What are diuretics and how do they work. Who should take diuretics and for what conditions. What are the different types of diuretics available. How should diuretics be taken properly. What are the potential side effects and risks of diuretic use. How do diuretics interact with other medications and foods.

What Are Diuretics and How Do They Function?

Diuretics, commonly known as “water pills,” are medications that help your body eliminate excess water and salt through increased urine production. By reducing the total fluid volume in your blood vessels, diuretics effectively lower blood pressure and ease the workload on your heart. They accomplish this by targeting the kidneys and altering their function to promote fluid elimination.

How do diuretics achieve their effects? These medications work by interfering with the kidney’s ability to reabsorb certain substances, primarily sodium and chloride. As these electrolytes are excreted, water follows, leading to increased urine output. This process not only reduces blood volume but also helps alleviate fluid retention in various parts of the body.

Types of Diuretics: Understanding the Different Categories

Diuretics come in several categories, each with its unique mechanism of action and specific uses. The three main types of diuretics are:

1. Thiazide diuretics
2. Loop diuretics
3. Potassium-sparing diuretics

Thiazide Diuretics

Thiazide diuretics are often the first choice for treating high blood pressure. They work by reducing the kidney’s ability to reabsorb sodium and chloride in the distal convoluted tubule. Examples of thiazide diuretics include:

• Hydrochlorothiazide (Esidrix)
• Chlorthalidone
• Indapamide

These medications are known for their long-lasting effects and can be used for extended periods. They are particularly effective in managing hypertension and reducing the risk of cardiovascular events.

Loop Diuretics

Loop diuretics are more potent than thiazides and act on the loop of Henle in the kidney. They are often used in situations requiring rapid and substantial fluid elimination. Common loop diuretics include:

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

These medications are particularly useful in treating severe edema associated with heart failure, liver cirrhosis, or kidney disease. They can produce a significant increase in urine output within a short period.

Potassium-Sparing Diuretics

Unlike other diuretics that can lead to potassium loss, potassium-sparing diuretics help maintain potassium levels while eliminating excess fluid. They are often used in combination with other diuretics to prevent hypokalemia. Examples include:

• Spironolactone (Aldactone)
• Amiloride
• Triamterene

These medications are particularly beneficial for patients with conditions that may cause potassium imbalances or those at risk of developing hypokalemia from other diuretic use.

Medical Conditions Treated with Diuretics

Diuretics are versatile medications used to treat a variety of medical conditions. Their ability to reduce fluid retention and lower blood pressure makes them valuable in managing several disorders. Here are some of the primary conditions for which diuretics are prescribed:

Hypertension (High Blood Pressure)

Diuretics, particularly thiazide diuretics, are often the first-line treatment for hypertension. By reducing blood volume, they help lower blood pressure, decreasing the risk of stroke and heart attack. Thiazide diuretics have been shown to be particularly effective in managing mild to moderate hypertension in many patients.

Heart Failure

In heart failure, the heart’s pumping ability is compromised, often leading to fluid accumulation in the lungs and extremities. Loop diuretics are commonly prescribed to alleviate this congestion, improve breathing, and reduce swelling in the legs and ankles. By reducing fluid overload, diuretics can significantly improve the quality of life for heart failure patients.

Edema

Edema, or swelling caused by fluid retention, can occur in various parts of the body due to different medical conditions. Diuretics help reduce this swelling by promoting fluid elimination. They are particularly useful in managing edema associated with heart, liver, or kidney diseases.

Kidney Disorders

In certain kidney disorders, the ability to excrete excess fluid and waste products is impaired. Diuretics can help compensate for this reduced kidney function by increasing urine output and facilitating the elimination of waste products.

Liver Cirrhosis

Advanced liver disease often leads to fluid accumulation in the abdomen (ascites) and legs. Diuretics, particularly spironolactone and furosemide, are used to manage this fluid retention and reduce the associated discomfort and complications.

Glaucoma

Some types of diuretics, particularly carbonic anhydrase inhibitors, are used in the treatment of glaucoma. These medications help reduce the production of aqueous humor, thereby lowering intraocular pressure.

Proper Usage and Administration of Diuretics

Proper administration of diuretics is crucial for their effectiveness and to minimize potential side effects. Here are some key guidelines for taking diuretics:

• Follow the prescribed dosage and schedule carefully
• Take the medication at the same time each day
• For once-daily dosing, take the diuretic in the morning with breakfast
• If multiple doses are prescribed, take the last dose no later than 4 p.m. to avoid nighttime urination
• Do not skip doses or stop taking the medication without consulting your doctor
• Stay well-hydrated unless otherwise instructed by your healthcare provider

Is timing important when taking diuretics? Indeed, the timing of diuretic administration can significantly impact its effectiveness and your quality of life. Taking the medication in the morning allows for increased urination during the day, minimizing nighttime disruptions. However, always follow your doctor’s specific instructions, as the optimal timing may vary based on your individual condition and lifestyle.

Potential Side Effects and Risks of Diuretic Use

While diuretics are generally safe and effective, they can cause side effects in some individuals. It’s important to be aware of these potential issues and report any concerning symptoms to your healthcare provider. Common side effects of diuretics include:

• Increased urination
• Dehydration
• Electrolyte imbalances (particularly potassium)
• Dizziness or lightheadedness
• Headache
• Muscle cramps
• Increased blood sugar levels
• Increased cholesterol levels
• Skin rash or sensitivity to sunlight (with certain diuretics)

Can diuretics cause serious complications? While rare, some individuals may experience more severe side effects. These can include severe electrolyte imbalances, kidney problems, or allergic reactions. It’s crucial to seek immediate medical attention if you experience symptoms such as severe weakness, irregular heartbeat, severe dizziness, or signs of an allergic reaction.

