aldectone

[Archer_]

I have stage 4 fibrosis (cirrhosis) and about two weeks after being in a coma / ICU from other surgical complications I got a first event of ascites. I was put on Aldectone 50mg. A week ago (three weeks following my first episode) my belly became distended, weight and girth increased. Three mornings ago my entire abdomen was taut, I was short of breath and my "belly button" painfully poking out. Next day at ER they took lung x-rays to exclude fluid - but no ultrasound scan. Agreed from physical check that I definitely had fluid - and prescribed Aldectone again.
The Aldectone prescription was for 200 mg a day when previously I responded to 50mg. The ER registrar advised on phone by a hepatologist who didnt know my case prescribed 200mg Aldactone. I stated that I didnt want unnecesarily high dose when previously I had only escalated dosage to 50mg daily to stabilise the ascites. Registrar  said the idea of the high dose was to really knock the ascites on the head as quickly as possible. Is there really, considering the side effects any added value in my taking the higher dose of Aldactone - if my condition is slowly improving with the lower doses.      

[Thomas D Schiano, MD]

aldactone doesnt work right away--it may take 10-14 days before all of the receptors are blanketed and it begins to work.  we typically do not treat ascites with aldactone alone as it works much better paired with furosemide.  i think that they should use them in combo which will also balance their potassium effects.

[Thomas D Schiano, MD]

how old are you?

[Archer_]

I find this reply interesting  - my weight and abdominal distension eased almost immediately - had returned to my previous weight on no more than 150 mg Aldectone within approx one week, certainly before ten days. I am now taking about 75 mgs daily, my potassium levels are normal, sodium slightly below normal. The test remaining of course is whether the ascites will increase with gradual Aldectone reduction and /or cessation. I would ideally like to restore capacity to manage this condition solely with dietary monitoring - and hope that I will not have to permanently sustain Aldectone dosing - which I see as a significant marker of deterioration and poorer prognosis. Please correct me if my perception is inaccurate. Now that I have been denied IFN treatment and am unlikely in this country (and because of my age) to obtain a liver transplant - for the purposes of my remaining longevity - I would like to have as clear a picture of my future trajectory as possible. Thanks for your reply. regards Archer -