ABSTRACT

DRUG UTILIZATION STUDY OF DIURETICS

IN HEPATIC CIRRHOSIS PATIENT WITH ASCITES
(Studied in Inpatient Rooms of Internal Medicine Installation
RSUD Dr. Soetomo Surabaya)

LAILY SOFIA ADIBA

Backgrounds : Cirrhosis is an advanced stage of liver fibrosis. Ascites is the most common
complication of cirrhosis. Diuretics (spironolactone with or without furosemide) are the first-line
treatment of patients with cirrhosis and ascites.

Objectives : The purpose of this study is to find the characteristic of hepatic cirrhosis patients, identify
the profile of diuretic drugs for hepatic cirrhosis patient with ascites, identify the pattern of diuresis
and electrolyte on hepatic cirrhosis patient with ascites, and the possibility of Drug Related Problem
(DRP) in diuretic therapy for hepatic cirrhosis patient with ascites at RSUD Dr. Soetomo Surabaya.

Methods : Data was collected crossectionally with non-random and time limited sampling method in
the period of 22 March until 22 June 2016 in Inpatient Rooms of Internal Medicine Installation RSUD
Dr. Soetomo Surabaya. The inclusion criteria were all hepatic cirrhosis inpatient with ascites
complication ongoing diuretic therapy for 3 days or more. This methodology has been approved by
ethics committee of RSUD Dr. Soetomo Surabaya.

Results and conclusion : The results of observational study on 34 patients showed that the general
characteristic of the cirrhosis patients is male (67,65%), age 51-60 (35,29%), education level Senior
High School (44,12%), private employees (35,29%), and from Surabaya (82,35%), while the disease
related characteristic are length of stay 6-8 days (38,24%), discharge condition recovered (82,35%),
etiology Hepatitis B (52,94%), severity rate Child Class C cirrhosis (55,88%), clinical manifestation
pretibial edema (70,59%), complication hypoalbuminemia (64,71%), comorbidity cardiovascular
disease (25,53%), with hypertension past medical history (23,53%).
Diuretic drugs that used the most in this study were combination of spironolactone and
furosemide (73,53%). Spironolactone mostly used orally 100 mg once daily dose (63,89%), while
furosemide mostly used IV 20 mg three times a day (36,11%). Initial therapy of diuretic used in Child
Class B cirrhosis is spironolactone 100 mg (58,33%), in Child Class C cirrhosis is spironolactone 100
mg combined with furosemide 60 mg (26,32%), and in malignant degeneration cirrhosis entirely
given furosemide 60 mg (100,00%). Patient with hypokalemia and normokalemia mostly used
combination therapy of spironolactone and furosemide, while hyperkalemia patient mostly used
furosemide monotherapy. Therapeutic response based on the daily loss of body weight and daily urine
volume was achieved in the most patients.
Drug Related Problem (DRP) in this study were adverse drug reaction such as hyperkalemia
due to spironolactone (2 patients), hypokalemia due to furosemide (6 patients), and hyponatremia (11
patients); potential drug interaction in the use of furosemide-digoxin (2,94%), spironolactone-digoxin
(2,94%), spironolactone-ASA (2,94%), and spironolactone- potassium supplements (44,12%). Actual
drug interaction was not found in this study.

Keywords: Diuretics, Spironolactone, Furosemide, Hepatic Cirrhosis, Ascites