What are diuretics and how do they work. Who should take diuretics and for what conditions. How should diuretics be taken and what are the potential side effects. What foods or drugs interact with diuretics and what precautions should be taken while using them.

Understanding Diuretics: The Water Pills That Manage Fluid Balance

Diuretics, commonly known as “water pills,” are a class of medications that play a crucial role in managing various health conditions by altering the body’s fluid balance. These drugs work by encouraging the kidneys to expel excess water and salt from the body through urine. This reduction in total fluid volume within blood vessels leads to decreased blood pressure, making it easier for the heart to pump blood effectively.

Why are diuretics often the first line of defense against high blood pressure? Diuretics are typically the initial medication prescribed by doctors to control hypertension due to their efficacy and relatively low risk of side effects when used appropriately. By reducing fluid volume, they effectively lower blood pressure, which in turn decreases the risk of stroke and heart attack.

Types of Diuretics: Choosing the Right One for Your Condition

Diuretics come in several categories, each with specific properties and uses:

• Thiazide-like diuretics: These are moderate-strength diuretics suitable for long-term use.
• Loop diuretics: More potent than thiazides, these are particularly useful in emergency situations.
• Potassium-sparing diuretics: These help maintain potassium levels while eliminating water and salt.

How do doctors determine which type of diuretic to prescribe? The choice depends on the patient’s specific condition, severity of symptoms, and overall health status. In some cases, different types of diuretics may be combined or used in conjunction with other medications to achieve optimal results.

Common Examples of Diuretics

Some frequently prescribed diuretics include:

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

Medical Conditions Treated with Diuretics: Beyond Hypertension

While diuretics are widely known for their role in managing high blood pressure, they are also beneficial in treating various other medical conditions. When might a doctor recommend diuretics for conditions other than hypertension?

• Edema: Diuretics help reduce swelling, particularly in the legs, by eliminating excess fluid.
• Heart failure: Loop diuretics are particularly effective in easing lung congestion and swelling associated with heart failure.
• Kidney problems: Diuretics can help manage fluid retention in patients with certain kidney disorders.
• Liver problems: In cases of cirrhosis, diuretics can alleviate fluid buildup that often accompanies the condition.
• Glaucoma: Some diuretics are used to reduce intraocular pressure in glaucoma patients.

How do diuretics benefit patients with heart failure? In heart failure, the heart’s pumping ability is compromised, often leading to fluid accumulation in the lungs and other tissues. Diuretics, particularly loop diuretics, help remove this excess fluid, easing breathing difficulties and reducing swelling. This not only improves symptoms but can also enhance overall heart function by reducing the workload on the weakened heart.

Proper Usage and Dosage: Maximizing Benefits and Minimizing Risks

Proper administration of diuretics is crucial for their effectiveness and safety. How should patients take diuretics to ensure optimal results?

• Follow the prescribed dosage and timing carefully.
• For single daily doses, take the medication in the morning with breakfast or immediately after.
• If multiple doses are prescribed, take the last dose no later than 4 p.m. to avoid nighttime urination disrupting sleep.
• Monitor your weight daily, using the same scale at the same time each day.
• Report any sudden weight gain (3 pounds in one day or 5 pounds in one week) to your doctor.

Why is it important to take diuretics at specific times? Taking diuretics as directed, especially in terms of timing, helps manage their effects on urination patterns. Morning doses allow for increased urination during waking hours, minimizing nighttime bathroom trips that could disrupt sleep. Additionally, consistent timing helps maintain steady medication levels in the body, optimizing their therapeutic effects.

Potential Side Effects and Risks: What Patients Should Watch For

While diuretics are generally well-tolerated, they can cause side effects in some patients. What are the most common side effects of diuretics, and how can they be managed?

