D

Diuretics

Uses

Thiazides: Management of edema resulting from a number of causes (e.g., HF, hepatic cirrhosis); hypertension either alone or in combination with other antihypertensives.

Loop: Management of edema associated with HF, cirrhosis of the liver, and renal disease. Furosemide used in treatment of hypertension alone or in combination with other antihypertensives.

Potassium-sparing: Adjunctive treatment with thiazides, loop diuretics in treatment of HF and hypertension.

Action

Increases the excretion of water/sodium and other electrolytes via the kidneys. Exact mechanism of antihypertensive effect unknown; may be due to reduced plasma volume or decreased peripheral vascular resistance. Subclassifications of diuretics are based on their mechanism and site of action.

Thiazides: Acts at cortical diluting segment of nephron, block reabsorption of Na, Cl, and water; promote excretion of Na, Cl, K, and water. Loop: Acts primarily at the thick ascending limb of Henle’s loop to inhibit Na, Cl, and water absorption.

Potassium-sparing: Spironolactone blocks aldosterone action on distal nephron (causes K retention, Na excretion). Triamterene, amiloride act on distal nephron, decreasing Na reuptake, reducing K secretion.

Diuretics

Name	Availability	Dosage Range	Side Effects
Thiazide, Thiazide-related
Chlorothiazide (Diuril)	T: 250 mg, 500 mg S: 250 mg/5 ml I: 500 mg	Edema: 500–1,000 mg 1–2 times/day HTN: 500–2,000 mg/day in 1–2 divided doses	Confusion, fatigue, muscle cramps, abdominal discomfort
Chlorthalidone (Hygroton)	Hygroton: 25 mg, 50 mg	Edema: 50–200 mg/day HTN: 12.5–100 mg/day	Same as chlorothiazide
Hydrochlorothiazide (p. 572) (HydroDIURIL)	T: 12.5 mg, 25 mg, 50 mg C: 12.5 mg	Edema: 25–100 mg/day in 1–2 divided doses HTN: 12.5/50 mg once daily	Orthostatic hypotension, photosensitivity, hypokalemia, anorexia, epigastric distress, increased blood glucose
Indapamide (p. 615) (Lozol)	T: 1.25 mg, 2.5 mg	Edema: 2.5–5 mg once daily HTN: 1.25–5 mg once daily	Loss of appetite, diarrhea, headaches, dizziness, light-headedness, insomnia, upset stomach
Metolazone (p. 775) (Zaroxolyn)	T: 2.5 mg, 5 mg, 10 mg	Edema: 2.5–20 mg once daily HTN: 2.5–5 mg once daily	Orthostatic hypotension, dizziness, hypokalemia, nausea, diarrhea, abdominal pain
Loop
Bumetanide (p. 161) (Bumex)	T: 0.5 mg, 1 mg, 2 mg I: 0.25 mg/ml	Edema: 1–10 mg/day	Orthostatic hypotension, cramps or pain, hypokalemia (dry mouth, fatigue, muscle cramps), blurred vision, headaches
Furosemide (p. 530) (Lasix)	T: 20 mg, 40 mg, 80 mg OS: 10 mg/ml, 40 mg/5 ml I: 10 mg/ml	HTN: 20–80 mg/day in 2 divided doses Edema: Up to 600 mg/day	Orthostatic hypotension, cramps or pain, hypokalemia (dry mouth, fatigue, muscle cramps), blurred vision, headaches
Torsemide (p. 1216) (Demadex)	T: 5 mg, 10 mg, 20 mg, 100 mg I: 10 mg/ml	Edema: 10–200 mg/day HTN: 5–10 mg/day	Constipation, dizziness, upset stomach, headache, hypokalemia (dry mouth, fatigue, muscle cramps)
Potassium-sparing
Amiloride (Midamor)	T: 5 mg	Edema: 5–20 mg/day HTN: 5–10 mg/day in 1–2 divided doses	Hyperkalemia, nausea, abdominal pain, diarrhea
Eplerenone (p. 430) (Inspra)	T: 25 mg, 50 mg	Heart Failure: 25–50 mg/day HTN: 50–100 mg/day	Hyperkalemia, hypertriglyceridemia
Spironolactone (p. 1125) (Aldactone)	T: 25 mg, 50 mg, 100 mg	Edema: 100 mg/day HTN: 50–200 mg/day Hypokalemia: 25–100 mg/day Heart Failure: 25–50 mg/day	Hyperkalemia, nausea, vomiting, abdominal cramps, diarrhea
Triamterene (p. 1233) (Dyrenium)	C: 50 mg, 100 mg	Edema, HTN: 100–300 mg/day in 1–2 divided doses	Same as amiloride

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