In patients with decompensated cirrhosis on diuretic therapy with tender gynaecomastia the best diuretic to substitute is:
Amiloride (10-40 mg/day) can be substituted for spironolactone in patients with tender gynecomastia. Amiloride is more expensive and less effective Ref: HEPATOLOGY, June 2009
Amiloride for spironolactone
Furosemide for spironolactone
Spironolactone for amiloride
Torsemide for spironolactone