Lister Plus
Generic Name
Furosemide + Spironolactone
Manufacturer
Acme Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| lister plus mouthwash | ৳ 150.00 | N/A |
Description
Overview of the medicine
Lister Plus is a combination diuretic containing Furosemide and Spironolactone, primarily used to treat edema (swelling) associated with various conditions and hypertension (high blood pressure). Furosemide is a potent loop diuretic, while Spironolactone is a potassium-sparing diuretic and aldosterone antagonist, which helps to counteract the potassium loss caused by furosemide.
Uses & Indications
Dosage
Adults
Typically, 1-2 tablets (Furosemide 20 mg + Spironolactone 50 mg) once daily. Dosage may be adjusted based on patient response and clinical condition.
Elderly
Lower initial doses are recommended, with careful titration due to increased sensitivity and potential for adverse effects.
Renal_impairment
Dose adjustment is necessary. Contraindicated in anuria and severe renal impairment. Monitor electrolytes and renal function closely.
How to Take
Lister Plus tablets should be taken orally, with or without food, as directed by a healthcare professional. It is usually taken once daily, preferably in the morning to avoid nocturnal diuresis.
Mechanism of Action
Furosemide inhibits the Na-K-2Cl cotransport system in the ascending limb of the loop of Henle, leading to increased excretion of sodium, chloride, and water. Spironolactone is an aldosterone antagonist that competitively binds to aldosterone receptors in the renal collecting tubules, increasing sodium and water excretion while decreasing potassium excretion.
Pharmacokinetics
Onset
Furosemide: Diuresis within 30-60 minutes. Spironolactone: Diuretic effect onset is gradual, usually after 2-3 days.
Excretion
Furosemide is primarily excreted unchanged by the kidneys (60-90%). Spironolactone metabolites are excreted mainly via urine and feces.
Half life
Furosemide: 1-2 hours. Spironolactone: Parent drug 1.3 hours, active metabolites (e.g., Canrenone) up to 16.5 hours.
Absorption
Furosemide is rapidly absorbed from the GI tract (bioavailability 60-70%). Spironolactone absorption is variable (bioavailability 65-90%) and increased with food.
Metabolism
Furosemide is minimally metabolized in the liver. Spironolactone is extensively metabolized in the liver to active metabolites like Canrenone.
Side Effects
Contraindications
- Anuria (absence of urine production)
- Acute renal insufficiency or rapidly deteriorating renal function
- Hyperkalemia (high potassium levels)
- Addison's disease
- Hypersensitivity to Furosemide, Spironolactone, or any excipients of the formulation
Drug Interactions
Digoxin
Increased risk of digoxin toxicity due to electrolyte disturbances (hypokalemia from furosemide, if potassium-sparing effect is insufficient).
Lithium
Reduced renal clearance of lithium, leading to increased lithium levels and toxicity.
Aminoglycoside antibiotics, Ethacrynic acid
Increased risk of ototoxicity (from furosemide).
ACE inhibitors, ARBs, NSAIDs, Potassium supplements
Increased risk of hyperkalemia.
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Overdose may lead to dehydration, electrolyte disturbances (especially hyperkalemia or hypokalemia, hyponatremia), hypotension, and cardiovascular collapse. Management involves discontinuing the drug, correcting fluid and electrolyte imbalances, and providing supportive care. Dialysis is generally not effective for furosemide but may be considered for spironolactone metabolites.
Pregnancy & Lactation
Lister Plus should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Furosemide crosses the placenta and Spironolactone metabolites may also. Both drugs are excreted in breast milk. Consult a doctor for advice regarding use during pregnancy and lactation.
Side Effects
Contraindications
- Anuria (absence of urine production)
- Acute renal insufficiency or rapidly deteriorating renal function
- Hyperkalemia (high potassium levels)
- Addison's disease
- Hypersensitivity to Furosemide, Spironolactone, or any excipients of the formulation
Drug Interactions
Digoxin
Increased risk of digoxin toxicity due to electrolyte disturbances (hypokalemia from furosemide, if potassium-sparing effect is insufficient).
Lithium
Reduced renal clearance of lithium, leading to increased lithium levels and toxicity.
Aminoglycoside antibiotics, Ethacrynic acid
Increased risk of ototoxicity (from furosemide).
ACE inhibitors, ARBs, NSAIDs, Potassium supplements
Increased risk of hyperkalemia.
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Overdose may lead to dehydration, electrolyte disturbances (especially hyperkalemia or hypokalemia, hyponatremia), hypotension, and cardiovascular collapse. Management involves discontinuing the drug, correcting fluid and electrolyte imbalances, and providing supportive care. Dialysis is generally not effective for furosemide but may be considered for spironolactone metabolites.
Pregnancy & Lactation
Lister Plus should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Furosemide crosses the placenta and Spironolactone metabolites may also. Both drugs are excreted in breast milk. Consult a doctor for advice regarding use during pregnancy and lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from the date of manufacture
Availability
Pharmacies, Hospitals
Approval Status
Approved in Bangladesh
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Clinical trial data supporting the efficacy and safety of Furosemide and Spironolactone combinations are available through established medical literature and regulatory submissions. Specific trials for 'Lister Plus' would be proprietary to the manufacturer.
Lab Monitoring
- Serum electrolytes (sodium, potassium, chloride, magnesium) at baseline and regularly during treatment
- Renal function (BUN, creatinine) at baseline and regularly
- Liver function tests
- Blood glucose levels (especially in diabetic patients)
- Uric acid levels
Doctor Notes
- Emphasize careful monitoring of serum electrolytes (especially potassium), renal function, and blood pressure during treatment.
- Advise patients on dietary restrictions (e.g., potassium-rich foods, salt substitutes).
- Be vigilant for signs of hyperkalemia (e.g., muscle weakness, fatigue, bradycardia) and hypokalemia (e.g., cramps, arrhythmias).
- Consider potential drug interactions, especially with ACE inhibitors, ARBs, and NSAIDs.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine without consulting your doctor, even if you feel better.
- Report any unusual side effects, especially severe dizziness, muscle weakness, or irregular heartbeat.
- Be aware of symptoms of dehydration, such as excessive thirst, dry mouth, or decreased urination.
- Avoid lying down immediately after taking the medicine to reduce the risk of heartburn.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Lister Plus may cause dizziness or lightheadedness, especially when starting the treatment or increasing the dose. If you experience these symptoms, avoid driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Follow a low-sodium diet as advised by your doctor to enhance the effectiveness of the diuretic and manage blood pressure.
- Limit or avoid foods high in potassium to prevent hyperkalemia.
- Engage in regular physical activity as appropriate, but be cautious of sudden changes in posture to avoid dizziness.
- Monitor your weight regularly and report any sudden, significant changes to your doctor.
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