Diuretics

Diuretics

Diuretics are agents that promote the excretion of urine through their effects on kidney function.

Information about Diuretics

Diuretics constitute a large family of medications that increase urine flow and induce urinary sodium loss and are widely used for therapy of hypertension, congestive heart failure, and edematous states.

FDA approval information for Diuretics

Diuretics in current use (and the year of their approval for use in the United States) include chlorothiazide (1958), hydrochlorothiazide (1959), bendroflumethiazide (1959), spironolactone (1960), chlorthalidone (1960), methychlothiazide (1961), polythiazide (1961), triamterene (1964), furosemide (1966), ethacrynic acid (1967), metolazone (1973), bumetanide (1983), indapamide (1983), amiloride (1986), acetazolamide (1986), torsemide (1993), and eplerenone (2002).

Types of diuretics

Diuretics are typically classified as thiazide diuretics (bendroflumethiazide, chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone and polythiazide), loop diuretics (bumetanide, ethacrynic acid, furosemide, and torsemide), and potassium-sparing agents (amiloride, eplerenone, spironolactone, and triamterene). The carbonic anhydrase blockers acetazolamide (1986) and methazolamide (1959) are also diuretics, but are more commonly used for the therapy of glaucoma.

Diuretics are some of the most frequently used medications in medicine and are usually well tolerated. Common side effects are those that are caused by the diuresis and mineral loss such as weakness, dizziness, electrolyte imbalance, low sodium and potassium.

Liver toxicity of Diuretics

Diuretics have not been associated with an appreciable increased rate of serum aminotransferase elevations and have rarely been associated with clinically apparent liver injury. Isolated case reports of idiosyncratic hepatotoxicity due to diuretics have been published, but there have been virtually no case series on individual diuretics or even whole class of drugs. The case reports that have been published provide only a very general pattern of injury that has not provided a clear clinical signature or suggestion that hepatotoxicity is a class effect among the thiazides and the loop diuretics. Switching from one diuretic to another has not been reported in any systematic fashion.

Most information on hepatotoxicity is available on the commonly used diuretics which include (and the number of prescriptions filled in 2007 for each): hydrochlorothiazide (45 million), furosemide (37 million), triamterene (21 million), spironolactone (8 million), and metolazone, bumetanide, indapamide and torsemide (1 to 2 million each). Diuretics implicated in rare cases of drug induced liver injury include hydrochlorothiazide, acetazolamide, amiloride, spironolactone and triamterene.

List of diuretics

Carbonic Anhydrase Inhibitors

• Acetazolamide
• Methazolamide

Loop Diuretics

• Bumetanide
• Ethacrynic Acid
• Furosemide
• Torsemide

Potassium-Sparing Diuretics

• Amiloride
• Eplerenone
• Spironolactone
• Triamterene

Thiazide Diuretics

• Bendroflumethiazide
• Chlorothiazide
• Chlorthalidone
• Hydrochlorothiazide
• Indapamide
• Metolazone
• Polythiazide

Vasopressin Antagonists

• Tolvaptan

Antihypertensive agents

• Dailymed label info on Diuretics
• FDA Diuretics

Diuretics Resources
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