Pharmacokinetics and pharmacodynamic effects of furosemide in patients with liver cirrhosis.

Ten patients with compensated cirrhosis of the liver, 7 patients with portal decompensated cirrhosis of the liver and 10 patients with intact liver function were investigated. After intravenous injection of 40 mg furosemide elimination half-life, total and excretory clearance were not significantly different in the 3 groups investigated, but renal clearance was enhanced in the 2 cirrhosis groups and nonrenal clearance diminished in patients with decompensated cirrhosis of the liver. In those patients distributional volumes were significantly higher than in the control group. According to the increased urinary excretion of unchanged furosemide in patients with cirrhosis of the liver, the pharmacodynamic effect of the drug is enhanced: In the first 4-h-collecting period the excretion of water, chloride and sodium is significantly more increased than in the control group. After a period of 24 h this effect is still noticeable. The effect of furosemide on the excretion of potassium, creatinine and urea nitrogen is not significantly influenced by liver disease. Doubling the dose from 40 to 80 mg furosemide did not enhance the diuretic effect of the drug despite the doubled urinary excretion of unchanged furosemide.