DIURETICS
DIURETICS PROPERTIES MECHANISM OF ACTION ADVERSE INDICATIONS DOSES
EFFECTS
THIAZIDE Secreted in proximal tubule 1. ↓Reabsorption & ↑Excretion Hypokalemia Congestive heart Chlorthalidone
DIURETICS lumen by organic acid of Na, Cl & H2O failure ↓
transport mechanism. ↓ Hypoglycemia 12.5-25mg
(Chlorthalidone, Short term Long term Hypertension
Metolazone, Derived from Effect effect Hyperuricemia Hydrochlorothiazide
Chlorothiazide, benzothiadiazine ( ↓ blood vol (↓Na content Insipidus ↓
Hydrochlorothiazide, ↓ of SM cells Hyperlipidemia 12.5-25mg
Bendroflumethiazide) Good oral bioavailability. ↓Cardiac output ↓ Calcium calculi
↓ ↓Muscle Bendroflumethiazide
Anti-diuretic effect of ADH ↓ BP) sensitivity) ↓
does not work on thiazide. ↓ 1.25-2.5mg
↓Peripheral
vascular
. resistance )
2. Block Na-Cl symporter.
3. Reduce urate excretion.
4. ↑Renal excretion of K & Mg.
5. ↑Reabsorption & ↓Excretion
of Ca by lowering Na conc. In
tubule epithelial cells.
6. ↑ Activity of basolateral Na-Ca
antiporter.
, LOOP Sulfonamide derivates Act on the loop of Henle. Hypokalemia Heart failure Ethacrynic acid
DIURETICS except Ethacrynic acid. ↓
Inhibit 30% of Na reabsorption. Hyponatremia Hypertension 25-50 mg
( Ethacrynic acid, I/V adm cause vasodilation.
Torsemide, Inhibit Na/K/2Cl co-transport Hypomagnesemia Edema Furosemide
Furosemide, Preferred in low CrCl level. system which is located on ↓
Azosemide, luminal membrane of cells in Hypocalcemia Cirrhosis 20-40 mg
Bumetanide) ↑dose of loop diuretics ascending loop of Henle.
gives high ceiling effect Ototoxicity Hypercalcemia Torsemide
after which no diuresis ↓
occurs but longer duration Fluid & Electrolyte Diuretic resistance 1.25-2.5 mg
of action clinically. losses overcome by
giving: Bumetanide
Patients become less Hypokalemic Metolazone ↓
responsive to loop diuretics alkalosis ↓ 0.5-1 mg
despite high dose; termed (orally)
as diuretic resistance. It Reduction in plasma OR
occurs due to high Na volume Chlorothiazide
reabsorption in distal tubule (I/V adm)
as a result of high load of Hypersensitivity ↓
Na; which is secondary to reactions 30min prior to loop
blockade of loop diuretics) diuretics
Hearing impairment
DIURETICS PROPERTIES MECHANISM OF ACTION ADVERSE INDICATIONS DOSES
EFFECTS
THIAZIDE Secreted in proximal tubule 1. ↓Reabsorption & ↑Excretion Hypokalemia Congestive heart Chlorthalidone
DIURETICS lumen by organic acid of Na, Cl & H2O failure ↓
transport mechanism. ↓ Hypoglycemia 12.5-25mg
(Chlorthalidone, Short term Long term Hypertension
Metolazone, Derived from Effect effect Hyperuricemia Hydrochlorothiazide
Chlorothiazide, benzothiadiazine ( ↓ blood vol (↓Na content Insipidus ↓
Hydrochlorothiazide, ↓ of SM cells Hyperlipidemia 12.5-25mg
Bendroflumethiazide) Good oral bioavailability. ↓Cardiac output ↓ Calcium calculi
↓ ↓Muscle Bendroflumethiazide
Anti-diuretic effect of ADH ↓ BP) sensitivity) ↓
does not work on thiazide. ↓ 1.25-2.5mg
↓Peripheral
vascular
. resistance )
2. Block Na-Cl symporter.
3. Reduce urate excretion.
4. ↑Renal excretion of K & Mg.
5. ↑Reabsorption & ↓Excretion
of Ca by lowering Na conc. In
tubule epithelial cells.
6. ↑ Activity of basolateral Na-Ca
antiporter.
, LOOP Sulfonamide derivates Act on the loop of Henle. Hypokalemia Heart failure Ethacrynic acid
DIURETICS except Ethacrynic acid. ↓
Inhibit 30% of Na reabsorption. Hyponatremia Hypertension 25-50 mg
( Ethacrynic acid, I/V adm cause vasodilation.
Torsemide, Inhibit Na/K/2Cl co-transport Hypomagnesemia Edema Furosemide
Furosemide, Preferred in low CrCl level. system which is located on ↓
Azosemide, luminal membrane of cells in Hypocalcemia Cirrhosis 20-40 mg
Bumetanide) ↑dose of loop diuretics ascending loop of Henle.
gives high ceiling effect Ototoxicity Hypercalcemia Torsemide
after which no diuresis ↓
occurs but longer duration Fluid & Electrolyte Diuretic resistance 1.25-2.5 mg
of action clinically. losses overcome by
giving: Bumetanide
Patients become less Hypokalemic Metolazone ↓
responsive to loop diuretics alkalosis ↓ 0.5-1 mg
despite high dose; termed (orally)
as diuretic resistance. It Reduction in plasma OR
occurs due to high Na volume Chlorothiazide
reabsorption in distal tubule (I/V adm)
as a result of high load of Hypersensitivity ↓
Na; which is secondary to reactions 30min prior to loop
blockade of loop diuretics) diuretics
Hearing impairment
