What Are Diuretics?
Diuretics are a class of antihypertensive drugs that help your kidneys get rid of extra salt and water via urine.
They are usually the first line of drugs used to control blood pressure in hypertensive patients.
Diuretics are also called ‘water pills’ as they help your kidneys pump out extra water from the blood, decreasing the fluid in your blood vessels.
This fluid reduction helps lower your blood pressure, making it easier for your heart to pump.
There are different types of diuretics, and each one acts on the kidneys differently.
Some diuretic medications have a combination of two or more drugs.
What Are The 3 Types Of Diuretics?
The three primary types of diuretics are – thiazides, loop diuretics and potassium-sparing diuretics.
Each of these diuretic groups has a different mechanism of action.
How To Pronounce Diuretic?
To pronounce diuretic correctly, you must say it as ‘dai - ur - eh - tuhk.’
How to Pronounce Diuretic? (CORRECTLY)
Courtesy: Julien Miquel’s YouTube channel
Commonly Asked Questions About Diuretics
Is Coffee A Diuretic?
Though coffee does increase urine production, it does not dehydrate.
So, coffee is a mild diuretic.
Is Pineapple A Diuretic?
Pineapple juice is a known diuretic that helps flush out toxins from the digestive system.
Is Beer A Diuretic?
Beer is alcohol, and all types of alcoholic drinks are diuretics because they cause your body to expel fluids from the excretory system quicker than most other liquids.
Alcohol can also cause dehydration.
Is Chocolate A Diuretic?
Chocolate contains caffeine and theobromine, both of which cause diuresis.
Why Are Diuretics Used?
Diuretics are usually prescribed to you if you suffer from one of the following conditions:
- High blood pressure or hypertension: Thiazide diuretics are prescribed in this case, lowering the chance of stroke or heart attack.
- Edema (fluid accumulation): Diuretics effectively reduce edema, especially in the legs.
- Heart failure: Since diuretics reduce the overall fluid levels in the blood and body, they reduce the congestion and swelling in the lungs.
This improves circulation and relieves pressure on the heart in case of heart failure.
Loop diuretics are usually prescribed in these cases.
- Kidney and liver problems: Diuretics ease up the fluid pressure that may impact the kidneys and the liver.
- Glaucoma: Diuretics reduce the pressure on the eye and relieve symptoms of glaucoma.
Do Diuretics Make You Lose Weight?
Diuretics facilitate the elimination of excess fluid from the body.
This can help reduce your water weight.
However, this does not help lose fat, and as a result, it cannot be used for weight loss.
How Do Diuretics Work?
Different types of diuretics have different mechanisms of action.
Thiazide Diuretics
Thiazide diuretics stimulate your kidneys to pull salt and extra water from the blood and increase urine output.
Common thiazide diuretics include hydrochlorothiazide and chlorthalidone.
Some side effects of thiazide diuretics include headache, loss of appetite, and hair loss.
Loop Diuretics
They are considered the most potent diuretics and prevent reabsorption of both sodium and chloride.
These diuretics are effective because they act directly on the loop of Henle portion of the renal tubule (in the kidneys).
Some commonly used loop diuretics are furosemide and bumetanide.
Few people may experience side effects like diarrhea, dizziness, or an upset stomach when taking loop diuretics.
Potassium-sparing Diuretics
These diuretics reduce the body’s fluid levels while preventing excessive loss of potassium, a vital mineral.
This group of diuretics is recommended for people who have low potassium levels in the body or are taking medications that may deplete potassium levels.
Triamterene and amiloride are two commonly used potassium-sparing diuretics.
Some people may experience side effects like gas, nausea, and headache on taking potassium-sparing diuretics.
Two other types of diuretics that are used less often are:–
Carbonic Anhydrase Inhibitors
This group of diuretics works by increasing the excretion of sodium, potassium, and bicarbonate, along with water, from the renal tubules.
The diuretic property of carbonic anhydrase inhibitors are usually mild, and hence, these drugs are not commonly used.
Some examples of carbonic anhydrase inhibitors include acetazolamide, dichlorphenamide, and methazolamide.
Osmotic Diuretics
These diuretics work by preventing the resorption of water, sodium, and chloride by increasing the osmotic pressure within the kidney.
How Long Does It Take For A Diuretic To Work?
Diuretics begin working around 1-2 hours after you take them.
What Is The Most Effective Natural Diuretic?
There are plenty of natural diuretics.
These include coffee, dandelion extract, parsley, hibiscus, green and black tea.
Black seed (Nigella sativa) is one of the most effective natural diuretics.
Side Effects Of Diuretics
Diuretics are generally well-tolerated and considered safe.
However, they may cause side effects in some individuals.
The most common side effects are:
- Headache
- Dizziness
- Increased thirst
- Increased blood sugar levels
- Muscle cramps
- Increased blood cholesterol
- Skin rash and itching
- Diarrhea
- Gout (increased deposit of uric acid crystals in the joints)
- Ringing in the ears is common with loop diuretics
- Low sodium, potassium, and magnesium levels may be seen with loop diuretics
- High levels of potassium in the blood may occur with potassium-sparing diuretics
Some rare but serious side effects of diuretics include:
- Severe allergic reaction
- Kidney failure
- Irregular heartbeat
Why Are Diuretics Bad For Kidneys?
Diuretics act directly on your kidneys as they are responsible for eliminating extra fluid and salts from the body.
