What are diuretics and how do they work. How do water pills help with high blood pressure and heart failure. What are the key facts about diuretics that patients should know. How should diuretics be taken properly. What potential interactions and side effects should patients be aware of when taking diuretics.

Understanding Diuretics: The Basics of Water Pills

Diuretics, commonly known as “water pills,” are a class of medications primarily used to treat high blood pressure and heart failure. These drugs work by helping the kidneys produce more urine, effectively flushing excess salt and water from the body. This reduction in fluid volume makes it easier for the heart to pump blood, thereby alleviating strain on the cardiovascular system.

Common examples of diuretics include:

• Chlorthalidone
• Ethacrynic acid (Edecrin速)
• Furosemide (Lasix速)
• Hydrochlorothiazide
• Indapamide (Lozide速)
• Metolazone (Zaroxolyn速)

It’s important to note that while generic names are listed first, Canadian brand names are typically provided in brackets. However, this list is not exhaustive, and patients should consult their pharmacist for information about specific prescriptions not mentioned here.

The Therapeutic Benefits of Diuretics in Cardiovascular Health

Diuretics offer several significant benefits for patients with cardiovascular issues:

• Lower blood pressure
• Relieve shortness of breath
• Reduce swelling and bloating
• Increase urination frequency
• Reduce hospital stays
• Improve longevity in heart failure patients

By effectively managing fluid retention, diuretics play a crucial role in maintaining cardiovascular health and improving quality of life for many patients.

How do diuretics lower blood pressure?

Diuretics lower blood pressure by reducing the volume of fluid in the bloodstream. As the kidneys excrete more water and salt, the overall blood volume decreases. This reduction in volume leads to less pressure on the blood vessel walls, resulting in lower blood pressure.

Proper Administration of Diuretics: Timing and Dosage Considerations

To maximize the effectiveness of diuretics while minimizing disruptions to daily life, patients should adhere to the following guidelines:

1. Take the medication exactly as prescribed by your healthcare provider.
2. Administer the diuretic at least six hours before bedtime to avoid nighttime bathroom trips.
3. Maintain consistent timing of doses to ensure steady medication levels in the body.

Proper timing is crucial for both efficacy and convenience. Taking the medication earlier in the day helps prevent sleep disturbances caused by increased urination.

Can the timing of diuretic intake affect its effectiveness?

Yes, the timing of diuretic intake can indeed affect its effectiveness. Taking diuretics earlier in the day allows for peak action during waking hours, which is when most people have easier access to restrooms. This timing also helps prevent sleep disturbances due to increased urination at night. Additionally, consistent timing helps maintain steady medication levels in the body, which is crucial for optimal blood pressure control and fluid balance management.

Potential Interactions and Dietary Considerations for Diuretic Users

Patients taking diuretics should be aware of potential interactions with other medications and dietary factors:

• Limit salt intake, as excessive sodium can counteract the effects of diuretics.
• Consult with a healthcare provider before using salt substitutes.
• Discuss fluid restriction requirements with your doctor.
• Be mindful of potassium levels, as some diuretics can cause potassium loss.
• Monitor weight regularly, as rapid weight gain may indicate fluid retention.

It’s crucial to inform your healthcare provider or pharmacist about all medications, supplements, and alternative therapies you’re using to avoid potential interactions.

Why is potassium intake important for diuretic users?

Potassium intake is important for diuretic users because some types of diuretics, particularly loop and thiazide diuretics, can cause excessive potassium loss through increased urination. This can lead to a condition called hypokalemia, which may cause muscle weakness, cramping, and in severe cases, heart rhythm abnormalities. However, it’s important to note that not all patients require additional potassium, especially if they’re taking potassium-sparing diuretics or other medications that retain potassium. Always consult with your healthcare provider before making changes to your potassium intake.