• Increased urination: This is the primary effect of diuretics and is expected.
• Electrolyte imbalances: Diuretics can affect levels of potassium, sodium, and magnesium in the blood.
• Dehydration: Excessive fluid loss can lead to dehydration if not monitored.
• Dizziness or lightheadedness: This can occur due to lowered blood pressure.
• Muscle cramps: Sometimes related to electrolyte imbalances.
• Increased blood sugar: Some diuretics can affect glucose metabolism.

How can patients minimize the risk of side effects from diuretics? Regular monitoring through blood tests and doctor visits is crucial. Patients should follow their doctor’s advice regarding diet, including salt intake and potassium-rich foods. Staying well-hydrated (unless fluid restriction is advised) and reporting any unusual symptoms promptly can help manage potential side effects effectively.

Who Should Exercise Caution with Diuretics?

Certain individuals may need to use diuretics with extra care or avoid them altogether. These include:

• People with severe kidney or liver disease
• Individuals with gout
• Diabetics (as some diuretics can affect blood sugar levels)
• Pregnant women (certain diuretics may pose risks to fetal development)
• Those with severe electrolyte imbalances

Why is it crucial for patients to disclose their full medical history before starting diuretics? Each patient’s response to diuretics can vary based on their underlying health conditions, other medications they’re taking, and individual physiology. By providing a comprehensive medical history, doctors can make informed decisions about the type, dosage, and monitoring requirements for diuretic therapy, minimizing risks and optimizing benefits.

Drug Interactions and Dietary Considerations: Navigating Potential Complications

Diuretics can interact with various medications and dietary factors, potentially altering their effectiveness or increasing the risk of side effects. What should patients be aware of regarding drug interactions and diet when taking diuretics?

Medication Interactions

Patients should inform their healthcare providers about all medications they’re taking, including:

• Other blood pressure medications
• Digoxin
• Indomethacin
• Probenecid
• Corticosteroids
• Over-the-counter drugs
• Herbal supplements
• Vitamins and nutritional supplements

Dietary Considerations

Depending on the type of diuretic prescribed, dietary adjustments may be necessary:

• Low-sodium diet: Often recommended to enhance the effectiveness of diuretics
• Potassium intake: May need to be increased or decreased based on the specific diuretic
• Alcohol: Should be limited or avoided as it can exacerbate side effects
• Caffeine: May interact with some diuretics, affecting their efficacy

How does potassium intake relate to diuretic use? Some diuretics, particularly thiazides and loop diuretics, can cause potassium loss, potentially leading to hypokalemia (low potassium levels). In these cases, doctors may recommend potassium-rich foods or supplements. Conversely, potassium-sparing diuretics can cause potassium retention, necessitating a reduction in dietary potassium. This delicate balance underscores the importance of personalized dietary advice and regular monitoring when using diuretics.

Monitoring and Follow-up: Ensuring Safe and Effective Diuretic Therapy

Regular monitoring is essential for patients on diuretic therapy to ensure safety and efficacy. What key aspects should be monitored in patients taking diuretics?

• Blood pressure: Regular checks to ensure the medication is effectively controlling hypertension
• Kidney function: Periodic blood tests to assess kidney health and function
• Electrolyte levels: Monitoring of potassium, sodium, and magnesium levels in the blood
• Body weight: Daily weight checks to track fluid balance
• Blood sugar levels: Particularly important for diabetic patients
• Uric acid levels: For patients at risk of gout

Why is consistent follow-up crucial for patients on diuretic therapy? Regular check-ups allow healthcare providers to assess the medication’s effectiveness, adjust dosages if necessary, and catch any potential side effects or complications early. This proactive approach helps optimize treatment outcomes and minimize risks associated with long-term diuretic use.

