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Pharmacy and Medications

Diuretics

07/26/2004

Question:

Can you pls tell me the difference in general and difference in effectivenss, and the plus`s and neg`s for both prescribed and over the counter diuretics.

And what sort of various conditions have water retention as a big symptom. and if you take the diuretic what does it do to make you get rid of overall water retention on your body? thank you

Answer:

Diuretics are medicines used to help the body remove excess salt and water. They are used to treat hypertension, and edema related congestive heart failure and other conditions in which the body is unable to adequately excrete water or salt.

There are very few over-the-counter (OTC) diuretics. Pamabrom is probably the most commonly used OTC diuretic. It is a mild diuretic related to theophylline. It is present in a few medicines used to treat fluid retention associated with menstruation. Alcohol, caffeine and theophylline are other readily available agents with a diuretic action in addition to their better known actions. Theophylline is a prescription drug that is also present in tea. If you are considering the use of an OTC diuretic, ask your pharmacist for advice first. Your pharmacist can help direct your choices to avoid potential side effects, drug and disease interactions

Prescription diuretics tend to be much more potent than OTC diuretics. They reliably increase excretion of fluid and salt from the body and are generally well tolerated, They are only available by prescription because they are very potent and may cause some significant adverse reactions. In addition, they are used to treat a variety of conditions, some of which can be dangerous to treat without a doctor's supervision Diuretics help to reduce the workload of the heart

Diuretics work by increasing the excretion of salt primarily, water primarily or both. It is important to understand that increasing salt excretion will also increase water excretion. The primary side effects associated with diuretics are dehydration and depletion of electrolytes.

Drugs that primarily increase salt excretion are:

The loop diuretics:

Bumetanide(Bumex) ,Furosemide (Lasix),Torsemide(Demadex)

These are considered to be the strongest diuretics available.

Thiazide &Thiazide-like Diuretics

Chlorothiazide, Chlorthalidone, Hydrochlorothiazide. The thiazide-like diuretics include indapamide (Lozol) and metolazone (Zaroxolyn). The thiazide and thiazide-like diuretics are used to treat high blood pressure as well as fluid retention. They work in a different part of the kidney and are inherently weaker than the loop diuretics.

The potassium sparing diuretics:

Triamterine, amiloride, spironolactone. Potassium-sparing diuretics have weak diuretic and anti-hypertensive properties and are used mainly to minimize potassium depletion that can often accompany use of thiazide and loop diuretics.

Drugs that modify water excretion are:

Demeclocycline

Vasopressin

These medicines are primarily used in hospital to treat relatively rare conditions.

The Osmotic diuretics:

Mannitol, Glycerin

Osmotic diuretics increase excretion of both water and electrolytes. Mannitol is given intravenously in the hospital setting. It is most commonly used to treat cerebral edema. Glycerin is given orally prior to eye surgery to reduce intra-occular pressure.

The following side effects may be seen with loop or thiazide diuretics.

Potassium depletion: Symptoms of potassium deficiency include: weakness, loss of appetite, irregular heartbeat, constipation, or muscle cramps, breathing problems, numbness or tingling in the hands, feet, or lips, confusion or nervousness, unusual tiredness or weakness, and weak or heavy feeling in the legs. Talk to your health care provider or pharmacist if you have these symptoms.

In addition to their effects on fluids and electrolytes and, the diuretics may cause other problems. The thiazide diuretics can cause increased blood sugar levels and can increase uric acid levels. Elevated uric acid levels can be a factor in the development of gout. Thiazide diuretics can also cause photosensitivity. This means that the skin can become more sensitive to sunlight. Even brief exposure to sun can cause severe sunburn, itching, rash, and redness. It is important to use a sunscreen and avoid prolonged sun exposure while taking thiazide diuretics.

Patients who are allergic to sulfa drugs (sulfonamides) are likely to be allergic to both the thiazide diuretics and the loop diuretics. Make sure your doctor knows about any allergies you have before taking any of these diuretics

Your physician or a pharmacist who knows you can provide further information about these medicines and their side effects. If you are using a diuretic and have any of the side effects mentioned above talk to your health care provider or pharmacist.

For more information:

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Response by:

Dennis   Mungall, PharmD Dennis Mungall, PharmD
Associate Professor, Pharmacy Practice
College of Pharmacy
The Ohio State University

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati

Maria Papouras-Volakis, PharmD Student, BS Pharmacy
Staff Pharmacist
Nationwide Children's Hospital
The Ohio State University