Furosemide with Clofibrate Interaction Details
Brand Names Associated with Furosemide
- Furosemide
- Lasix®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
Muscle pain and stiffness, accentuation of diuretic effects, and elevations in serum transaminases and creatine phosphokinase
Interaction Summary
The concurrent administration of furosemide and clofibrate has resulted in muscular pain and stiffness, general malaise, pronounced diuresis, and elevated levels of serum transaminases and creatine phosphokinase. These are more prominent in patients with nephrotic syndrome, hypoalbuminemia, and hyperlipoproteinemia. Similar muscular effects have also been reported with clofibrate monotherapy . The proposed mechanism for the furosemide-clofibrate interaction involves competition for protein binding sites, especially in the presence of hypoalbuminemia, which results in higher free levels of each drug .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Avoid the concurrent use of clofibrate and furosemide. If concomitant therapy is required, monitor the patient for signs of myopathy (muscle pain and weakness) and for excessive diuretic effects. Also monitor renal function, serum transaminases and creatine phosphokinase. In a patient with low serum albumin, the daily dose of clofibrate should not exceed 0.5 grams for each 1 gram per 100 ml of the serum albumin concentration.
Mechanism Of Interaction
Competition for plasma albumin binding sites
Literature Reports
A) One study described five patients on maintenance diuretic therapy who experienced muscular pain, stiffness, and malaise when given clofibrate. All of the patients had hyperlipoproteinemia secondary to nephrotic syndrome. It was discovered that a higher proportion of clofibrate was not bound, possibly because low serum albumin reduces the number of binding sites for the drug. The increased proportion of clofibrate that was unbound may be responsible for its toxic effects. Furosemide is also bound to albumin, thereby creating a competitive environment for binding sites. Three of the patients experienced pronounced diuresis, which could be attributed to clofibrate displacing some of the bound furosemide. This sudden diuresis could also contribute to muscular cramping by causing increased urinary losses of potassium and sodium. Additionally, the half-life of clofibrate was increased from 12 hours to over 36 hours in most of these cases, which could also potentiate its toxic effects .
Furosemide Overview
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Furosemide is used alone or in combination with other medications to treat high blood pressure. Furosemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Furosemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.