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Lasix, Spironolactone and swelling?
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Lasix, Spironolactone and swelling?

I have a daily fight going on with swelling of my feet, lower legs, and my hands.  I've been prescribed lasix and spironolactone and it helps but it only helps to get me to go to the bathroom more I don't really think it minimizes the swelling.  Anyways I have two questions for y'all as I know there's at least two other ppl on this forum who take these direutics.  

1.  What if the Lasix stops working, is there another direutic I can take that you know about?  

2.  I'm really apprehensive about taking the Spironolactone because I know it helps remove ascities from the belley and if you don't have ascities in the first place, does it create a new elimination route to remove the ascities?  
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18 Comments Post a Comment
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446474_tn?1404424777
Hi fretboard!

Sorry if this is not articulate. My encephalopathy is making itself know in a big way so please bare with me...here goes.

From what I understand, you seem to be saying that you have edema but not ascites? And you are only taking Lasix now. So apparently your illness has progressed and needs more help eliminating the edema?
(Check out the articles below that explain how ascites and (perhaps more useful) edema develops and functions).

A couple of dumb questions first.
1. How is your salt intake? The only reason I ask is that if I have too much salt in my diet the meds don't work as effectively. Remember to stay under 2000 mg. sodium per day. Read labels on processed food and avoid salty foods.

2. Do you have "pitting".

1. Other meds similar to Lasix are torsemide (Demadex) and butethamine (Bumex). I never tried these and everyone I know is taking the standard Spironlactone and Lasix combo as we all have both symptoms which seem to occur in tandem.

(There is another med for Spironolactone, Aldactone, but it is not as effective for me and many others. I tried it for a month or two but didn't control my ascites as well as the Spironolactone. I am back on Spironolactone. I had switched because of the "tender and enlarged breasts" but would rather deal with that then ascites and edema).

2.  It eliminates the fluid in the same way. It is nothing to worry.
Remember that Spiron and Lasix are normally use in combination in order to keep Potassium levels in balance. Spironolactone and Aldactone cause the body to retain potassium Lasix decreases potassium. That is why there is a formula for for how much dosage should be taken of each. Together they work to keep  potassium levels normal.

Best-
Hectorsf
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http://www.medicinenet.com/edema/page7.htm#diuretics

Which diuretics are used to treat edema?

Edema can become a problem in systemic diseases of the heart, liver or kidneys. Diuretic therapy can be initiated, often alleviating the edema. The most potent diuretics are loop diuretics, so-called because they work in the portion of the kidney tubules referred to as the loop of Henle. The kidney tubules are small ducts that regulate salt and water balance, while transporting the forming urine. Clinical loop diuretics available are:

    * furosemide (Lasix),

    * torsemide (Demadex), and

    * butethamine (Bumex).

The doses of these diuretics vary depending upon the clinical circumstances. These drugs can be given orally, although seriously ill patients in the hospital may receive them intravenously for more prompt or effective response. If one of the loop diuretics is not effective alone, it may be combined with an agent that works further down (more distally) in the tubule. These agents include the thiazide type diuretics, such as hydrochlorothiazide (HydroDIURIL), or a similar but more potent type of diuretic called metolazone (Zaroxolyn). When diuretics that work at different sites in the kidney are used together, the response often is greater than the combined responses to the individual diuretics (synergistic response).

Some diuretics frequently cause an excessive loss of potassium in the urine, leading to the depletion of body potassium. These drugs include the loop diuretics, the thiazide diuretics, and metolazone. Patients on these diuretics are commonly advised to take potassium supplements and/or to eat foods high in potassium. High potassium foods include certain fruits such as:

    * bananas,

    * orange juice,

    * tomatoes, and

    * potatoes.
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As cirrhosis of the liver develops, signals are sent to the kidneys to retain salt and water. This excess fluid first accumulates in the tissue beneath the skin of the ankles and legs (due to the pressure of gravity). This accumulation of fluid is called edema or  pitting edema. Pitting edema refers to the observation that pressing a fingertip against a swollen ankle or leg causes an indentation that persists for some time after release of the pressure. Actually, any type of sufficient pressure, such as from the elastic part of socks, can produce pitting edema. The swelling often is worse at the end of the day and may lessen overnight. As more salt and water are retained and liver function decreases, fluid may also accumulate in the abdomen. This accumulation of fluid (called ascites) causes swelling of the abdomen.
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http://www.focusondiabetes.com/script/main/Art.asp?li=MNI&ArticleKey=12699&page=4

"Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. The edema is a consequence of the hypoalbuminemia and activation of the renin-angiotensin-aldosterone hormonal system, which prompt the kidneys to retain salt and water".


