Diuretics

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Also indexed as:

Acetazolamide, Carbonic Anhydrase Inhibitors, Diamox, Mannitol, Methazolamide, Neptazane

Diuretics are a family of drugs that promote urination. They are used to reduce water accumulation or edema associated with heart failure, cirrhosis, and corticosteroid therapy, as well as to treat high blood pressure. Diuretics are classified as "potassium-depleting" if they cause loss of potassium in the urine, or "potassium-sparing" if they cause retention of potassium.

Interactions involving diuretics in general are described on this page. For interactions involving a category of diuretics or a specific drug, refer to the highlighted items below.

Categories

Carbonic anhydrase inhibitors, Potassium-Depleting

• Acetazolamide (Diamox)
• Dichlorphenamide (Daranide)
• Methazolamide (Neptazane)

Thiazides, Potassium-Depleting

• Bendroflumethiazide (Naturetin)
• Benzthiazide (Exna)
• Chlorothiazide (Diuril)
• Chlorthalidone (Hygroton)
• Hydrochlorothiazide (Esidrix, HydroDiuril®, Microzide)
• Hydroflumethiazide (Diucardin)
• Indapamide (Lozol)
• Methyclothiazide (Enduron)
• Metolazone (Zaroxolyn, Mykrox)
• Polythiazide (Renese)
• Quinethazone (Hydromox)
• Trichlormethiazide (Naqua)

Loop diuretics, Potassium-Depleting

• Bumetanide (Bumex)
• Ethacrynic acid (Edecrin)
• Furosemide (Lasix)
• Torsemide (Demadex)

Potassium-sparing

• Amiloride (Midamor)
• Amiloride and Hydrochlorothiazide (Moduretic)
• Spironolactone (Aldactone)
• Spironolactone and Hydrochlorothiazide (Aldactazide)
• Triamterene (Dyrenium)
• Triamterene and Hydrochlorothiazide (Dyazide, Maxzide)

Herbs

Summary of Interactions for Diuretics

Depletion or interference	Folic acid
Adverse interaction	Alder buckthorn Buckthorn
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known
Interactions common to many, if not all, Diuretics are described in this article. Interactions reported for only one or several drugs in this class may not be listed in this article. Some drugs listed in this article are linked to articles specific to that respective drug; please refer to those individual drug articles. The information in this article may not necessarily apply to drugs in this class for which no separate article exists. If you are taking a Diuretic for which no separate article exists, talk with your doctor or pharmacist.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Folic acid

One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.¹ Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

Interactions with Herbs

Alder Buckthorn, Buckthorn(Rhamnus catartica, Rhamnus frangula, Frangula alnus)

Use buckthorn or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.²

References

1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70.
2. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: University of Exeter, Centre for Complementary Health Studies, 1997.

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Last Review: 09-01-2007

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