Recognizing and Managing Side Effects of Diuretic Therapy

While most people tolerate diuretics well, it’s important to be aware of potential side effects:

• Dehydration symptoms: dry mouth, decreased skin elasticity, muscle cramps, weakness
• Dizziness or fainting, especially when combined with alcohol
• Upset stomach
• Increased sun sensitivity (particularly with furosemide)
• Fever, sore throat, or skin rash (rare but should be reported)

If you experience any of these side effects, it’s crucial to communicate with your healthcare provider or pharmacist promptly. They can provide guidance on managing these effects or adjusting your treatment plan if necessary.

How can patients manage increased sun sensitivity caused by diuretics?

To manage increased sun sensitivity caused by diuretics, particularly furosemide, patients can take the following precautions:

1. Use broad-spectrum sunscreen with a high SPF (30 or above) on all exposed skin
2. Wear protective clothing, including long sleeves, pants, and wide-brimmed hats
3. Seek shade, especially during peak sun hours (typically 10 am to 4 pm)
4. Use sunglasses to protect the eyes from UV radiation
5. Be extra cautious on cloudy days, as UV rays can penetrate cloud cover
6. Consider using UV-protective clothing for additional protection

By implementing these measures, patients can enjoy outdoor activities while minimizing the risk of sunburn and long-term skin damage associated with increased photosensitivity.

Complementary Lifestyle Changes for Optimal Heart Health

While diuretics play a crucial role in managing heart health and blood pressure, they are most effective when combined with healthy lifestyle choices. Patients are encouraged to:

• Adopt a heart-healthy diet low in sodium and rich in fruits, vegetables, and whole grains
• Engage in regular physical activity as approved by their healthcare provider
• Maintain a healthy weight
• Limit alcohol consumption
• Quit smoking
• Manage stress through relaxation techniques or counseling

These lifestyle modifications can help minimize the need for medication and improve overall cardiovascular health. Patients should work closely with their healthcare providers to develop a comprehensive treatment plan that incorporates both medication and lifestyle changes.

How does regular physical activity complement diuretic therapy?

Regular physical activity complements diuretic therapy in several ways:

1. It helps lower blood pressure naturally, potentially reducing the required dosage of diuretics
2. Exercise improves cardiovascular function, making the heart more efficient at pumping blood
3. Physical activity promotes weight loss, which can reduce fluid retention and strain on the heart
4. Regular exercise enhances the body’s ability to regulate fluid balance, supporting the effects of diuretics
5. Activity improves overall circulation, reducing the risk of fluid accumulation in the extremities

By incorporating regular physical activity into their routine, patients can enhance the effectiveness of their diuretic therapy and improve their overall cardiovascular health. However, it’s crucial to consult with a healthcare provider before starting any new exercise regimen, especially for those with heart conditions.

Accessing Additional Resources and Support for Diuretic Users

Patients using diuretics can benefit from a wealth of resources and support systems to enhance their understanding and management of their medication:

• Health Canada’s Drugs and Health Products website offers comprehensive information on safe medication use and drug safety alerts.
• Provincial health ministries provide resources tailored to local populations, such as Ontario’s MedsCheck program for free pharmacist consultations.
• The Heart and Stroke Foundation’s website (heartandstroke.ca/get-healthy) offers expert advice on maintaining heart health.
• Pharmacists are excellent sources of information for medication-specific queries and potential interactions.
• Support groups, both online and in-person, can provide valuable peer support and shared experiences.

Utilizing these resources can help patients feel more empowered in their healthcare journey and ensure they’re making informed decisions about their diuretic use and overall heart health management.

How can patients effectively communicate with their healthcare providers about diuretic therapy?

Effective communication with healthcare providers about diuretic therapy involves several key strategies:

1. Keep a detailed log of medication timing, dosage, and any side effects experienced
2. Prepare a list of questions or concerns before each appointment
3. Be honest about adherence to the medication regimen and any difficulties faced
4. Report any changes in symptoms or new health issues promptly
5. Discuss lifestyle factors that may impact treatment, such as diet and exercise habits
6. Ask for clarification on any instructions or medical terms that are unclear
7. Inform the provider about all other medications, supplements, and alternative therapies being used

By maintaining open and thorough communication, patients can work collaboratively with their healthcare providers to optimize their diuretic therapy and overall cardiovascular health management.

