Medications for ascites

Fluid buildup in the abdomen (ascites) is a serious problem that often develops in people who have cirrhosis. A doctor may want to perform a procedure called a paracentesis to collect a sample of fluid from the abdomen. The fluid would be analyzed to help the doctor determine the cause of the fluid buildup if cirrhosis has not been diagnosed.

Diuretics, such as spironolactone and furosemide, are a key treatment for ascites. They help the kidneys eliminate salt and water from the body. When diuretic medications are combined with a low-salt diet, 90% of people are able to control their ascites.¹

Side effects of diuretics may include:

• Frequent urination.
• Increased thirst.
• Dry skin and eyes.
• Reduced levels of potassium, magnesium, and sodium in the blood. Very low levels of these salts (electrolytes) can lead to serious irregular heartbeats (arrhythmias).
• Increased levels of uric acid (which may lead to gout), calcium, blood sugar (which may complicate control of diabetes), triglycerides, and cholesterol.
• Weakness.
• Muscle cramps.
• Breast swelling and tenderness in males (gynecomastia) when spironolactone is used.

Higher doses can cause excess fluid loss from the body (dehydration), decreased kidney function (renal insufficiency), and fainting, especially in older adults. People who are taking diuretics to treat ascites caused by cirrhosis need to have their body weight, electrolytes, and kidney function carefully monitored while taking the medications.

People who continue to have ascites despite the standard treatment with diuretics and a low-sodium diet may need additional treatments, such as:

• Repeated paracenteses.
• Transjugular intrahepatic portosystemic shunt (TIPS). This procedure redirects blood flow to reduce pressure in the liver's portal vein system.
• Liver transplantation. Not everyone is an acceptable candidate to receive a liver transplant.

Citations

1. Runyon BA (2006). Ascites and spontaneous bacterial peritonitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1935–1964. Philadelphia: W.B. Saunders.