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Avatar_f_tn
If the diuretic isn't helping the swelling, could the swelling from another cause, such as osteoarthritis?  

I'm pretty sure that if lasix "stops working" they can prescribe a diuretic pill for you that contains more than one type of diuretic.  There are 3 basic types of diuretics; each of which work in a different way.  Attached is a link describing diuretics by Mayo Clinic.  

http://www.mayoclinic.com/health/diuretics/HI00030

Good luck with this.

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374652_tn?1311302831
Maybe you could find someone who does Manual Lymph Drainage.  It works well for edema, burn victims, patients who have had lymph nodes removed and it feels wonderful, it is so gentle and rhythmic.  Anyone who is certified has had extensive training and is competent to work with serious illness. with consent from Dr.
I believe it is out of Austria, and Germany, where they do extensive manual therapies.
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Avatar_f_tn
In addition to what Hector said, watch the foods you buy as they always
seem to have salt,sodium in them.  You have to be very careful.
Stay clear of MSG also.  You have to read the labels of everything you purchase for
food with edema.

Consult with your hepatologist also, as they can change your diuretic or up the dose.

Also, what helped my son a lot is.....after being on your feet all day.....try and
elevate your legs and feet at the end of the day, if possible raise them above the heart.
It really does help. His team also said to raise the mattress at the end of the bed at night.
(he tried that, however , could not sleep)

We went from boots to sandals to socks to nothing...as the feet and legs swelled and
sometimes cracked.  Some of these little things in addition to the advice of  your hepatologist
will help.
I sincerely wish you the very best.

Hector , it looks like you're doing OK from here !!! all my very best to you as well Hector.
Keep me informed:)
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374652_tn?1311302831
Another thing that helps move lymph is a bouncing motion, like a physioball, or a mini trampoline.  very gently, very consistently,
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Avatar_m_tn
Hector:  My doc recently switched me from Spironolactone to inspra (eplerenone) due to the breast enlargement issues. The tenderness has subsided and, so far, the edema is under control. Hopefully, this will prevent me from graduating to a b cup :0.  I'm not sure if this combo will work for you, but it may be worth checking into.  Be well!

Fretboard:  As usual, Hector has pretty much covered everything. I'm not sure what dose you are on, but it may need to be increased.  Whatever you do, please make sure to keep an eye on your potassium levels when taking diuretics.
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87972_tn?1322664839
I wasn’t aware you were cirrhotic, Fretboard. Has this edema been formally attributed to liver disease?

Other possible causes of edema are right side heart failure, kidney issues, and DVT of the legs (especially if only apparent on one side).

Is the edema painful? It’s my understanding that edema itself isn’t damaging, but that it can be flagging something potentially more serious.

Others have given you some really good thoughts; I just had to butt in myself :o).

Good luck,

Bill
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87972_tn?1322664839
Oops, rereading, it looks like Hector pretty much covered everything I mentioned.

Bill
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446474_tn?1404424777
"graduating to a b cup" hmmmm...I think I'm still an "A' cup. (Any ladies that can tell me the difference between "A" and "B" cups would be appreciated). I figure it makes be look more muscular in the chest. Buff. Maybe the encephalopathy is worse then I know? ha ha

The sensitivity is what drives me crazy. If anything just pushes on my nipples it gets my attention real fast. Biting? Forget about it. I will hit the ceiling. But not in a good way, if you know what I mean. ;-)

Ah, the many joys of decompensated cirrhosis.