Patient Education and Self-monitoring

Empowering patients with knowledge about their medication is crucial for successful diuretic therapy. Key points for patient education include:

• Understanding the importance of consistent medication adherence
• Recognizing signs of potential side effects or complications
• Proper techniques for home blood pressure monitoring
• Guidelines for daily weight monitoring and when to report changes
• Awareness of dietary restrictions or recommendations
• The importance of staying hydrated (unless fluid restriction is advised)

How can patients actively participate in managing their diuretic therapy? By understanding their medication, monitoring their symptoms, and maintaining open communication with their healthcare providers, patients can play an active role in their treatment. This collaborative approach often leads to better outcomes and improved quality of life for those requiring long-term diuretic therapy.

Special Considerations for Long-term Diuretic Use

While diuretics are generally safe for long-term use, patients on extended therapy may require additional considerations. What special precautions should be taken for patients on long-term diuretic therapy?

• Regular reassessment of the need for continued therapy
• Monitoring for potential long-term side effects, such as bone density changes
• Periodic evaluation of kidney function and electrolyte balance
• Assessment of overall cardiovascular health and risk factors
• Consideration of combination therapies to minimize individual drug doses
• Evaluation of quality of life and medication burden

Why might long-term diuretic use require adjustments over time? The body’s response to medications can change over extended periods. Factors such as aging, changes in overall health status, or the development of new medical conditions may necessitate adjustments in diuretic therapy. Regular reassessment ensures that the treatment remains appropriate, effective, and safe as the patient’s health evolves over time.

Lifestyle Modifications to Complement Diuretic Therapy

While diuretics are effective, combining them with lifestyle changes can enhance their benefits and potentially reduce the required medication dose. Key lifestyle modifications include:

• Adopting a heart-healthy diet low in sodium and rich in fruits, vegetables, and whole grains
• Engaging in regular physical activity as recommended by a healthcare provider
• Maintaining a healthy weight
• Limiting alcohol consumption
• Quitting smoking
• Managing stress through relaxation techniques or counseling

How do lifestyle changes complement diuretic therapy? Healthy lifestyle choices can improve overall cardiovascular health, enhance the body’s response to medications, and address underlying factors contributing to conditions like hypertension or heart failure. This holistic approach often leads to better disease management and may even allow for reduced medication doses in some cases, minimizing the risk of side effects while maintaining therapeutic benefits.

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.

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What Are Beta-Blockers for High Blood Pressure? List of Beta-Blockers

Written by WebMD Editorial Contributors

• Drug Names
• While You’re Taking Beta-Blockers
• Who Shouldn’t Take Them?
• Side Effects

Beta-blockers are drugs that block the effects of adrenaline, the hormone that triggers your body’s fight-or-flight response when you’re stressed. This slows your heart rate and eases up on the force your heart squeezes with. Your blood pressure goes down because your heart isn’t working so hard. These medicines can also relax blood vessels so the blood flows better.

Beta-blockers include:

• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone)
• Bisoprolol (Zebeta, Ziac)
• Carteolol (Cartrol)
• Carvedilol (Coreg)
• Labetalol (Normodyne, Trandate)
• Metoprolol (Lopressor, Toprol-XL)
• Nadolol (Corgard)
• Nebivolol (Bystolic)
• Penbutolol (Levatol)
• Pindolol (Visken)
• Propanolol (Inderal)
• Sotalol (Betapace)
• Timolol (Blocadren)

Your doctor will probably want you to try another medicine to control your blood pressure before they prescribe a beta-blocker. You may need to take other kinds of medicine for your high blood pressure, too.

You might have to check your pulse daily. When it’s slower than it should be, find out from your doctor if you should take your medication that day.

Take your medicine regularly with meals to keep the level steady so it works consistently.

Beta-blockers may not work right when you take them while you’re also using another drug. Or they could change how another medicine works. To avoid problems, let your doctor know about any medications — prescription or over-the-counter — or supplements that you’re taking, especially:

• Other blood pressure and heart medicines
• Allergy shots
• Antidepressants
• Diabetes medicines and insulin
• Street drugs, such as cocaine

Avoid products with caffeine and alcohol. Don’t take cold medicines, antihistamines, or antacids that have aluminum in them.