Diuretics | Heart and Stroke Foundation

Heart

What is this medication?

Diuretics are also called “water pills.” They are usually taken with other medications.

Diuretics include:

• Chlorthalidone
• Ethacrynic acid (Edecrin^®)
• Furosemide (Lasix^®)
• Hydrochlorothiazide
• Indapamide (Lozide^®)
• Metolazone (Zaroxolyn^®)

Be aware:

• Generic names are listed first.
• Canadian brand names are in brackets.
• This list doesn’t include every brand name.
• If your prescription isn’t listed, your pharmacist is the best source for more information.

What does it do?

These drugs treat high blood pressure and heart failure. They do it by helping your kidneys produce more urine.

• The more you pee, the more excess salt and water you flush out of your body.
• Without the extra fluid, it’s easier for your heart to pump.

Key facts about diuretics:

• Lower your blood pressure.
• Can relieve shortness of breath.
• Reduce swelling and bloating.
• Make you pee more often.
• Reduce the time you spend in hospital.
• Help you to live longer with heart failure.

How do I take it?

Take your diuretic exactly as prescribed.

• Take it at least six hours before bedtime to help avoid getting up in the night.

Are there any interactions?

Some medications can stop your heart medicine from working properly. They may even cause other health problems.

Water pills can affect your routine. If you take a diuretic:

• Your kidneys will make more urine (pee). You will need to use the bathroom more often.
  • To avoid getting up at night, take your medication at least six hours before bedtime.
• Limit your salt.
• Do not use salt substitutes without first talking to your healthcare provider or pharmacist.
  • Ask if you should restrict your fluids.
• Some diuretics can cause you to lose potassium.
  • Ask your pharmacist if you should eat foods rich in potassium or take a potassium supplement.
  • If you are on other medications that retain potassium, you may not need extra potassium.
• You may be asked to weigh yourself every day or two.
  • Rapid weight gain can be a sign of water retention.

Be aware: Furosemide may cause your skin to be more sensitive to sunlight. Protect yourself from sunburn.

Always tell your healthcare provider or pharmacist about any other medications you are taking. These include:

• Prescriptions
• Non-prescription drugs
• Inhalers
• Creams or ointments
• Over-the-counter or natural health products
• Alternative therapies
• Vitamins, minerals or supplements
• Herbal remedies
• Homeopathic medicines
• Traditional remedies, such as Chinese medicines
• Probiotics
• Amino acids or essential fatty acids

Are there any side effects?

Most people have no problem with diuretics.

Call your healthcare provider or pharmacist if you experience:

• Dehydration
  • Not enough pee
  •  Dry mouth
  • Decreased skin “springiness”
  • Muscle cramps
  • Weakness
  • Fever, sore throat or skin rash
• Dizziness
  • If you feel dizzy or faint, limit how much alcohol you drink.
• Upset stomach

If you have side effects, talk to your pharmacist or healthcare provider.

Lifestyle changes that can also help

There are two ways to control and manage your heart health: medication and lifestyle.

Medication can help you control heart disease and high blood pressure, but it cannot cure it.

A healthy lifestyle can help you keep medication to a minimum.

Visit heartandstroke.ca/get-healthy. Learn how to keep your heart healthy with current information and advice from Heart and Stroke Foundation experts.

Talk to your healthcare provider about the most beneficial lifestyle goals for you.

Related information

Your healthcare provider or pharmacist are your best sources of information. You can also learn more about medications at any of these trusted sites.

Health Canada – Drugs and Health Products
Provides health and medical information for Canadians to maintain and improve their health.

Learn more about:

• Safe Use of Medicines
• Safety and Effectiveness of Generic Drugs
• Buying drugs over the Internet
• Drug Product Database
• MedEffect Canada
  Provides safety alerts, public health advisories, warnings and recalls.

Your ministry of health also offers health resources in your province or territory. For example, Ontario’s MedsCheck program provides free pharmacist consultations. And British Columbia’s Senior Healthcare web page provides information about important health programs.

