Who needs diuretics and why?

Diuretics help the body get rid of excess fluid by stimulating urine production. This action is called a diuretic. As a result, the person has to go to the toilet more often.

In the “ Yod ” telegram channel we tell you how to take care of your health based on evidence-based medicine.

When is diuretic treatment prescribed?

Medicines are taken both at home and in the hospital. The drugs are used to treat chronic diseases and some emergency disorders. The action of diuretics helps with the following conditions:

• increased arterial, intracranial and ocular pressure;
• electrolyte disturbances;
• heart failure;
• swelling of the limbs, brain and lungs;
• kidney and liver diseases.

Depending on the disease and its cause, the doctor selects a drug from a suitable group.

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What are the types of diuretics?

Types of diuretics differ from each other in the active substance, the method of removing urine from the kidneys, the speed of onset of the effect and its duration. Therefore, you cannot choose the medicine yourself and buy it at the pharmacy. The doctor must select a drug suitable for the disease and write a prescription for it.

There are six types of diuretics.

Thiazide diuretics

Sodium attracts and holds water. And thiazide diuretics reduce the reabsorption of this mineral into the blood, so sodium remains in the kidneys, and along with it – water. This helps increase urinary fluid loss and reduce plasma volume. This effect is usually needed to lower blood pressure.

The effect of thiazide diuretics is weaker compared to other types of diuretic drugs.

Drugs in this group include:

• metolazone;
• hydrochlorothiazide;

Loop diuretics

These diuretics work in a part of the kidney called the loop of Henle, hence the name. The drugs increase the excretion of salts, reducing the reabsorption of sodium, chlorine and potassium, calcium and magnesium.

Loop diuretics are used to treat high blood pressure, edema due to heart failure, liver and kidney diseases.

Loop diuretics include furosemide and torsemide.

Potassium-sparing diuretics

Diuretics in this group increase urination without losing potassium. The drugs block sodium channels in kidney cells, so only sodium and water are excreted from the body.

During treatment with diuretics of this group, it is important to monitor your diet so that there is no excess of potassium-containing products. Otherwise, hyperkalemia may occur , a dangerous condition that can cause a heart attack .

When it is important to preserve the mineral, potassium-sparing diuretics are combined with thiazide or loop drugs.

Diuretics of this group:

• spironolactone;
• eplerenone;
• triamterene (available as a combination drug with hydrochlorothiazide;
• amiloride

Carbonic anhydrase inhibitors

The drugs reduce the activity of carbonic anhydrase, an enzyme responsible for the reaction between carbon dioxide and water. The overall effect is to alkalinize the urine.

Although the medications are considered diuretics, they also reduce the level of fluid in the eye, which is why they are used to treat glaucoma. The drugs are also used to control certain seizures in the treatment of epilepsy.

Some drugs begin to act within 15 minutes after administration, so they are also used as emergency aid. For example, to relieve symptoms of acute mountain sickness.

The carbonic anhydrase inhibitor is acetazolamide.

Osmotic diuretics

These drugs increase the osmotic pressure of plasma and promote the transfer of fluid from tissues to blood vessels. As a result, the volume of circulating blood increases. In the kidneys, the drug prevents the reabsorption of water, which leads to its retention and an increase in urine volume .

The drugs are used to enhance water diuresis and prevent the development of anuria – complete cessation of urination. Osmotic diuretics are also used to reduce intracranial and intraocular pressure.

Mannitol is an osmotic diuretic.

Vasopressin receptor antagonists

Vasopressin is a hormone that is produced when water levels in the body decrease. It retains fluid and stops urine production. It is also called antidiuretic hormone.

Vasopressin antagonists are drugs that bind to the hormone’s receptors and block its action.

The drugs are used to treat hyponatremia—low sodium levels. Blocking the receptors helps remove water from the body while preserving electrolytes.

Vasopressin antagonists include conivaptan and tolvaptan. Both active ingredients are not available on the Russian market.

What are the side effects of diuretics?

Diuretics are safe when taken as directed and under medical supervision. Possible side effects may include the following:

• dehydration;
• imbalance of electrolytes: potassium, magnesium, sodium, chlorine;
• dizziness and headache;
• weakness, fatigue;
• muscle spasms;
• constipation ;
• dry mouth;
• increased blood sugar levels;
• gout;
• potency disorders.

To avoid side effects, you should drink more fluids while taking diuretics. If you have to take medications for a long time, you may need to monitor your electrolyte levels.

Is it possible to take diuretics during pregnancy and lactation?

Diuretics cross the placental barrier and into breast milk, so their use is limited during pregnancy and lactation.

During pregnancy

Diuretics do not cause birth defects, but can affect fetal weight gain and disrupt the electrolyte balance in the body of the mother and child. These medications also increase fetal urination, which can cause polyhydramnios.

Diuretics are prescribed to treat pregnant women with heart failure and pulmonary edema associated with it. At the same time, the drugs are not taken over a long course, so as not to disrupt the child’s weight gain. Sometimes diuretics are used for hypertension in pregnant women, but they are not the first choice drugs.

Diuretics are not used to treat swelling of the arms and legs during pregnancy. They are also not used to treat or prevent the development of preeclampsia.

While breastfeeding

Diuretics are generally not recommended during breastfeeding because they suppress lactation and have a diuretic effect on the infant. If it is necessary to prescribe diuretics, the doctor weighs the expected benefit for the mother and the possible risk for the child.