Treatment of ascites: Part I. Pharmacological armamentarium

Orsolya Halmos, Paolo Inturri, Lorenzo Rossaro

Research output: Contribution to journalArticle

Abstract

Ascites is a frequent complication of cirrhosis and results from increased sodium and water retention with fluid accumulation in the peritoneal cavity. This complication not only impairs the quality of life of patients with advanced liver disease, but also represents an important cost to society. The main therapeutic goal is to achieve negative sodium balance by sodium restriction and diuretics. Aldosterone antagonists are the first- line treatment and 50-90% of patients respond to these drugs alone. Loop diuretics are effectively combined with aldosterone antagonists with an additional increase in the response rate to 90%. Side effect profiles for both classes of drugs are acceptable but need to be recognized (electrolyte disturbance, renal impairment, gynecomastia). Other possible effective drugs under investigation are torasemide, atrial natriuretic factor, vasopressin and aquaretics. In the case of refractory or tense ascites, paracentesis is the first choice of treatment, while alternative procedures such as peritoneovenous shunts, transjugular intrahepatic portosystemic stent shunt and liver transplantation should be considered in patients whose ascites reaccumulates despite intensive conservative therapy.

Original languageEnglish (US)
Pages (from-to)343-352
Number of pages10
JournalDrugs of Today
Volume33
Issue number5
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology (medical)
  • Pharmacology

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