Frequently Asked Questions About Diuretics

Diuretics are formulations that potentiate the exertion of urine and reduce the level of liquids in the organism. This is due to the action on the kidneys that is primarily induced by the prevention of repeated uptake of sodium ions in the kidneys, which leads to a diminished in water repeated absorption. Another action with the lesser effect which is also rendered is the enhancement of filtration in the glomeruli.

Diuretics are split into the direct kidney diuretics, i.e. those that impact the kidneys and provide the most potent effect, and extrarenal, i.e. those that render a diuretic effect indirectly, through other systems of the body.

There are several groups of diuretics that are rendering different potency effects. They are called:
– Loop;
– Potassium-sparing;
– Osmotic.

The formulations with the most powerful action are loop diuretics. They act on the lifting up part of the Henle loop and preclude the repeated uptake of chlorine and sodium ions; the washing out of potassium is also enhanced.

Thiazides are also very powerful. The actions of these pills takes place mainly in the cortical segment of the nephron loop, where the repeated uptake of sodium and potassium is blocked.

Enhancing the diuresis, the formulations diminish the volume of the circulating blood, its return to the heart and subsequently the load on the myocardium. On top of that thiazides relax the vessels walls through the diminishing of sodium ions levels which leads to the diminished swelling and drop of overall vascular resistance.

Potassium-sparing diuretics also potentiate the washing out of sodium ions but also lower the washing out of potassium ions. They act in places where sodium and potassium ions are exchanged. They are much less potent and render a shorter effect than loop diuretics but do not cause hypokalemia (low potassium) as those medicines do.

Osmotic diuretics are the only ones that do not “block” urination. They potentiate the osmotic tension of the "primary urine" and are used to induce potent diuresis in poisoning, acute kidney failure, acute heart failure in individuals with impaired renal filtration, and in edema of the brain.

Diuretics are appointed in:
– Arterial hypertension;
– Cardiovascular diseases with swelling;
– Renal and hepatic diseases with swelling;
– Swelling of the brain;
– Premenstrual swelling.

However, the medications are prescribed not always for these conditions even if they are accompanied by swellings. They can be utilized only in the lack of contraindications for use especially in congestive heart failure and in the cases when proven positive sodium balance is present. The washing out of sodium is accompanied by swelling reduction.

For high arterial pressure, first of all, thiazide diuretics are appointed. If their effect is insufficient, it’s not advised to raise their dosage or use more potent drugs but rather an additional therapy with other antihypertensive formulations such as ACE inhibitors, beta blockers, and so on is appointed.

The time diuretics can be used by a certain individual must be chosen by a qualified doctor.

It is preferable not to use the formulations for long periods of time because they can impair water-electrolyte balance. You should also get your arterial tension and kidney function monitored while taking water pills.

In some diagnoses, for instance, congestive heart failure, the therapy with diuretics is made without interruptions. However, dosages can greatly vary. For example, during an exacerbation, a course of active therapy with higher dosages should be used and in the improvement of the condition, the lowering of the dosage to the minimum is prescribed.

No. Some people claim that they have lost weight with diuretics but it’s not possible without cutting the calorie intake. Weight loss is only possible in fewer consumed calories than burned. Besides, an uncontrollable use of diuretics can cause severe health damage as they affect the kidney function and level of minerals in the body.

Swelling is a frequent occurrence during pregnancy. However, it is not advised in general to use any medications except for certain vitamins prescribed by a doctor especially during the first three months of pregnancy. Some medications, and precisely some of diuretics are prohibited only during the first trimester of pregnancy but can be used in the following ones but only if your doctor approves and prescribes them. It usually happens when the negative consequences of water retention in the body exceed the potential risk of diuretics use by the woman.

Children, as well as adults, can have diseases and conditions that cause water retention in the body. There are no special water pills for kids so they are given the pills for adults but in the lower dosages. Besides, as kids are more prone to the lowering of potassium level below the norm, they are usually given the pills for short periods of time. For instance, they can be given the pills for three days with a break of 3-4 days and then the use is resumed. However, it is an approximate scheme and the precise treatment plan must be prescribed by a pediatrician.

The symptoms of low potassium in kids are:
– Fatigue;
– Loss of appetite;
– Sleepiness;
– Constipation;
– Seizures and cramps.

When giving water pills to your kid, make sure to include in their diet products rich in potassium such as apricots, oatmeal, beef, beets, pine nuts, raisins, avocados, yogurt, cocoa, and tea. Besides, when taking a break from diuretics, it is advised to minimize or cease at all salt use in food preparation as it can cause swelling.

The most commonly prescribed diuretics for kids include (these are the generic names):
1. Spironolactone;
2. Acetazolamide;
3. Hydrochlorothiazide;
4. Furosemide (Lasix by Sanofi Aventis).

Spironolactone-based medications are the most preferable because they are potassium-sparing diuretics that do not cause potassium deficiency. Using these pills for your kid, you don’t need to include a lot of potassium-rich products in their diet.

Since there are different types of diuretics, the contraindications for their use also differ. However, there are some common rules.

You should not use diuretics if:
– You are allergic to them (a certain active agent);
– You have low blood pressure;
– You have impaired kidney function with difficulty urinating;
– You have water-electrolyte imbalance.

The cases in which the use of the medications is possible but with caution are:
– Arrhythmia;
– Diabetes;
– Severely impaired liver function;
– Prostatic hyperplasia;
– Gout.

The use of water pills in high doses and for long periods of time can lead to severe dehydration and hypovolemia, i.e. the drop of the blood volume below normal. Other adverse effects include:
– The drop of the potassium in the body below the norm.  This causes headaches, loss of appetite, fatigue, sleepiness, cramps, and seizures. In case the symptoms occur, the use of diuretic must be immediately discontinued;
– Sometimes the use of diuretics can lead to worsening of the course of diabetes mellitus and raise the risk of developing gout, since some of them elevate the level of glucose and uric acid in the blood;
– Allergic reactions;
– Drop of blood pressure below the norm;
– Nausea.

Different diuretics differently interact with other medicines.

The most notable combinations include:
– Thiazide diuretics with oral antidiabetic medicines. The water pills lower the level of antidiabetic medicines so their dosages should be increased;
– Use of diuretics with Digoxin is fraught with hypokalemia, lowering of potassium level which can be fatal;
– Diuretics with Lithium use should be avoided since it can potentiate the toxicity of psychiatric medication;
– Potassium-sparing diuretics with ACE inhibitors or anti-inflammatories can cause potassium level raise and hyperkalemia that can be fatal;
– The blood tension lowering effect of diuretics is enhanced with other blood pressure formulations. They can be combined but only a doctor should decide on the combinations and dosages.