Frulac 40 - Tablet Frusemide + Spironolactone - 40mg+50mg 10 Tablet(s) / Strip Orion Pharma Ltd. Indication: Hypertension, Congestive heart failure, Oedema, Ascites Adult Dose: Adult: Per tab contains furosemide 20 mg and spironolactone 50 mg. 1-4 tabs/day. Contraindication: Hypersensitivity, anuria or severe oliguria, hypovolaemia, hyponatraemia, hypotension, urinary retention due to prostatic hypertrophy, Addison's disease, renal impairment, hyperkalaemia, acute or severe liver failure. Pregnancy and lactation. Mode of Action: Furosemide inhibits reabsorption of Na+, Cl- and K+. Continuous use may also lead to secondary hyperaldosteronism. Spironolactone is a specific antagonist of aldosterone. It increases Na and water excretion but retains K+. Thus it acts both as diuretic and an antihypertensive. It reduces oedema and counteracts secondary aldosteronism caused by vol depletion Na loss. K loss is reduced. Precaution: Concomitant use with ACE inhibitors, monitor fluids and electrolytes including changes in serum K levels. Dilutional hyponatraemia or even a true low-salt syndrome may develop. General anaesthesia. Side Effect: Fluid and electrolyte imbalance, nausea, diarrhoea, blurred vision, headache, dizziness, hypotension, photosensitisation, hepatic dysfunction, hyperglycaemia and glycosuria, rarely bone marrow depression, gynaecomastia, hirsutism, hoarseness, menstrual irregularities, loss of libido, impotence. Potentially Fatal: Severe hyperkalaemia in patients with preexisting renal impairment or taking ACE inhibitors, agranulocytosis, cardiac arrhythmias. Interaction: 1. Frusemide: Aminoglycosides and ethacrynic acid (increased ototoxicity), tubocurazine, succinylcholine (effects enhanced). Sucralfate reduces effects of furosemide. Should be given 2 hr apart. NSAIDs reduce natriuretic and antihypertensive effects of furosemide. Corticosteroids may antagonise action. Digoxin levels may be increased. Warfarin effects may be reduced. Potentially Fatal: Potassium supplements or potassium-rich diet, ACE inhibitors, general anaesthetics (reduced vascular responsiveness to catecholamines), lithium toxicity. 2. Spironolactone: Sodium excretion effect may be inhibited by aspirin. May reduce ulcer-healing properties of carbenoxolone. Increased risk of nephrotoxicity when used with NSAIDs or ciclosporin. Hyperkalaemia may occur if given with potassium supplements, ACE inhibitors, angiotensin...