Action and Spectrum

Actions and spectrum: 

• Diuretic Effect: piretanide belongs to a class of diuretic drugs known as loop diuretics. It works by inhibiting reabsorption of sodium & chloride ions in ascending limb of the loop of Henle in the kidney. This action prevents the kidneys from reabsorbing these ions, leading to increased excretion of sodium, chloride, and water in the urine. The diuretic effect helps reduce fluid retention and lower blood pressure, making it useful in conditions such as edema (fluid retention) and hypertension (high blood pressure). 
• Antihypertensive Effect: piretanide’s ability to increase urine production and reduce fluid volume can lower blood pressure, making it beneficial in the treatment of hypertension. 
• Edema: piretanide is commonly prescribed to treat edema associated with conditions like congestive heart failure, cirrhosis of the liver, and kidney disorders. By removing excess fluid from the body, it can relieve symptoms of swelling and shortness of breath. 
• Congestive Heart Failure: piretanide is used in the management of congestive heart failure (CHF) to reduce fluid overload and alleviate symptoms such as swelling in the legs and shortness of breath. 
• Liver Cirrhosis: In cases of liver cirrhosis, piretanide can help reduce fluid accumulation (ascites) in the abdominal cavity. 

Drug Interaction

Adverse Reaction

Frequency not defined 

hypokalaemia 

hypochloraemic alkalosis 

hypotension 

Hyponatraemia 

hypomagnesaemia 

increased Ca excretion 

nausea 

hyperuricaemia 

hyperglycaemia 

GI disturbances 

Gout 

Rashes 

bone marrow depression 

Tinnitus 

pancreatitis 

Deafness 

muscle cramps 

Black Box Warning

Black Box Warning: 

piretanide does not have any black box warning. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: piretanide should not be used in individuals who are hypersensitive or allergic to the medication or other sulfonamide-derived drugs. 
• Anuria: piretanide is contraindicated in patients with anuria, which is a condition characterized by the complete absence of urine production. Since piretanide is a diuretic that increases urine output, it would not be effective in such cases. 
• Severe Hypokalemia: Hypokalemia is a condition marked by low levels of potassium in blood. piretanide can further lower potassium levels, so it should be avoided in patients with severe hypokalemia unless potassium supplementation is provided concurrently. 
• Severe Hyponatremia: piretanide can exacerbate hyponatremia, characterized by low levels of sodium in blood. It should be avoided in cases of severe hyponatremia unless sodium replacement is also administered. 
• Dehydration: piretanide can lead to increased fluid loss through diuresis, potentially worsening dehydration. It should be used cautiously in individuals at risk of dehydration and only under medical supervision. 
• Renal Failure: piretanide is primarily excreted by the kidneys. In cases of severe renal failure or kidney dysfunction, the accumulation of the drug can occur, leading to potential toxicity. Dosing adjustments are necessary in such cases.

Caution: 

• Electrolyte Imbalances: piretanide can cause imbalances in electrolytes, including low levels of potassium (hypokalemia), sodium (hyponatremia), and others. Patients with pre-existing electrolyte disturbances, such as those with heart conditions or kidney problems, should be closely monitored while using piretanide. 
• Gout: piretanide may increase uric acid levels in the blood, potentially worsening gout or precipitating gouty attacks in individuals with a history of this condition. 
• Blood Pressure: piretanide can lower blood pressure. Patients with hypotension or those taking other antihypertensive medications should be monitored closely to prevent excessive blood pressure reduction. 
• Pregnancy and Lactation: The use of piretanide during pregnancy and breastfeeding should be carefully considered. It can affect fluid and electrolyte balance, potentially impacting both the mother and the developing fetus or infant. Consultation with a healthcare provider is crucial in these situations.

Comorbidities: 

• Hypertension: piretanide is commonly prescribed to manage hypertension. Hypertensive patients often have other comorbidities such as heart disease, kidney disease, or diabetes that require ongoing medical attention. 
• Congestive Heart Failure: piretanide is used to treat edema associated with congestive heart failure. CHF is frequently accompanied by other cardiovascular conditions and comorbidities, including coronary artery disease, arrhythmias, and valvular heart disease. 
• Kidney Disease: piretanide’s effects on renal function make it important to consider kidney health. Patients with underlying kidney disease or reduced renal function may require dosage adjustments and careful monitoring of electrolytes and renal function. 
• Diabetes: Diabetic patients may need close monitoring while taking piretanide because diuretics can affect blood glucose levels. Adjustments in diabetes medications may be necessary. 
• Electrolyte Disorders: Patients with a history of electrolyte imbalances, such as hypokalemia or hyponatremia, may be more prone to experiencing these imbalances while on piretanide. Monitoring of electrolyte levels is crucial. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category: not assigned 

Lactation: excreted into breast milk: unknown 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

piretanide is a diuretic medication that exerts its pharmacological effects primarily in the kidneys. As a loop diuretic, it inhibits the reabsorption of sodium and chloride ions in ascending limb of loop of Henle, a part of the nephron in the kidney. By blocking these ion channels, piretanide prevents the normal reabsorption of these electrolytes and water, leading to increased urine production and subsequent elimination of excess fluid from the body.

