Value of mercaptomerin and intravenous aminophylline in cardiac oedema resistant to other diuretics.

Abstract

Since the introduction of chlorothiazide and its analogues the place of mercurial diuretics in the treat ment of oedema due to congestive cardiac failure has become much smaller, and their use is now practically restricted to cases which fail to respond to the benzthiazide derivatives (Brit. med. J., 1959). Nevertheless, in any extensive cardiological practice there will be found a hard core of such cases, and some of these will prove unresponsive also to mercurials by injection, in spite of concurrent salt restriction, bed rest, and digitalis therapy. Ammonium chloride may sometimes restore responsiveness to mercurials, but its administration for this purpose has proved disappointing in our experience. It has therefore been for several years the practice of this unit to treat such resistant cases with the combination of mercaptomerin ( thiomerin ) intra muscularly, and, two hours later, aminophylline intravenously. The observed response of individual patients recently treated was so impressive that a search of the records during the past four years was made in an attempt to evaluate the true efficacy of this combina tion in producing diuresis, natriuresis, loss of weight, and clinical improvement where other drugs (usually including chlorothiazide) had failed. The analysis of this accumulated experience confirms the power of these diuretic agents combined in this way. No similar large-scale clinical assessment appears to have been recorded, although many 'years have passed since early descriptions of potentiation of mercurial diuresis by intravenous aminophylline (Goodman et al., 1942; Weston and Escher, 1948 ; Vogl, 1953), and this may possibly account for the less widespread use of the combination than its value would seem to merit.