Short term effect of withdrawal of diuretic drugs prescribed for ankle oedema

BMJ 1994;308:511-513 (19 February)

General practice

Short term effect of withdrawal of diuretic drugs prescribed for ankle oedema

J W de Jonge, J A Knottnerus, W M van Zutphen, G A de Bruijne, H A J Struijker-Boudier

University of Limburg, PO Box 616, 6200 MD Maastricht, Netherlands Department of Pharmacology, University of Limburg, Netherlands Correspondence to: Dr de Jonge.

Abstract

Objective : To determine the effect of withdrawing diureticdrugs on oedema in patients prescribed them for only ankle oedema,excluding patients with cardiac, hepatic, or renal failure.
Design : Randomised controlled trial.
Setting : 15 general practices in the Netherlands.
Patients : 1202 patients aged 65 years or older and takingdiuretic drugs, 63 of whom were eligible for the trial.
Main outcome measure : Change in volumetrically determinedankle oedema (oedema index) over six weeks.
Results : 34 patients were randomised to stop diuretics and29 to the control group. In eight patients diuretics had tobe restarted. Among patients who had diuretics withdrawn successfully,rebound oedema caused a temporary increase in mean oedema index.The peak level (3.5% (95% confidence interval 1.5% to 5.2%)was reached in the third week, after which the oedema seemedto be returning to the baseline level.
Conclusion : Few patients who have been prescribed diureticsfor only ankle oedema clearly have no contraindications to withdrawingdiuretics. If patients are unlikely to have cardiac insufficiencyand careful monitoring is provided, withdrawal of diureticsseems to be feasible, though moderate rebound oedema may occurfor a short time.

General practice implications

General practice implications
Concern has been raised about the unnecessary use of diuretics by elderly patients
Withdrawal can be appropriate in elderly patients taking diuretics for ankle oedema provided that the oedema is not caused by cardiac, renal, or hepatic insufficiency
In this study 17% of the patients taking diuretics for ankle oedema were eligible for withdrawal
Withdrawal was successful in 26 of 34 patients
Patients should be closely monitored after withdrawal as they may develop a temporary increase of ankle oedema

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