In some cases, excessive elimination of water can result in dehydration, which can be bad for your kidneys.
If you are suffering from a kidney ailment, it is best to inform your doctor before taking a diuretic.
Interactions With Other Drugs
Diuretics can react with other drugs when they are taken together. Some significant interactions of diuretics with other drugs are:
Antidiabetic drugs
When thiazide diuretics are given with antidiabetic drugs like insulin, they may decrease the blood levels of the antidiabetic drug.
In this case, the antidiabetic drug dosage may need to be increased.
Digoxin
Digoxin is a cardiac glycoside used to manage heart failure symptoms and atrial fibrillation.
Digoxin with thiazide and loop diuretics may cause side effects like weakness, cramps, and irregular heartbeat.
Lithium-containing drugs
Lithobid (a mood-stabilizing medication used to treat manic disorders and bipolar disorder) and other lithium-containing drugs with thiazide or loop diuretics may induce lithium toxicity due to decreased elimination of lithium from the body.
ACE inhibitors and NSAIDs
Taking potassium-sparing diuretics with angiotensin-converting enzyme (ACE) inhibitors of NSAIDs may result in severely elevated potassium levels.
This condition is called hyperkalemia and may cause muscle weakness, fatigue, and reduced heart rate (bradycardia).
Other antihypertensive drugs
Diuretics are a class of antihypertensive drugs and may be prescribed with other similar drugs to bring down blood pressure levels.
However, combining diuretics with other antihypertensive drugs may cause electrolyte imbalance in the body, especially reduced potassium levels.
Diuretics: Gene-Drug Interactions
The PDE4D Gene
Phosphodiesterase 4D or the PDE4D gene provides instructions for producing the enzyme cAMP-specific 3',5'-cyclic phosphodiesterase 4D.
This enzyme plays an essential role in regulating inflammation in the body and is associated with hypertension.
rs702553 is a single nucleotide polymorphism or SNP in the PDE4D gene. This SNP has been linked to arterial blood pressure.
Individuals with TT genotype of SNP rs702553 had significantly lower mean arterial blood pressure than AA and AT genotypes upon treatment with a diuretic.
The NEDD4L Gene
NEDD4-like E3 ubiquitin-protein ligase or the NEDD4L gene belongs to the NEDD4 family of genes.
This gene contains instructions for producing an enzyme that plays a role in sodium transport and regulates the reabsorption of sodium in the kidneys.
The NEDD4L gene has a strong effect on the efficacy of thiazide diuretics.
SNPs in the NEDD4L gene have been associated with hypertension.
Individuals with the AA genotype of rs4149601 and hypertension have a decreased response to diuretics compared to those having the AG or the GG genotypes.
Recommendations To Use Diuretics
Medical History
Before taking diuretics, it is recommended that you inform your doctor about your medical history.
Some crucial conditions that need to be mentioned include diabetes, pregnancy, pancreatitis, kidney problems, liver problems, lupus or history of lupus, gout, menstrual problems, and a tendency to get dehydrated.
History of Allergies
Inform your doctor about allergies to sulfa drugs like Septra and Bactrim before taking any diuretic.
Potassium-rich Diet
Diuretics cause the elimination of water and minerals like sodium and potassium.
If you are taking loop or thiazide diuretics, eating potassium-rich foods like bananas, sweet potatoes, spinach, lentils, etc., can ensure that you are getting enough for your body functions.
However, if you take potassium-sparing diuretics, avoid potassium-rich foods, low-sodium milk, or salt substitutes to prevent potassium overload.
Genetic Testing
Genetic testing helps your doctor determine your response to different diuretics based on your genotype.
This can help them prescribe an appropriate dosage of the diuretic drugs to manage your hypertension.
Analyze Your Genetic Response to Diuretics
Should You Drink More Water When Taking Diuretics?
While taking diuretics, you will have to urinate more often.
The goal is to avoid getting dehydrated while on diuretics.
Your doctor will also guide you about how much water you should consume every day when taking diuretics.
You will need to visit your doctor for regular checkups to monitor your hydration and potassium levels and determine how your kidneys are working.
Summary
- Diuretics or water pills are a class of antihypertensive drugs that help your kidneys get rid of excess salt and water via urine.
- The three primary diuretics are thiazide, loop, and potassium-sparing diuretics, and their mechanisms of action differ.
- Though largely safe, diuretics can cause side effects like muscle cramps, diarrhea, and kidney problems in some individuals.
- It is essential to inform your doctor about medications you are currently taking to avoid interaction with diuretics.
- Two significant genes that influence diuretic prescription are the PDE4D and the NEDD4L.
- Diuretics can dehydrate your body - therefore, it is recommended to regulate your water intake according to your physician's advice.
- Genetic testing can help plan optimal dosages according to your body type and shine light on your risk for any adverse drug reactions.
References
- https://my.clevelandclinic.org/health/treatments/21826-diuretics
- https://www.rxlist.com/diuretics/drugs-condition.htm
- https://www.webmd.com/hypertension-high-blood-pressure/guide/diuretic-treatment-high-blood-pressure
- https://www.healthline.com/health/does-alcohol-dehydrate-you
- https://www.livestrong.com/article/126110-fruits-natural-diuretics/
- https://www.healthline.com/nutrition/does-coffee-dehydrate-you#caffeine-and-hydration
- https://my.clevelandclinic.org/health/treatments/21826-diuretics
- https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129
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