Drug coverage

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Diuretics (Water Pills): Types, Side Effects, Risks

Written by WebMD Editorial Contributors

• What Are Diuretics?
• Who Should Take Them?
• How Should I Take Them?
• What Foods or Drugs Interact With Them?
• While You’re Taking Diuretics
• Side Effects
• Who Shouldn’t Take Them?
• More

Commonly known as “water pills,” these drugs help your kidneys get rid of extra water and salt from your body through your urine. Because you have less total fluid in your blood vessels, like a garden hose that’s not turned on all the way, the pressure inside will be lower. This also makes it easier for your heart to pump.

They’re usually the first type of medication that your doctor will try to control your blood pressure.

Examples of diuretics include:

• Aldactone (spironolactone)
• Bumex (bumetanide)
• Demadex (torsemide)
• Esidrix (hydrochlorothiazide)
• Lasix (furosemide)
• Zaroxolyn (metolazone)

Diuretics come in different categories:

• Thiazide-like. These get rid of a moderate amount of water. They can be used for a long time.
• Loop. They’re more powerful and are very useful in emergencies.
• Potassium-sparing. They help you keep potassium as you’re getting rid of water and salt.

Different diuretics can be taken together, and you can take them with other medications, sometimes in the same pill.

Your doctor may recommend a diuretic if you have:

• Edema. Diuretics lessen swelling that usually happens in the legs.
• High blood pressure. Thiazide diuretics lower blood pressure. That lowers your chance of a stroke or heart attack.
• Heart failure. Diuretics ease swelling and congestion in the lungs. You’ll usually get a loop diuretic for heart failure.
• Kidney problems. You’ll keep less water.
• Liver problems. If you have cirrhosis, a diuretic will ease the fluid buildup you’ll get with it.
• Glaucoma. They’ll reduce the pressure in your eye.

Before you’re prescribed a diuretic, tell your doctor if you have diabetes, kidney disease, liver disease, or gout.

Follow the directions on the label. If you’re taking one dose a day, take it in the morning with your breakfast or right after. If you’re taking more than one dose a day, take the last one no later than 4 p.m.

The number of doses you take each day, the time allowed between doses, and how long you need to take a diuretic will depend on the type prescribed, as well as your condition.

Weigh yourself at the same time every day (on the same scale) and write down your weight. Call your doctor if you gain 3 pounds in one day or 5 pounds in one week.

While you’re taking these, have your blood pressure and kidney strength tested regularly. Diuretics can change your blood potassium and magnesium levels.

Keep all your doctor and lab appointments so your response to this medicine can be tracked.

To avoid a potential problem, tell your doctor and pharmacist about all the medicines you are taking, including:

• Herbal preparations
• Over-the-counter drugs
• Vitamins
• Nutrition supplements

Diuretics are often prescribed with other drugs. If you have more side effects when you take them together, contact your doctor. You may need to change the times you take each one.

Before a diuretic is prescribed, tell your doctor if you’re taking:

• Medication for high blood pressure
• Digoxin
• Indomethacin
• Probenecid
• Corticosteroids

Some diuretics may require you to avoid or eat certain foods. Follow your doctor’s advice, which may include:

• A low-salt diet
• A potassium supplement or high-potassium foods such as bananas and orange juice.

As always, talk with your doctor.

Let your doctor know what medications (prescription and over-the-counter), supplements, and herbal remedies you use. Also, tell them about other medical problems you have.

They may want to regularly check your blood pressure as well as test your blood and urine for levels of specific minerals and to see how well your kidneys are working. They’ll probably tell you to follow a low-sodium diet and limit how much salt you eat.

Because some diuretics also pull potassium out of your body, you might need to eat more foods like bananas, sweet potatoes, spinach, and lentils, or take a potassium supplement. On the other hand, if you’re taking a potassium-sparing diuretic, such as amiloride (Midamar), spironolactone (Aldactone), or triamterene (Dyrenium), they may want you to avoid potassium-rich foods, salt substitutes, low-sodium milk, and other sources of potassium.

