Main indications for the use of diuretics. Types of diuretics (diuretics) by composition and mechanism of action

Diuretics increase urine output (diuresis)

- filtration enhancement(formation of primary urine)

- inhibition of electrolyte reabsorption processes(primarily Na +, Cl -) and water in kidney tubules(formation of secondary urine).

In medical practice, they are used for edema of various etiologies (acute and chronic). In addition, diuretics are used for poisoning with drugs and other chemical compounds to accelerate their elimination from the body (the so-called forced diuresis), and also as antihypertensive agents.

Classification of diuretics:

By localization of action in the nephron:

Thiazide– act on the initial part of the distal renal tubules (hydrochlorothiazide).

Thiazide-like– act on the initial part of the distal parts of the renal tubules (clopamide (brinaldix), indapamide (arifon), chlorthalidone (oxodoline)).

Loop diuretics– act on the ascending limb of the loop of Henle (furosemide (Lasix), bumetanide (Bufenox), ethacrynic acid (Uregit)).

Potassium-sparing diuretics– act on the distal tubules and collecting ducts (triamterene (pterophen), amiloride, spironolactone (aldactone, veroshpiron).

Osmotic– act on the proximal tubules, the descending part of the loop of Henle, collecting ducts (mannitol (mannitol), sorbitol, urea).

Carbonic anhydrase inhibitors– act on the proximal tubules

(diacarb (acetazolamide)).

Aquaretics– demeclocin (ADH antagonist).

Herbs that have a diuretic effect– bearberry leaf (folium Uvaeursi), lingonberry leaf (folium Vitisidaei), birch buds (gemmae Betulae), horsetail grass (herba Equiseti Arvensis), juniper fruits (fructus Juniperi).

Medicines with a diuretic effect: cardiac glycosides,

xanthines – enhance glomerular filtration;

By strength:

Strong(cause excretion of 15-25% of filtered sodium) - loop diuretics, osmotic (natriuresis is not great).

Medium strength(excretion of 5-10% filtered sodium) – thiazide, thiazide-like diuretics.

Weak(excretion not 5%) – diacarb (fonurite), potassium-sparing (triamterene, amiloride, spironolactone).

By the nature of the effect:

Hydrouretics

Saluretics

Potassium-sparing

Carbonic anhydrase inhibitors.

By speed and duration of action:

- quick and short-lasting effect: loop, osmotic.

- medium strength and duration: thiazide, potassium-sparing (triamterene),

carbonic anhydrase inhibitors, xanthines.

- delayed and long-acting: thiazide-like, potassium-sparing (spironolactone).

Comparative characteristics, distinctive properties and features of the prescription of diuretics are presented in Table 1.

Table 1

Comparative characteristics of diuretics

Table 2

Indications for the use of diuretics.

Side effects of diuretics are mainly associated with a direct effect on the electrolyte balance and acid-base balance of the body.

Table 3

Side effects of diuretics

General principles for prescribing diuretics

Daily diuresis during treatment should not exceed 2-2.5 liters.

Rational choice taking into account:

- severity of edema syndrome

- hemodynamic imbalance

- state of initial electrolyte balance

- features of the pharmacological characteristics of the diuretic, its undesirable effects

- individual tolerance

Combining diuretics

In urgent cases - intravenous administration of strong and fast-acting diuretics

Monitoring and correction of electrolyte and acid-base balance

Diuretics

Antigout drugs

Gout is a disease caused by a disorder of purine metabolism and is manifested by a high concentration of uric acid in the blood serum (hyperuricemia). As a result of the deposition of crystals of uric acid salts (urates) in the synovial tissue of joints and cartilage, repeated episodes of acute arthritis occur. In addition, the formation of uric acid kidney stones is possible.

When pharmacotherapy of gout, it is necessary to eliminate the acute attack as quickly as possible, as well as prevent repeated exacerbations and the formation of urate crystals in the tissues and kidneys.

Remedies for relieving an acute attack of gout:

Non-steroidal anti-inflammatory drugs: colchicine, naproxen, indomethacin, diclofenac, etc.

Steroid anti-inflammatory drugs: prednisolone, methylprednisolone, etc.

Remedies for the treatment of gout:

Uricodepressive(inhibit xanthine oxidase => decreases uric acid synthesis) : allopurinol

Uricosuric(increasing the excretion of uric acid by reducing the reabsorption of uric acid in the renal tubules) : etamide, sulfinpyrazone.

Mixed type: freak.

Drugs that affect the tone and contractile activity of the myometrium.

Classification of drugs affecting the myometrium.

Royal funds weaken or strengthen uterine contractions. They are used to maintain pregnancy, stimulate labor and stop uterine bleeding.

Many people have heard the term “diuretic” more than once. We will try to figure out what this is below. This group drugs have their own classification, properties and characteristics

Diuretic - what is it?

