Rheumatic heart disease complicating pregnancy. The remote prospects.

1 RIAMTERENE MEDICAL JOURNAL azotaemia with intermittent use of SKF 8542 suggests there is some reversible effect on renal blood-flow. The diuretic response to the combination of SKF 8542 and chlorothiazide is excellent and all patients lost their ascites. The drug was active within a few hours of administration, and, unlike spironolactone, need not be given on consecutive days to obtain a diuretic response. In no patient could the administration of SKF 8542 be related directly to the production of hepatic precoma or coma. The maximal effective dose was between 150 and 200 mg. daily, given in two doses daily. Long-term follow-up of four patients showed only one patient who reaccumulated ascites while on combined SKF 8542 and chlorothiazide therapy. There have been no toxic effects with 14 months' continuous use of the drug. SKF 8542 is an effective diuretic in patients with cirrhosis and intractable ascites, particularly when given in combination with a proximal tubular diuretic of the thiazide series. The similarity to spironolactone suggests a distal tubular site of action through a mechanism not dependent upon the blockade of aldosterone. Summary The effect of triamterene (SKF 8542), a new pteridine diuretic, alone and in combination with cblorothiazide has been assessed in 10 patients with ascites due to cirrhosis of the liver. When given alone SKF 8542 produced only a small sodium diuresis without clinical alteration of the ascites. However, when combined with chlorothiazide the previous diuretic resistance to both diuretics individually was abolished and a satisfactory control of ascites was achieved in all cases. The similarity of action to spironolactone suggests it acts on the distal renal tube, although potassium depletion did occur and supplements were necessary when the drug was combined with chlorothiazide. SKF 8542 significantly increased the sodium diuresis in four patients already receiving spiro4olactone and chlorothiazide. This observation confirmed previous suggestions that SKF 8542 produces a sodium diuresis independently of an antagonism of aldosterone. Glomerular filtration rates were reduced by an average of 30% during continuous combined diuretic therapy with SKF 8542 and chlorothiazide, but reverted to control levels when intermittent therapy was given. No direct evidence of nephrotoxicity was found. Two patients have been maintained for 14 months on intermittent SKF 8542 and chlorothiazide without adverse side-effects. We wish to thank Messrs. Smith Kline and French Laboratories Ltd. for supplies of SKF 8542 (" dytac ") and financial assistance, and Miss J. Middleton for …