If you only need one dose a day, you might want to take your diuretic in the morning so you can sleep through the night instead of getting up to go to the bathroom.

Avoid alcohol and medicines to help you sleep. They may make side effects worse.

The water that comes out of your body has to go somewhere, so you can expect to be peeing more and more, often for several hours after a dose. If you’re taking two doses each day, take the second dose no later than late afternoon so you can sleep through the night without waking up to urinate.

You also run the risk of getting dehydrated, and simply drinking more fluids may not be enough. Call your doctor if you’re very thirsty or have a very dry mouth, your pee is a deep yellow, you aren’t peeing much or get constipated, or you have a bad headache.

You may have extreme tiredness or weakness. These should ease as your body gets used to the medicine. Call your doctor if these symptoms hang around. That could mean your dose needs to be adjusted.

You may feel dizzy or lightheaded, especially when you stand up, if your blood pressure has dropped too low, or you’re getting dehydrated.

Your blood chemistry can get thrown off. You could have too little or too much sodium or potassium in your system. This can make you tired or weak or give you muscle cramps or a headache. It’s rare, but your heart may speed up (over 100 beats a minute) or you might start throwing up because of a dangerously low potassium level.

Diuretics may make it harder for you to control your blood sugar, which can lead to diabetes if you don’t already have it. You might be more likely to get gout.

Taking combination pills or multiple medicines could boost these side effects. To help lower those odds, ask your doctor when during the day you should take each medication.

If you have constant or severe blurred vision, confusion, headache, increased sweating, or restlessness, call your doctor.

Call your doctor or nurse if you have:

• Fever, sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss
• Skin rash
• Loss of appetite, nausea, vomiting, or muscle cramps

Also call them if you have any other symptoms that concern you.

Some diuretics are sulfa drugs, so they could cause a reaction if you’re allergic.

Older people tend to have more side effects such as fainting and dizziness from dehydration. You’ll need to work closely with your doctor.

Most diuretics are fine to take if you’re breastfeeding, with some precautions. Talk with your doctor.

Kids can safely take them, but they need smaller doses. The side effects are similar to adults. But potassium-sparing diuretics can cause low levels of calcium, which could hurt bone development.

Top Picks

What are diuretics? – article on the website Aptechestvo, Nizhny Novgorod

Diuretics are diuretic substances found in tissues that promote the formation and excretion of urine from the body. The action of diuretics is that they affect certain parts of the kidneys, due to which the stimulation of urination occurs. Diuretic tablets inhibit the absorption of sodium particles in the channels and, as a result, reduce the level of fluid absorption. The key role of diuretics is that they accelerate the excretion of waste products from the body. Before buying, be sure to consult a doctor.

Effects on the body

As you know, the accumulation of harmful substances makes it difficult for the normal functioning of internal organs. At the same time, salts are no longer excreted from the body, which generally has a negative effect on metabolism. Diuretics, due to their pharmacological properties, stabilize the processes of formation and excretion of urine, because they directly affect different parts of the nephron – the structural part of the kidney where urine is formed.

Diuretics classification

• Carbonic anhydrase inhibitors – affect the central part of the narrow duct: acetazolamide, methazolamide.

• Loop – stimulate the ascending part of the nephron: bumetanide, furosemide, torasemide.

• Thiazides – affect the near channels in the kidney: bendroflumethiazide, hydrochlorothiazide, indapamide, chlorthalidone, metolazone, xipamide.

• Potassium-sparing – affect the distant sections of the canals in the kidney where urine collects. There are 2 types: blockers – amiloride, triamterene and antagonists – eplerenone, spironolactone.

• Aquaretics – act on the tubes where urine is collected: an antidiuretic hormone antagonist – demeclocycline.

• Osmotic – stimulate the central section of the kidney canals, the urinary tube and the lower region of the loop of Henle.

In addition, there are combined diuretics, they include active components of different groups.

Contraindications

Diuretics are considered harmless drugs. However, diabetics and pregnant women should take these drugs with caution. And for people with a low level of potassium, severe respiratory failure, kidney disease, they are completely contraindicated.