Cheers!
Hectorsf
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Avatar_m_tn
If you are able to bite them, you've obviously grown beyond an A cup ;)

Seriously, though, the change in meds has dramatically improved the sensitivity issue for me!!!
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408795_tn?1324939275
I appreciate the comments friends!.  I guess I better start taking my fully prescribed dosage levels, it just seems like way to much for me and I've been really leery about taking the spironlactone.  I'm supposed to take 3 of those spironlactones a day of the 25mg tablets and a 20 mg lasix.  I'm gonna talk to my doctor again too b/c I think I was doing better when I was on 40mg lasix.  I didn't need 40 mgs every single day but I think I need more than the 20mgs that's for sure.  I work hard to stay away from salt but I guess I'll have to get even more aggressive.  anyways, thanks again gang!!

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446474_tn?1404424777
Fret

Trying to stay away from salt is a full-time occupation. But it s a must! The meds won't be effective if you are taking in too much sodium. Sodium is everywhere! After awhile you'll get used to it. No processed food. No restaurant food (loaded with salt for flavor). Just a can of soup can be 40% of your daily intake. Just look on the labels at sodium. What out for the "Reduced salt" labels. They still have a lot of salt. You must look at sodium per serving. Also remember edema doesn't change in a day. It is like HCV treatment, it builds up in the body. If I become bloated it take me 2 weeks to get it back under control. So you need to be consistent day to day with your sodium intake and meds.  
The good news is you live in California. Look in health food stores. They usually will have foods with a ton of salt. But be careful. It may  be organic, healthy etc. but they still put as much sodium in many of the foods as the regular brands.

Remember to increase the effects of the dialectics, your doctor will increase BOTH meds. I currently take Spiro 100 mg and Lasix 40 mg. Used to take 200 & 80. They work in combination. Now that you will be talking both together the diuretic effect will be more then Lasix alone. This is what you want. You should notice your peeing more then before.

Gotta go an have endoscopy...later

Good luck. Let us know how it goes.

Hectorsf
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446474_tn?1404424777
Here is more info about how ascites and edema develop.
It also shows that the combination of Spironolactone & Lasix is more effective because it treats multiple causes of the problem of fluid retention. (The aldosterone (Which Spironolactone stops) causes the kidneys to retain sodium in the first palace). Lasix alone only gets rid of the sodium in the kidneys AFTER sodium is stored in the kidneys.

These notes are from imkindly.

"In cirrhosis patients, edema and ascites are directly related to the kidneys retaining sodium. But there's other things involved too...
------------------------------------------------------------------------------
First-- lets look at how a perfectly healthy body works.

In a healthy person---

    * If the blood pressure or blood volume falls (for any reason)..... the adrenal glands (ontop of each kidney) release aldosterone.
          o The aldosterone causes the kidneys to retain sodium
                + The retained sodium (in the kidneys), causes the body to retain fluid
                      # The retained fluid (in the body) causes the blood volume (amount of blood in our veins) to increase
                            * The increased amount of blood (in our veins) causes our blood pressure to rise. (Problem solved)

Ok, keeping all of that in mind....
--------------------------------------------------------------------------------------------------------------------
People with advanced liver disease may have portal hypertension and low albumin.

    * Portal hypertension and low albumin, cause fluid to leak out of blood vessels (and collect as ascites or edema)
          o Fluid leaking out of the blood vessels, can cause blood volume and blood pressure to drop
                + * If the blood pressure or blood volume falls (for any reason)..... the adrenal glands (ontop of each kidney) release aldosterone.
                      # The aldosterone causes the kidneys to retain sodium
                            * The retained sodium (in the kidneys), causes the body to retain fluid
                                  o The retained fluid (in the body) causes the blood volume (amount of blood in our veins) to increase
                                  o Portal hypertension and low albumin, cause fluid to leak out of blood vessels (and collect as ascites or edema)
                                        + Fluid leaking out of the blood vessels, can cause blood volume and blood pressure to drop
                                        + * If the blood pressure or blood volume falls (for any reason)..... the adrenal glands (ontop of each kidney) release aldosterone........ and the whole problem continues to REPEAT.......