This diuretic action is effective in reducing blood volume, lowering blood pressure, and alleviating conditions associated with fluid retention, such as edema and congestive heart failure. piretanide’s onset of action is rapid, making it a valuable medication for the treatment of conditions related to fluid and electrolyte imbalances.  

Pharmacodynamics: 

• Inhibition of Sodium and Chloride Reabsorption: piretanide is a loop diuretic that acts on ascending limb of loop of Henle. It inhibits the sodium-potassium-chloride co-transporter, preventing the reabsorption of sodium & chloride ions from the urine filtrate back into the bloodstream. This leads to the excretion of these ions in the urine. 
• Enhanced Diuresis: By blocking sodium and chloride reabsorption, piretanide promotes the excretion of these electrolytes, which draws water along with them. This results in increased urine production (diuresis) and a reduction in blood volume. 
• Reduction in Blood Pressure: The diuretic effect of piretanide contributes to a decrease in blood volume, subsequently reducing blood pressure. It is often used to manage hypertension (high blood pressure). 
• Treatment of Edema: piretanide is effective in reducing edema (fluid retention) associated with conditions such as congestive heart failure and renal dysfunction. By increasing urine output, it helps remove excess fluid from the body tissues. 
• Electrolyte Imbalance: piretanide’s diuretic action can lead to electrolyte imbalances, including hypokalemia (low potassium levels) and hyponatremia (low sodium levels). These imbalances can have various effects on the body and may require correction.

Pharmacokinetics: 

Absorption 

piretanide is typically administered orally in the form of tablets or capsules. It is absorbed primarily in the stomach and small intestine after oral administration. The absorption of piretanide is rapid, and its therapeutic effects can occur within about one hour after ingestion. 

Distribution 

piretanide is distributed throughout the body via the bloodstream. It has a large volume of distribution, meaning it can distribute widely into tissues and body compartments. piretanide is not extensively bound to plasma proteins, allowing it to exert its diuretic effects efficiently. 

Metabolism 

piretanide undergoes minimal metabolism in the liver. Unlike some other drugs, it does not undergo extensive hepatic biotransformation. Therefore, the parent drug is the primary active form of piretanide. 

Elimination and excretion 

The primary route of excretion for piretanide is through the kidneys. It is eliminated from the body in its unchanged form through renal excretion. piretanide’s diuretic effects contribute to the elimination of excess fluid and the drug itself via urine. 

Adminstartion

Administration: 

• Dosage: The dosage of piretanide can vary depending on the patient’s condition, age, renal function, and the specific product prescribed.  
• Timing: piretanide is usually taken once or multiple times a day, as directed by the healthcare provider. It is often recommended to take it in the morning to minimize nighttime diuresis, which can disrupt sleep. If multiple doses are prescribed, spacing them throughout the day can help maintain a consistent diuretic effect. 
• Take with Food: piretanide can be taken with or without food. However, taking it with food can help reduce the risk of stomach upset or gastrointestinal discomfort. 
• Consistent Timing: To maximize the drug’s effectiveness, try to take piretanide at the same time(s) each day. This helps maintain a consistent diuretic effect and ensures that the medication is working optimally. 
• Hydration: It is important to maintain adequate fluid intake while taking piretanide to prevent dehydration. Your healthcare provider may provide specific guidance on fluid intake based on your individual needs. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: piretanide 

Pronounced: (pye-RET-a-nide)  

Why do we use piretanide? 

• Hypertension (High Blood Pressure): piretanide is prescribed to lower blood pressure in individuals with hypertension. By reducing blood volume, it helps decrease the pressure on the walls of the arteries, thus contributing to better blood pressure control. 
• Congestive Heart Failure (CHF): piretanide is used to manage edema (fluid retention) associated with congestive heart failure. CHF can cause fluid to accumulate in the lungs and peripheral tissues, leading to shortness of breath and swelling of extremities. piretanide helps alleviate these symptoms by promoting diuresis. 
• Edema: piretanide is effective in reducing edema caused by various conditions, including heart disease, kidney dysfunction, and liver disease. It removes excess fluid from body tissues, reducing swelling and discomfort. 
• Renal Dysfunction: In cases of kidney dysfunction, such as nephrotic syndrome or acute kidney injury, piretanide may be used to manage fluid retention and maintain fluid balance. 
• Cirrhosis: piretanide can be prescribed to manage edema associated with liver cirrhosis. Liver cirrhosis can lead to fluid accumulation in the abdominal cavity (ascites) and lower extremities. 
• Pulmonary Edema: piretanide may be used to treat pulmonary edema, characterized by the fluid accumulation in the lungs. This condition often requires immediate medical attention.