Doctor’s order

Diuretics are an integral part of the treatment of many serious diseases. For example, pathologies of the liver or the cardiovascular system, hypertension or food poisoning. The drugs have a high therapeutic effect, but have features of use that the patient may not know about. Therefore, diuretics should be taken only as prescribed by a doctor.

Diuretics: classification, use, side effects and contraindications | PharmZnanie

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Diuretics in a pharmacy: classification, application, and what a pharmacist needs to know

Diuretics are a small but complex pharmacological group of drugs: no more than a dozen active substances. At the same time, diuretics are widely used in clinical practice and are often bought at a pharmacy. When drugs of this group are prescribed, how they differ, and whether they can be used for weight loss, read our article.

Why diuretics are needed

The general property of diuretics to increase the excretion of Na ions from the body, and hence water with urine, is used in the treatment of edema of various origins, but not only.

Miscellaneous pharmacological effects of diuretics:

1. Antihypertensive: Diuretics reduce blood volume and may affect vascular tone. Therefore, the main scope of diuretics is cardiovascular diseases: hypertension and heart failure with edematous syndrome .
2. Decongestant: diuretics are actively used in acute and chronic renal failure, ascites on the background of liver cirrhosis.
3. Detoxification. Diuretics, especially loop and osmotic, are used to accelerate the elimination of water-soluble xenobiotics in case of poisoning.
4. Specific effects of acetazolamide. Known effects of acetazolamide in glaucoma, intracranial pressure, altitude sickness, some types of epilepsy.
5. Other non-trivial effects. Among the unusual indications: the treatment of lung obstruction for loop diuretics, the use of acetazolamide for cerebellar ataxia, sleep apnea syndrome, psychosis. There is a high anti-inflammatory activity of furosemide and hydrochlorothiazide, the latter can be used in the treatment of diabetes insipidus.

Classification of diuretics. Table

Diuretic drugs are heterogeneous in their chemical structure, strength, speed and duration of the main diuretic action, which largely depend on the point of application. The table shows the classification depending on the locus of action and the observed diuretic effect.

Brief characteristics of the representatives of groups

Acetazolamide is of limited use due to weak and unstable diuretic action, intensive excretion of potassium and bicarbonates and rapidly developing tolerance. It is used to reduce intraocular and intracranial pressure, in some forms of small seizures of epilepsy, to prevent altitude sickness. Inhibits carbonic anhydrase of the ciliary body, resulting in reduced production of aqueous humor in the anterior chamber of the eye; reduces the production of cerebrospinal fluid.

Osmotic diuretics mannitol and urea are administered by intravenous drip in a hospital setting. The main indication: the removal of cerebral edema.

Thiazide diuretics hydrochlorothiazide and chlorthalidone have a moderate diuretic effect and a high ability to lower blood pressure. Long-term action allows them to be widely used in the treatment of hypertension and edematous syndrome. These drugs are preferred in patients with osteoporosis because they delay calcium excretion . These diuretics are characterized by a dose ceiling , above which there is no increase in the diuretic effect, therefore, they are not suitable for removing severe edema. In addition, thiazides remove potassium most of all. The result of therapy with these drugs depends on the state of the kidneys: with a decrease in their function, the clinical effect weakens.

Thiazide drugs directly affect the pancreatic islet apparatus by interfering with insulin secretion. There is a certain pathogenetic relationship between hyperglycemia and hypokalemia, since potassium ions stimulate insulin secretion. Thus, thiazide diuretics should not be given to diabetic patients, and potassium supplements may be used to correct this side effect.

The thiazide-like indapamide has a too mild diuretic effect, so it is not used as a decongestant. Its action is based on its ability to cause dilatation of peripheral vessels , so the main indication for the use of indapamide is the correction of elevated blood pressure. Therapeutic dosages prescribed for hypertension do not lead to an increase in diuresis. Taking the drug is not accompanied by electrolyte disturbances and kidney function does not affect its effectiveness.

Loop diuretics ascending loop of Henle are two drugs that differ primarily in the speed of action.

