(Non-official.)

(Sodiosalicylate Of Theobromine.)

Origin. - The name indicates the origin, the drug being a chemical combination of theobromine (49.7 per cent.) and salicylic acid (38.1 per cent.). It is, in reality, a mixture of theobromine and sodium salicylate.

Description and Properties. - A white powder, soluble in less than half its weight of hot water, the solution remaining perfect on cooling. Sparingly soluble in cold water; soluble in warm alcohol; insoluble in chloroform or ether. The drug has a disagreeable, soap-like taste, and undergoes decomposition when exposed to the air.

Dose. - 15 grains (1.0 Gm.); 45 to 105 grains (2.9-7.0 Gm.) may be given in divided portions in twenty-four hours.

Antagonists and Incompatibles. - The action of the drug would be retarded by the motor and cardiac depressants. Mineral and vegetable acids are incompatible.

Synergists. - The therapeutic influence of the drug would theoretically be enhanced by caffeine, digitalis, and many of the cardiac stimulants and diuretics.

Physiological Action. - Externally and Locally. - There is none. Theobromine, being a xanthin derivative, has the action of that series of compounds. See Caffeine.

Internally. - Digestive System. - Diuretin has no important action, though in many cases it may cause disturbance of digestion, impair the appetite, and even occasion nausea, vomiting, and diarrhea.

Circulatory System. - The drug has a very beneficial action upon the system in failing compensation and edema, its favorable influence being due to its effect upon the kidneys. Theobromine, like caffeine, exercises a direct, stimulating action upon the renal epithelium and also a very slight stimulating effect upon the vasomotor center in the medulla.

Nervous System. - Large and continued doses frequently occasion headache, somnolence, or insomnia, with buzzing in the ears, and symptoms resembling those produced by the salicylates. The xanthin action is to stimulate the vasomotor centers, and slight stimulation of the respiratory center. Theobromine is one of the least stimulating xanthins and shows little of this action.

Repiratory System. - Diuretin exerts no direct influence upon the respiratory system. Yet dyspnea, bronchitis, etc., the result of a dropsical condition, are relieved by the administration of the drug.

Absorption and Elimination. - Diuretin is somewhat rapidly absorbed, being eliminated mainly by the kidneys, the process greatly stimulating the renal epithelium. The rise in blood-pressure is helpful, but the chief action has been shown to be on the renal epithelium. Both fluid and solid parts are increased. The chief increase in solids taking place in the chlorides. The amount of nitrogenous matter eliminated is also increased.

In cases where diuretin is indicated the amount of urine is increased from three- to sixfold in twenty-four hours, under its administration the diuretic action of the drug gradually reaching its maximum between the second and third days. In the case of healthy persons diuretin has little influence upon the amount of urine excreted.

Untoward Action. - In certain individuals the drug causes great disturbance of the gastro-intestinal tract, such as nausea, vomiting, diarrhea, palpitation of the heart, headache, and slight fever; occasionally cutaneous eruptions may be present.

Poisoning. - No cases of poisoning are recorded.

Therapeutics. - The drug is used exclusively as a diuretic in cases of dropsy, ascites, pleuritic effusion, etc.

Diuretin is worthy of a thorough trial for the removal of dropsical fluids, irrespective of the cause.

Diuretin is best suited to cases in which there is general dropsical effusion. It is the best medicinal remedy for removing dropsical fluid due to valvular disease of the heart after digitalis and pure cardiac tonics have failed. Diuretin has oftentimes a beneficial effect in other circulatory diseases with dropsy, as myocarditis, pericarditis, aneurism, arteriosclerosis. Its action is here more uncertain than in valvular disease. In the dropsy of nephritis it can be used without danger of irritating the kidney, the effects in acute nephritis being more certain than in chronic nephritis. Where the renal epithelium has undergone too extensive degeneration the drug may fail to act. In the dropsy of portal obstruction, and especially of cirrhosis of the liver, it usually fails to give good results.

Contraindications. - There are no special contraindications to the use of diuretin, unless it be in cases of marked gastric irritation, when the drug would undoubtedly aggravate the symptoms.

Administration. - Diuretin may be given in capsules or dissolved in some aromatic water or in milk. It should never be dispensed in powders, since it absorbs carbonic acid from the air and undergoes decomposition.

It is preferable to give the drug in solution; and it can be easily-associated with digitalis and similar remedies, but when used with the cardiac remedies the doses of diuretin should be smaller.

When giving this drug in cases of marked ascites, or for the removal of large quantities of dropsical fluid, the first doses should be small and gradually increased to the maximum amount or until the desired effect be produced, lest by a too sudden removal of the fluid alarming collapse ensue.

As acids are incompatible with the drug, diuretin should not be given immediately after meals, but its administration postponed for about three hours to avoid unpleasant symptoms arising from the action of the gastric juice upon the remedy.

The practice of adding fruit syrups or juices to a solution of diuretin for the purpose of rendering it more palatable should be strictly avoided, since the theobromine is precipitated by the vegetable acids as a thick white sediment.

The maximum daily amount which can be safely administered is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 grains (2.9-7.0 Gm.), given in divided doses of about 15 grains (1.0 Gm.) each.

If diuresis is not increased in six days, the use of the drug should be suspended and recourse to other treatment adopted.