Trip Answers

Question answered:02/07/07 Warning! this question is over two years old.

We searched the UK Medicines Information website, the BNF, TRIP and Medline databases but found very little robust information to answer this question.

 

Lee et al examined  whether presumed “sulfa allergy” in patients treated for intracranial hypertension with acetazolamide or furosemide resulted in a cross reaction. They report:

 

“RESULTS: We reviewed 363 charts. Of these, 329 patients (91%) were excluded. Of the remaining 34 cases that did report a so-called sulfa allergy, 13 (38%) received acetazolamide alone, 7 (21%) received furosemide alone, and 14 (41%) received both acetazolamide and furosemide. Of the 27 patients who received acetazolamide, 10 (37%) had no documented allergic cross-reaction to sulfa, and 2 (7%) cases had urticaria. The remaining 15 (56%) of acetazolamide-treated patients experienced predictable adverse reactions for this drug (for example, paresthesias). No patient experienced a severe allergic cross-reaction to sulfa. Of 21 patients who received furosemide, no unpredictable adverse reactions or allergic cross-reactions to sulfa were noted. CONCLUSIONS: We find little clinical or pharmacological evidence to suggest that a self-reported sulfa allergy is likely to produce a life-threatening cross-reaction with acetazolamide or furosemide. These medications should be considered for intracranial hypertension if the risk-to-benefit ratio warrants their use.” [1]

 

An article published in the ‘Annals of Long Term Care’ in 1999 discussing loop diuretics in the management of congestive heart failure notes:

 

“Several other important adverse effects have been noted. Patients with hypersensitivity to sulfonamides may experience an allergic reaction to loop diuretics. However, bumetanide has been administered following allergic reactions to furosemide, suggesting a lack of cross-sensitivity between the two agents. Ototoxicity has been found to occur with large oral doses (greater than 1000 mg/day) and high infusion rates (greater than 4 mg/min) of furosemide.” [2]

 

Given the lack of evidence-based information on the cross-sensitivity of furosemide or bumetanide to sulfonamides, the NLH Q & A Service would recommend this question be referred to a specialist drugs information service. Should you wish us to refer this query on your behalf, please let us know using the following link: http://www.clinicalanswers.nhs.uk/index.cfm?action=contact

 

References
1. Lee AG, Anderson R, Kardon RH et al. Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? Am J Ophthalmol. 2004 Jul;138(1):114-8. (http://www.hubmed.org/display.cgi?uids=15234289).
2. Loop diuretics in the management of congestive heart failure. Annals of Long Term Care 1999; 7[10]:369-374. (http://www.annalsoflongtermcare.com/article/124).

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