Furosemide is a short-acting, powerful loop diuretic with a dose-dependent effect . The higher the dosage of the drug, the stronger the excretion of urine. The main indication is the removal of pronounced edema, acute heart failure, the removal of a hypertensive crisis. With the use of furosemide, especially in large doses, daily, the development of tolerance and the phenomenon of rebound (a sharp decrease in diuresis after cancellation when using large doses) is possible. Furosemide has side effects in the form of electrolyte shifts and ototoxicity .

Torasemide is a long-acting diuretic, comparable in strength to furosemide. The main difference from furosemide, in addition to long-term action, will also be the absence of electrolyte shifts and ototoxicity. It is used for edematous syndrome of various origins and arterial hypertension.

Loop diuretics can be used effectively in patients with poor kidney function. They remove calcium from the body, which is unfavorable for osteoporosis. The drugs of this group also delay the secretion of uric acid, thereby causing the phenomena of hyperuricemia. This is especially important to consider in patients with gout.

Clopamid is a loop diuretic with a different site of application in the loop of Henle. Average in strength, with a long-term developing, persistent hypotensive effect. It is used only in Normatens, indications: to reduce pressure in combination with reserpine and dihydroergocristine.

Potassium-sparing diuretics are most often used in combination with loop and thiazide diuretics to enhance the diuretic effect and reduce K losses.0072 Triampur compositum . They are used to treat edema and hypertension. The combination of spironolactone and cardiac glycosides can enhance the effect of cardiac glycosides, reduce their dose and at the same time prevent hypokalemia during their use.

Aldosterone blockers spironolactone and its derivative eplerenone have found particular use in groups of patients with chronic heart failure and postinfarction left ventricular systolic dysfunction. This is due to the fact that patients with CHF have increased secretion of aldosterone, which negatively affects the cardiovascular system. Spironolactone and more selective eplerenone can increase survival in this group of patients.

Aldosterone blockers, as having a steroid structure, can cause hormonal changes: gynecomastia may occur in men; in women – masculinization and menstrual irregularities.

In the treatment of potassium-sparing diuretics, it is critical to control the level of potassium in people with severe CHF, since hyperkalemia can be fatal. Combinations with drugs that cause hyperkalemia (potassium preparations, other potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, heparin) are dangerous.

Why only a doctor should prescribe diuretics, and why they cannot be used independently

Pathologies that require diuretics are serious, and only a doctor can prescribe therapy, taking into account all the features of pharmacology and the patient’s condition. The doctor prescribes them in the absence of contraindications, especially in CHF in cases where the patient has a positive sodium balance (that is, the amount of sodium taken with food exceeds its excretion). Both the drug and the dose are selected by the doctor individually for each specific case.

Therefore, diuretics should only be sold according to their indications and prescription!

All diuretics are prescription drugs, but they are often purchased over the counter for weight loss purposes, as well as for athletes to quickly lose weight or eliminate illegal supplements in the urine. In these cases, diuretics are used in large doses, which increases the chance of side effects. Medicines of this group are capable of causing a large number of undesirable reactions, which those who want to “penetrate” do not know about, but which the pharmacist knows about. Side effects primarily relate to water-electrolyte homeostasis, acid-base balance, metabolism of carbohydrates and lipids, phosphates and uric acid. There are also specific types of side effects, for example, endocrine disorders in the treatment with spironolactone, ototoxicity – when using loop diuretics. One of the classic side effects of diuretics is hypokalemia, which can be manifested by muscle cramps, palpitations, and muscle weakness. With hypokalemia, changes in the electrocardiogram occur and the risk of ischemic stroke increases. However, this is far from the only side effect of diuretics. The table shows the main significant side effects of diuretics.

The use of diuretics for weight loss is dangerous. Diuretics in athletes may adversely affect maximum exercise capacity and duration of sustained submaximal exercise. Dehydration adversely affects the cardiovascular and thermoregulatory systems of the body during exercise. In the course of pharmacological counseling, the pharmacist must not only find out to whom and why the drug is being purchased, but also to learn about the huge potential harm of self-prescribing.

