[Fatal untoward effect of furosemide: immunocytopenic purpura and cerebral hemorrhage]. / Immunthrombozytopenische Purpura und letale zerebrale Blutung als unerwünschte Wirkung von Furosemid.

A 74 year old man was admitted to the hospital for purpura. The history revealed coronary heart disease. Bypass surgery had been performed 18 months ago. Furosemide had recently been prescribed for cardiac insufficiency and the patient had taken the drug intermittently over two weeks. Laboratory analysis showed severe thrombocytopenia. Despite immediate treatment with intravenous prednisolone and platelet transfusions the patient succumbed to cerebral hemorrhage. Autopsy confirmed a diffuse hemorrhagic diathesis and a cellular response of the bone marrow typical for an acute immune reaction. The start of the purpura nine to ten days after the first dose of furosemide, the exclusion of other possible causes for purpura and the focal proliferation of T-lymphocytes in the bone marrow render it highly probable, that furosemide was responsible for the fatal thrombocytopenia. Furosemide is discussed to have a potential for autoimmunological untoward effects due to its sulfonamide structure. Few case reports describe vasculitic and allergic phenomena. The generation of antibodies against thrombocytes and the depression of megakaryocytic function are thought to be involved. Our patient had been treated with furosemide during the bypass surgery 18 months before the development of purpura. A sensitization to furosemide probably took place at that time.

Use of optical biosensor technology to study immunological cross-reactivity between different sulfonamide drugs.

Adverse reactions to medications account for a substantial number of hospitalizations and in some cases fatalities. The nature of the many drug-drug interactions caused by the inhibition of drug-metabolizing enzymes can now be predicted and examined with a greater deal of accuracy due to research developments in the understanding of the drug-metabolizing enzymes. However, the more troubling aspects of drug-drug interactions are the idiosyncratic reactions that are unpredictable and quite often life-threatening. These reactions are often caused by a prior sensitization of a person's immune system to a given drug or class of drugs. The following work offers a technique to examine in a medium-throughput system the cross-reactivity of drugs to antibodies in order to predict if structures share the same antigenic potential toward a sensitized individual. Two commercially important sulfonamide drugs, sulfamethazine and furosemide, were taken and their binding to their respective antibodies were tested in the presence of other structurally related sulfonamide drugs. The BIACORE 3000 biosensor was used for the study and the solution-phase equilibrium assay principle was employed. The data obtained help us determine which drugs can react, and to what extent, with sulfamethazine and furosemide, giving rise to possible allergic or hypersensitivity reactions. Though sulfamethazine and furosemide were used in this study; this principle and methodology can be applied to study any drug molecule-antibody pair.

Immunosuppressive and cytotoxic effects of furosemide on human peripheral blood mononuclear cells.

BACKGROUND: We have previously shown that children with mild asthma have a modest improvement in their pulmonary function tests after aerosolized furosemide. The mechanism of action is not known. The observation that furosemide possesses a similar profile of protection as sodium cromoglycate and nedocromil sodium suggests that furosemide may inhibit mediator production and release. OBJECTIVE: We studied the in vitro effects of furosemide on cytokine release from normal human peripheral blood mononuclear cells (PBMC) induced by E. coli lipopolysaccharide (LPS). METHODS: Peripheral blood mononuclear cells were isolated by density gradient centrifugation, stimulated with LPS and incubated at 37 degrees C with varying concentrations of furosemide, hydrocortisone, sodium cromoglycate, and nedocromil sodium for 24 hours. Supernatants were extracted and study for levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8). Intracellular IL-6 and TNF-alpha concentrations were also measured by cell cytometry. Cell viability was examined using XTT cell proliferation test and-measuring the release of lactate dehydrogenase (LDH). RESULTS: There was a significant reduction in levels of TNF-alpha and IL-6 at a furosemide concentration of 0.5 x 10(-2) M and a reduction in IL-8 levels at 10(-2) M. This inhibition was comparable to that found with equivalent molar concentrations of hydrocortisone. These findings were also confirmed with measurements of intracellular IL-6 and TNF-alpha by cell cytometry. High concentration of furosemide at 10(-2) M caused significant cellular cytotoxicity. CONCLUSION: These data suggest that furosemide may exhibit an anti-inflammatory effect. Specifically, the addition of furosemide resulted in decreased production of cytokines. This effect may be due to an immunosuppressive activity on monocytes as well as a direct cytotoxic effect at high furosemide concentrations.

Characterization of monoclonal anti-furosemide antibodies and molecular modeling studies of cross-reactive compounds.

Four mouse monoclonal antibodies directed against furosemide have been isolated and characterized. The cross-reactivity of the antibodies with eight compounds which are structurally and/or functionally related to furosemide was determined using a competition ELISA. All of the compounds, including furosemide, were then modeled using molecular mechanical and quantum mechanical methods in an attempt to correlate antibody binding with the conformational and electronic properties of the molecules. The results of these experiments demonstrated that all of the cross-reactivity observed could be readily explained using these techniques. Furthermore, these results should allow for more accurate prediction of unexpected cross-reactivities with these antibodies when they are used in immunoassays for determination of furosemide.

Anaphylaxis to intravenous furosemide.

A patient with long-standing hypertension developed urticaria, angioedema, and hypotension within 5 minutes after the intravenous administration of furosemide. Immediate hypersensitivity was documented by positive skin tests to furosemide as well as to related sulfonamide-based drugs. This is the first finding of an anaphylactic reaction to furosemide and underscores the need to consider such adverse reactions when patients who are sensitive to other sulfonamide-containing drugs are being treated.

[Combined action of rubomycin and diuretics on the induction of antibody synthesis in mice]. / Sochetannoe deistvie rubomitsina i diuretikov na induktsiiu sinteza antitel u myshei.

The effect of 2 diuretics, diacarb and lasix on the intensity of immunodepressant action of low doses of rubomycin was studied. It was shown that diacarb increased the inhibitory effect of rubomycin on accumulation of the antibody-forming cells in the spleen. This effect was evident by the 3rd, 4th and 7th day after the antigen injection to the mice (the 4th, 5th and 8th day after the last injection of rubomycin). Combined use of rubomycin and diacarb also resulted in a low number of nuclear cells in the spleen as compared to control. Lasix did not increase the immunodepressant effect of rubomycin. Still, when used alone it had a capacity for changing the time course of the immune response development.