosemide and spironolactone are. Indicatively, take 5-10 mg of the drug orally or intravenously, once a day.
Ethacrynic acid (eg reomax): the drug is a loop diuretic. For the treatment of ascites, it is recommended to take the drug at a dosage of 50 mg per day, orally or intravenously, preferably with food. Ethacrynic acid is recommended in case of ascites ascites, if spironolactone and furosemide do not show appreciable benefits.
Triamterene (eg. Dyrenium): the drug is a diuretic also indicated for the treatment of ascites; the indicative dosage is to take 100 mg of active, twice a day, by mouth. The drug is also available in association with furosemide ( eg Fluss): in this case, it is recommended to take 1-2 tablets a day, every other day (each tablet is formulated with 25 mg of triamterene and 40 mg of furosemide).

Antibiotic drugs for the treatment of bacterial superinfections in the context of ascites:

Amoxicillin + clavulanic acid (eg Amoxicillin E Clavulanic Acid Sandoz): it is recommended to take 1 gram of amoxicillin combined with 200 mg of clavulanic acid for bacterial infections in the context of ascites. indications dictated by the doctor.
Cefotaxime (eg Cefotaxime, Aximad, Lirgosin, Lexor): the drug is a third generation cephalosporin. As an indication, administer 2 grams of the drug every 8 hours. This drug treatment is particularly suitable for cases of ascites associated with pancreatitis.
Cefoxitin (eg Mefoxin): second generation cephalosporin used in therapy for the treatment of ascites; the treatment with this active is particularly indicated for superinfections caused by Enterococci. Indicatively, take 1 gram of drug every 6-8 hours, for 3-7 days.
Aztreonam (eg Cayston) the indicative dose is to take 500 mg of the drug every 8 hours. The duration of therapy should be determined by the doctor on the basis of the severity of the symptoms and the infection.

Albumin: for the treatment of ascites dependent on advanced cirrhosis.
The administration of albumin from the outside is also and above all indicated in evacuative paracentesis for the treatment of ascites resistant to pharmacological treatments: following an evacuative paracentesis (volume of ascitic fluid removed> 5 liters), it is recommended to inject albumin by route intravenous dose with low sodium content, approximately at a dose of 40g / paracentesis (corresponding to 6-8 grams per liter of removed ascitic fluid). It is also recommended not to exceed the infusion rate of 16 grams per hour.

A step back: let us briefly remember that albumin is a protein whose function is very important for the organism; albumin is involved in the complex mechanism of regulation of plasma oncotic pressure and the delivery of vitamins, drugs, free fatty acids and steroid hormones. The clinical-pathological picture of severe ascites is also characterized by hypoalbuminemia: for this reason , it is necessary to take albumin from the outside, following the evacuative paracentesis.