You can download all the tables in one excel file here

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• Symphony of calmness and health, or why our body needs magnesium The secret of a chic hairstyle: how to properly and incorrectly take care of hair
  • Padiganova Alsu Vazikhovna
• 4

• Roszdravnadzor withdraws batches of falsified Ocrevus drug

  Series of Ocrevus drug

  withdrawn from the market

• Necessary theory and sales skills development

• How to recognize depression in a person?

  Review of recent research.

• The Ministry of Health recommends changing the instructions for preparations containing topiramate

  Overview of the recommendations of the Ministry of Health of the Russian Federation

• We are discussing with the expert the order of the Ministry of Health No. 206n

  What will happen to pharmaceutical technologists? Who can retrain at the UEF? Let’s break down these and…

• Difficulties when applying through the FRM

  Answering your questions

• Applying for accreditation through the FRM

  Step-by-step instructions for pharmacists 900 03

• Order of the Ministry of Health No.

  709n: What will be the accreditation of pharmaceutical specialists?

  We study the order of the Ministry of Health No. 709n

• Accounting for expiration dates of drugs in a pharmacy

  Rules and responsibility of pharmacy organizations

• Payments in a pharmacy : answers to popular questions

  Detailed answers to your questions

• New qualification requirements and nomenclature of specialties

  Orders of the Ministry of Health No. 206n and No. 205n

• Pharmacist’s vacation: answers to popular questions

  8 questions about vacations that concern pharmacists

• Wound healing agents: mechanism of action, indication

  Classification, indications and mechanism of action 9000 3

• Buyer with fatty liver: counseling algorithm

  How to consult in case of a disease that affects 37% of Russians

• Pharmaceutical cosmetics: classification, legal regulation

  Classification and rules for the circulation of cosmetics

• Year-round and seasonal inquiries in the pharmacy: focus on allergic diseases

  Allergies affect 10% to 40% of people

• It definitely happened to you: we analyze three painfully familiar pharmacy cases

  3 cases at the first table

• Summer work in a pharmacy: what to do with yourself?

  Lie low in the pharmacy

• Sales in a pharmacy in summer: how to increase revenue when there are more visitors.

  ..

  How solid knowledge of the summer assortment and a little magic of mathematics will help…

• Types of difficult customers in a pharmacy 0003

• A pharmacy with a robotic warehouse in the suburbs of Moscow

  We talked with the CEO about how this happened

• Long-term effects of coronavirus on the body

  Review of recent scientific publications on the effects of coronavirus on the body

• Proper nutrition: recommendations from an endocrinologist and a checklist of products

  How to make a diet

• An important factor in the treatment of erectile dysfunction 9003 9

  Erectile dysfunction (ED) – a permanent inability to achieve and maintain. ..

• What is the primary responsibility for when consulting in a pharmacy?

  How to advise patients and not break the law

• Is it possible to take money for a consultation at a pharmacy

  Learned what pharmaceutical specialists think

• Mandatory labeling of dietary supplements: what do pharmacy workers think?

  Will the innovation become the same headache for pharmacies as drug labeling?

• Increasing the fine for dispensing PKU without a prescription: what pharmacists think

  “It will become impossible to work in such conditions”: what pharmacists and pharmacists think…

• Exercise therapy for first-timers

  Recommendations of a phlebologist and reflexologist

• How to overcome the fear of flying on an airplane?

  Educational program from an experienced aviator

• Top interesting places in Russia where you need to go in the summer

  Domestic tourist destinations that will surely surprise you.

• How to painlessly survive menopause?

  How to survive menopause as painlessly as possible

• Kraken coronavirus strain: signs and treatment

  A variety of omicron strain has reached Russia

• Coronavirus pandemic in 2023: expert forecasts

  What Russians can expect this autumn-winter

• Vaccination against coronavirus in Russia: the most important thing to know about vaccines

  About the effectiveness of Russian vaccines and whether it is worth getting vaccinated.

• Coronavirus antivirals: facts and responsibility…

  Telling whether antiviral drugs are effective in preventing.