Dirusid Tablet

Combination of a loop diuretic and a potassium-sparing (aldosterone antagonist) diuretic for:

• Fluid retention (oedema) and ascites in liver cirrhosis
• Oedema in heart failure and nephrotic syndrome
• Resistant fluid retention where potassium needs to be preserved

Adults: 1–4 tablets daily (each frusemide 20 mg + spironolactone 50 mg, or 40/50 mg), usually in the morning, adjusted to response.

• Ascites in cirrhosis: commonly spironolactone 100 mg + frusemide 40 mg daily, increased stepwise (ratio about 100:40) to a maximum of spironolactone 400 mg + frusemide 160 mg.
• Aim for gradual weight loss (about 0.5 kg/day without leg swelling, up to 1 kg/day with swelling).
• Take in the morning (and early afternoon if twice daily) to avoid night-time urination.
• Not for children.

• High potassium, Addison's disease
• Severe kidney impairment or no urine output
• Severe low sodium, dehydration, low blood volume
• Hepatic coma/pre-coma
• Use with potassium supplements or other potassium-sparing diuretics (amiloride, triamterene), eplerenone
• Pregnancy and breastfeeding
• Allergy to furosemide, sulphonamides or spironolactone

Common: passing more urine, dizziness, thirst, dehydration, low blood pressure, high or low potassium, low sodium, raised uric acid (gout), raised blood sugar, muscle cramps.

Spironolactone: breast enlargement/tenderness in men, menstrual changes, reduced libido, stomach upset.

Rare but serious: kidney injury, confusion or hepatic encephalopathy in cirrhosis, severe skin reactions, pancreatitis, low blood counts, hearing loss (high-dose furosemide).

• Regular blood tests for potassium, sodium and kidney function, especially at the start and after dose changes.
• Weigh daily; report rapid weight loss, dizziness, confusion or very little urine.
• Avoid salt substitutes containing potassium.
• Diabetes, gout, enlarged prostate (urinary retention): caution.

Not recommended in pregnancy (spironolactone has anti-androgen effects; diuretics reduce placental blood flow) or while breastfeeding.

• ACE inhibitors, ARBs, potassium supplements, trimethoprim, ciclosporin (dangerous high potassium)
• NSAIDs (reduce effect, kidney injury)
• Lithium (toxicity)
• Digoxin (toxicity if potassium changes)
• Aminoglycosides, vancomycin (ear/kidney damage with furosemide)
• Other antihypertensives (low blood pressure)

Dehydration, low blood pressure, electrolyte disturbances (high or low potassium, low sodium), confusion. Seek medical care.

Store below 30°C, protected from light.