Interactions Between Diuretics and Other Medications or Foods

Diuretics can interact with various medications and certain foods, potentially altering their effectiveness or increasing the risk of side effects. It’s essential to inform your healthcare provider about all medications, supplements, and herbal remedies you’re taking. Some notable interactions include:

Medication Interactions

• Other blood pressure medications: May enhance blood pressure-lowering effects
• NSAIDs (e.g., ibuprofen): Can reduce the effectiveness of diuretics
• Digoxin: Increased risk of digoxin toxicity, especially with low potassium levels
• Lithium: Thiazide diuretics can increase lithium levels
• Diabetes medications: Diuretics may affect blood sugar levels

Food Interactions

Depending on the type of diuretic, dietary considerations may include:

• Potassium intake: May need to be increased with thiazide and loop diuretics, or decreased with potassium-sparing diuretics
• Salt intake: Generally should be restricted
• Alcohol: Can enhance the effects of diuretics and increase the risk of dehydration

How can patients manage these interactions effectively? The key is open communication with your healthcare provider. Regular monitoring of blood pressure, electrolyte levels, and kidney function can help detect and prevent potential problems. Your doctor may adjust your medication dosages or recommend specific dietary modifications based on your individual needs and response to treatment.

Monitoring and Follow-up Care for Diuretic Users

Regular monitoring is crucial for individuals taking diuretics to ensure their effectiveness and minimize potential risks. Your healthcare provider will likely recommend periodic check-ups and tests, which may include:

• Blood pressure measurements
• Blood tests to check electrolyte levels (particularly potassium and sodium)
• Kidney function tests
• Uric acid levels (as some diuretics can increase the risk of gout)
• Blood sugar levels, especially in diabetic patients

What should patients track at home while on diuretic therapy? Self-monitoring can play a vital role in managing your health while on diuretics. Consider keeping a log of the following:

• Daily weight: Sudden weight gain could indicate fluid retention
• Blood pressure readings (if you have a home blood pressure monitor)
• Any side effects or unusual symptoms
• Urine output changes

Report any significant changes or concerns to your healthcare provider promptly. This proactive approach can help ensure that your diuretic therapy remains safe and effective over time.

Special Considerations for Specific Patient Groups

While diuretics are widely used, certain patient groups require special attention and tailored approaches. These considerations can significantly impact the choice of diuretic, dosage, and monitoring requirements:

Elderly Patients

Older adults may be more sensitive to the effects of diuretics and at higher risk for side effects such as dehydration and electrolyte imbalances. Lower initial doses and more frequent monitoring may be necessary.

Patients with Diabetes

Diuretics can affect blood sugar levels, potentially complicating diabetes management. Close monitoring of glucose levels and potential adjustments to diabetes medications may be required.

Individuals with Kidney Disease

Patients with impaired kidney function may have altered responses to diuretics and be at higher risk for electrolyte imbalances. Careful dosing and more frequent monitoring of kidney function and electrolyte levels are essential.

Pregnant Women

Some diuretics can cross the placenta and affect the fetus. The use of diuretics during pregnancy should be carefully considered and monitored by a healthcare provider specializing in high-risk pregnancies.

Patients with Liver Disease

Individuals with liver cirrhosis may require specific diuretic regimens to manage ascites while minimizing the risk of complications such as hepatic encephalopathy.

How do healthcare providers tailor diuretic therapy for these special populations? The approach typically involves:

• Careful selection of the most appropriate type of diuretic
• Starting with lower doses and gradually titrating as needed
• More frequent monitoring of blood tests and clinical response
• Consideration of potential drug interactions with other medications
• Patient education on self-monitoring and when to seek medical attention

By taking these factors into account, healthcare providers can optimize diuretic therapy for each individual, maximizing benefits while minimizing risks.

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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• A symphony of calmness and health, or why our body needs magnesium
  • Fedechkina Elena
• The secret of a chic hairstyle: how to properly and incorrectly care for hair
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• Not a temporary relief, but real help: counseling for a cold
  • Kovrigina Elena Semenovna

Required Sales Theory and Practice

• 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? Let’s analyze these and…

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  Answering your questions

• Submit documents for accreditation through the FRM

  Step-by-step instructions for pharmacists

• Order of the Ministry of Health No. alists?

  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 90 039

  8 dispensing questions that concern pharmacists

• Wound healing agents: mechanism of action, indication

  Classification, indications and mechanism of action

• pathosis: counseling algorithm

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

• Pharmacy cosmetics: classification, legal regulation

  Classification and rules for the circulation of cosmetics

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

  From 10% to 40% of people suffer from allergies

• 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?

  Lay low in the pharmacy

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

  ..

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

• Pharmacy with a robotic warehouse in the Moscow region

  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 checklist products

  How to properly formulate a diet

• An important factor in the treatment of erectile dysfunction

  Erectile dysfunction (ED) is a persistent 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 OTC dispensing without a prescription: what pharmacists think

  “It will become impossible to work under such conditions”: what do pharmacists and pharmacists think. .. 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 the menopause as painlessly as possible

• Kraken coronavirus strain: signs and treatment

  A variety of omicron strain reached Russia

• 906 73 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

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