Diuretics are also called diuretics. They are drugs of synthetic or plant origin, which can increase urine excretion by the kidneys. Due to this, along with urine, water increases, and the level of fluid in the cavities and tissues of the body decreases. Because of this, swelling decreases or disappears altogether. Diuretics are drugs that are widely used in the treatment of hypertension (high blood pressure). They are often used to treat mild congestive heart failure, as well as a number of liver ailments and diseases associated with circulatory disorders, which provoke congestion in the body. Diuretic medications are often used to reduce or completely eliminate the symptoms of flatulence, which sometimes accompanies PMS or appears already during menstruation. If the treatment regimen and dosage are strictly followed, they do not cause severe side effects. They are quite safe to use.

during pregnancy

Many gynecologists do not recommend taking diuretics during pregnancy. The drugs may be unsafe for the fetus and the health of the mother. The negative action was discovered not so long ago. Previously, diuretic drugs were used to reduce edema in pregnant women, counteract preeclampsia, etc.

Diuretics: classification

There are various types diuretic medications. Each category has its own disadvantages. Today there are such groups medicines:

Loop medications.

Thiazide medications.
. Thiazide-like agents.

These groups will be discussed in more detail below.

Loop diuretics

This category of drugs is the most common. It includes such drugs as “Ethacrynic acid”, “Torasemide”, “Furosemide”, “Piretanide”, “Bumetanide”. Despite the fact that chemical structure They can differ significantly; these diuretics have the same mechanism of action. These medications inhibit the reabsorption of substances such as sodium, chlorine and potassium. The name "loop diuretics" is associated with their mechanism of action. Resorption occurs in the ascending lobe of the loop of Henle. It is carried out due to the blockade of sodium, chlorine, and potassium ions in the apical membrane of the tubular epithelium cells. Due to this, the work of the rotary-countercurrent system in the kidneys is suppressed. In addition, diuretics of this type are able to dilate the vessels of the cortex.

Side effects of loop diuretics

The strength of the effect of these medications is unusually great: they can increase diuresis by 25%. Unlike other drugs that lose their effect with the normalization of blood volume, loop-type diuretics continue to function under these conditions. It is thanks to their strong diuretic effect that they can provoke such side effects. The most rare and severe are a drop in blood pressure, hypovolemia, a decrease in the level of GFR and renal blood flow. Due to the increased level of excretion of hydrogen, chlorine and potassium, metabolic alkalosis cannot be ruled out. Sometimes loop diuretics provoke hyponatremia and hypokalemia. In rare cases - hyperglycemia, hyperuricemia. Other side effects are: lightheadedness, nausea, weakness. The medicine often provokes permanent or temporary deafness, as well as neutropenia. All medications of this type, which were listed above, are excreted from the body through the kidneys, metabolized in the liver.

Indications for loop diuretics

These medications are prescribed for all types of heart failure. And they are especially necessary for diseases such as refractory heart failure and pulmonary edema. The medications are also effective for hyponatremia, hypoalbuminemia, hypokalemia, hypochloremia, and renal failure. Loop diuretics continue to work when other groups of diuretics and their combinations are ineffective. This is their great value. That's why this type, the loop diuretic, is so common. We have already figured out what it is.

Thiazide diuretics

These medications and their derivatives (Indapamide, Chlorthalidone and Metolazone) are used quite often. First of all, this is due to their high rate of absorption in the gastrointestinal tract, as well as good level tolerability by patients. Thiazide diuretics are less powerful than loop diuretics, but due to their long duration of action, they are indicated for people with chronic diseases such as essential hypertension and mild congestive heart failure. Thiazide diuretics are prescribed for oral administration. Diuresis usually begins after 1-2 hours, but the therapeutic antihypertensive effect in some cases can be observed only after 3 months of continuous treatment. The founder of this group is chlorothiazide. It is characterized by low fat solubility and, consequently, low bioavailability. Because of this, higher dosages of the drug are required for a therapeutic effect. The drug "Chlorthalidone" is absorbed rather slowly, so its duration of action is somewhat longer. The drug "Metolazone" is often very effective in patients with reduced kidney function, unlike other medications in this category.

Potassium-sparing diuretics

There is also a potassium-sparing diuretic. What is it? These drugs are used to treat hypertension in combination with other types of drugs. They prevent excess potassium excretion from the body, which is a common side effect of other categories of diuretic drugs. Hypokalemia is a decrease in plasma potassium levels. It is a constant companion of thiazide diuretics, which are often prescribed for the treatment of hypertension. When potassium levels drop significantly, the patient begins to feel weak, gets tired faster, and develops cardiac arrhythmia. To prevent this, potassium-sparing diuretics are often prescribed along with thiazide medications. They retain in the body, along with potassium, other essential minerals - magnesium and calcium. At the same time, they practically do not delay the removal of excess fluid and sodium. The disadvantage of potassium-sparing medications is as follows. Plasma potassium levels may increase excessively (more than 5 mmol/L). This condition called hyperkalemia. It can cause muscle paralysis and heart rhythm disturbances, up to its complete stop. The development of pathology is most likely in patients with renal failure.