If you’re going to have surgery of any kind (including dental procedures), make sure the doctor knows you’re taking a beta-blocker.

Beta-blockers may not work as well for older people and for African-Americans.

Doctors don’t usually prescribe them for people with asthma, COPD, or breathing trouble or for those with very low blood pressure (hypotension), a type of heart rhythm problem called a heart block, or a slow pulse (bradycardia). Beta-blockers can make symptoms of these conditions worse.

These drugs can hide signs of low blood sugar. You’ll have to check your blood sugar more often when you have diabetes.

They may not be safe for women who are planning a pregnancy, pregnant, or breastfeeding. Tell your doctor right away if you get pregnant while you’re taking a beta-blocker.

When you’re taking a beta blocker, you may:

• Feel drained of energy
• Have cold hands and feet
• Be dizzy
• Gain weight

You could also have:

• Trouble sleeping or vivid dreams
• Swelling in your hands, feet, and ankles
• Shortness of breath, wheezing, or other breathing problems
• Depression

Let your doctor know if any of these bother you a lot. They may change your dose or switch you to a different medicine.

A beta-blocker might raise your triglycerides and lower your “good” HDL cholesterol a bit for a little while.

Don’t stop taking your beta blocker unless your doctor says it’s OK. That could raise your chance of a heart attack or other heart problems.

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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.

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  Up to 9600 ₽

• • 18 ac. hours

  Update on COVID-19for pharmaceutical specialists

  Up to 1300 ₽

• • 36 acc. hours

  New aspects of the pharmacological approach to the treatment of infectious diseases

  Up to 2500 ₽

• Pharmacotherapy of osteoarthritis: the benefits of slow-release drugs
  • Elena Karatun 9001 4
• Symphony of calmness and health, or why our body needs magnesium
  • Elena Fedechkina
• The secret of a chic hairstyle: how to properly and incorrectly take care of your hair
  • Padyganova Alsu Vazikhovna
• Not a temporary relief, but a real help: counseling for a runny nose
  9 0642 Kovrigina Elena Semyonovna

• Roszdravnadzor withdraws batches of falsified Ocrevus drug

  there should be sales in a pharmacy: we talk about the new course from Pharmznanie

  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

  Review of the recommendations of the Ministry of Health of the Russian Federation ami? Who can retrain at the UEF? Parsing these and…

• Difficulties in applying through the FRM

  Answering your questions

• Applying for accreditation through the FRM

  Step-by-step instructions for pharmacists

  900 14

• Order of the Ministry of Health No. 709n: What will be the accreditation of pharmaceutical specialists?

  Studying the order of the Ministry of Health No. 709n

• Accounting for expiration dates of drugs in a pharmacy

  Rules and responsibility of pharmacy organizations

• Pharmacy payments: 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 90 003

• Pharmacist’s leave: answers to popular questions

  8 questions about leave that concern pharmacists

• Wound healing agents: mechanism of action, indication

  Classification, indications and mechanism of action

• A buyer with fatty liver: a counseling algorithm

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

• Pharmaceutical cosmetics: classification, legal regulation

  of their products

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

  Allergies affect 10% to 40% of people

• This is exactly what 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?

  Lay low in the pharmacy

• Pharmacy sales in the summer: how to increase revenue when there are more visitors.

  .. th visitors in the pharmacy

  How not to violate anyone’s rights and not harm yourself

• Pharmacy with a robotic warehouse in the suburbs

  We talked to 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 food checklist

  How to properly formulate a diet

• An important factor in the treatment of erectile dysfunction

  Erectile dysfunction (ED) is a permanent inability to achieve and maintain…

• 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 nutritional supplements: what do pharmacy workers think?

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

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

  “It will become impossible to work under such conditions”: what pharmacists and pharmacists think. .. 039

  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

• Coronavirus vaccination in Russia: the most important thing to know about vaccines whether to be vaccinated.