So the person with advanced liver disease, ends up with a combination of problems:

1. The adrenal glands are constantly releasing aldosterone (hyperaldosteronism)
2. The kidneys are retaining as much sodium as they can
3. Ascites and edema build up in the body (because of portal hypertension and low albumin... and also because of the kidneys retaining that sodium)

(To put an absolute stop to the whole problem, you'd need the albumin level to improve, and the portal hypertension to improve)

Meanwhile though---- a person can cut down on sodium (so there's not an excess for the kidneys to retain)..... a person can also take Spironolactone* (spironolactone decreases sodium AND inhibits aldosterone)

****(Lasix decreases sodium, but does NOT inhibit aldosterone.)****"


Hectorsf
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408795_tn?1324939275
I appreciate your answering my questions about swelling as the subject doesn't come up much.  I started taking my 75mgs of spironlactone along with my 20mgs of lasix and I'm already feeling better.  I'm gonna have my doctor give me the 40mg lasix tabs as I know I can use them.  Thanks a million and take care of yourself amigo!!  
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233616_tn?1312790796
I'm really sorry to hear you are having this issue Fret, it sukss big time

the only thing that helped me was to eliminate restaurant food...unless I can order it with no salt, so sugar, no msg (and then salt it myself).

the thing is almost all the restaurants use msg now, and too much salt, and thats a big part of the battle.

It might seem like why bother if I have to be on lasix anyway, but the diuretics are really strong drugs so do as much control as you can manage to keep your dosage of them down, because they can really mess up your mineral balance, even if you do take potassium, they can still upset the apple cart and lead to a lot of pain and other issues.

hope you'll feel better soon.

mb
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Avatar_f_tn
Do the diuretics affect muscles? I have debilitating cramps (like Charley horses) in muscles throughout my body.  Even when I yawn, I get a cramp that is extremely painful and takes a little while to subside.  My fingers, toes, inner thighs, and even my abdomen cramp up to the point of rendering me unable to drive, or even stand up straight.  At night, I need help out of bed.  Doc says magnesium supplements, but I really don't think he understands the extent of the problem.  Any insights would be appreciated.  God bless us all.
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Avatar_n_tn
I am amazed at the wealth of information you all have.  I could really use your help. I have Autoimmune Hepatitis, diagnosed 12 years ago after taking Sulfa antibiotics. Had been stable up until 2 years ago when I was diagnosed hypothyroid, given generic medication which I again had an allergic reaction. To make a long story short, that event triggered my A.H. to rage, sending me into nearly total liver failure. After 3 weeks in the hospital, at the time only expected to live 2 weeks - that was 2 years ago and I've been on the liver transplant list.  I've worked very hard at getting healthy again and 3 months ago finally my liver tests are normal (doctors did not expect this). I also suffer from hepatic encephalopathy, became diabetic, etc. from all the medications to save my liver and my life.

I currently take Lasix 20mg and Spirolactone 50mg once a day. I still have severe abdominal bloating but doctors want to leave it alone.  My current and "new" problem is burning feet and leg spasms. I thought this might be attributed to diabetes but when I stopped taking Prednisone in March 2012, I have been able to go without having to take insulin for the last 2 months.  Doctors now want to send me to a Rheumatologist.  My new problem is so bad that  I had go to a sleep study a month ago and another one in a week.  I think it is not so much sleep but has something to do with the diuretics.  Would like to hear what you experts think about this. I have been to every specialist, every test.....hoping for a simple, if that is possible solution.  I would so like to hear from you all.
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Avatar_f_tn
Hi, first time post, I've just stumbled across this forum and seems few of you suffer similar things that I do.
While waiting for a liver transplant I had dreadful ascites and edema and took spiracton and lasix which helped, but the cramps! Holy mother of  devil spawned cramps!!
I actually blacked out once from the pain, both legs, every single muscle! I had my second liver transplant 3 months ago and things are fantastic, function tests normal, bilirubin 9 down from nearly 600 , energy levels returning etc BUT I'm getting the most horrific pain in my hips and legs and joints in my fingers, feels to me like an inflammatory condition, not cramps, drug side effect or something maybe  but it's unbearable at times. I'm also struggling still with edema, the ascites (my 2 year pregnancy!) has gone but not the edema.
I would love to hear any similar stories or thoughts on possible cause of the pain??
Cheers Heidi
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