Undervalued for years, and then we got evidence that a diuretic could do more than symptom control in heart failure.
Given that unlike loop diuretics its use at low dose in heart failure is associated with reduced mortality it should be diuretic of choice in those not at risk of hyperkalaemia complications in this indication.
- Left ventricular failure
- Malignant ascities
- Nephrotic syndrome
Needs careful monitoring of electrolytes when combined (which should be at low dose) with an ACE inhibitor or angiotensin-II receptor antagonist.