Use to treat hypertension

Diuretics for hypertension have proven themselves well. They help remove fluid from the body, which reduces blood pressure. It is a proven fact that diuretics are more effective in the treatment of elderly patients compared to beta-blockers. Diuretic medications are included in the list of first-line medications that are used to normalize blood pressure. According to US medical recommendations, this category should be used for initial treatment of hypertension (uncomplicated). Due to the great importance of blood pressure control, as well as reducing cardiovascular risks during treatment, special attention is paid to the metabolic effects that are characteristic of antihypertensive medications. Their influence on the course of associated ailments and organoprotective characteristics is also important.

Thiazide-like and thiazide medications for hypertension

In the past, hypertension was typically treated with loop diuretics. But now they are used more for the treatment of kidney, heart failure and edema. The research results showed good effectiveness of thiazide-type drugs. They improve the prognosis of hypertension. However, the reduction in the risk of coronary complications when using these drugs was not as pronounced in comparison with the expected results. The use of thiazide drugs increases the likelihood of developing arrhythmias. In some patients, even sudden arrhythmic death is possible. Disorders of carbohydrate and lipid metabolism, as well as hyperuricemia, are also common. The course of atherosclerosis and diabetes mellitus may worsen. Medications in this group are often combined with potassium-sparing diuretics.

The next level of evolution of diuretics for the treatment of hypertension was thiazide-like drugs. In particular, their ancestor, the drug Indapamide, synthesized in 1974, has proven itself well. The advantage is that thiazide-like drugs have a much lesser effect on sodium reabsorption, which means they remove significantly less potassium from the body. Therefore, negative metabolic and diabetogenic effects are practically absent. It has now been proven that the drug Indapamide, used in small dosages, in addition to its diuretic effect, can play a role due to its vasodilatory activity and stimulation of the production of prostaglandin E2.

In modern conditions, thiazide and thiazide-like medications are very widely used not only to reduce blood pressure, but also for preventive purposes, as well as for the treatment of target organ damage. These drugs are often prescribed as part of combination courses of therapy. They have proven themselves well and are therefore widely used in different countries of the world.

Solutions) have become quite firmly established in our lives. They are used to correct the acid-base balance in the body. After all, they perfectly remove excess acid and alkali from it. Diuretic tablets, the list of which is quite impressive, are used in the treatment of poisoning, some injuries (especially when it comes to head injuries), and to combat hypertension. But, unfortunately, not everyone knows not only the mechanism of action of these drugs, but also side effects that they can cause. And improper use of diuretics can lead to serious complications.

Brief information

Diuretic tablets are used to treat many ailments. The list of effective drugs continues to grow today. Diuretics are also called diuretics.

Their main purpose is to remove excess water from the body, chemicals, salts that tend to accumulate in the walls of blood vessels and tissues. In addition, diuretics have positive influence on water-salt balance.

If a large number of sodium ions accumulate in the body, subcutaneous tissue begins to be deposited. It has a very negative effect on the functioning of the kidneys, heart, and hematopoietic system. As a result, the patient develops a variety of diseases and disorders.

In addition, diuretics are in great demand in sports medicine. They are often used for weight loss. Very often, diuretics (tablets) are included in complex therapy to combat various ailments.

Based on their effect on the body, modern diuretics are divided into two main forms. The first category of drugs affects the process of urine formation directly in the kidneys. The second form of diuretics is responsible for the hormonal regulation of urine production.

Important Warning

There is a lot of information that diuretic tablets, the list of which is given below, also easily solve cosmetic problems. However, many people believe that such drugs are completely safe. Some women take these medications on their own for weight loss purposes. Athletes widely use drugs before competitions in order to lose weight. Even bodybuilders use them, trying to create artificial dehydration so that the muscles look more prominent.

However, people who take diuretics without a doctor's prescription are at great risk. After all, treatment with diuretics can result in unpleasant consequences. You should know that diuretics can:

Quite often, even those patients who understand the risk believe that the latest drugs"Indapamide", "Torasemide", "Arifon" do not have a detrimental effect on metabolism. Such medications are indeed much better tolerated than older generation medications. However, they are also harmful to health. But the negative impact of these funds is revealed much later. It is enough to understand the mechanism of their action. Medicines of the new and old generation are aimed at one thing - to stimulate the kidneys to work more intensively. Consequently, they excrete more salt and water.

It is important to understand that fluid retention in the body is a symptom of a serious illness. Swelling cannot occur on its own. It is provoked by serious disruptions in the functioning of the kidneys, heart, and sometimes other reasons. Consequently, diuretics are drugs (their list is very extensive) with exclusively symptomatic action. Unfortunately, they do not get rid of the cause of the disease. Thus, medications only delay the unpleasant ending for patients. Therefore, people who want to improve their health and fight a real disease should not make do with diuretics alone, much less use them themselves.

Classification of drugs

Until today, there is no single system according to which all diuretics are divided, since all drugs have different chemical structure, have different effects on body systems. Therefore, it is impossible to create an ideal classification.

Often the division occurs according to the mechanism of action. According to this classification, there are:

1. Thiazide drugs. They are excellent for the treatment of hypertension, perfectly reduce blood pressure. It is recommended to use them in parallel with other medications. Thiazides can negatively affect metabolism, so such diuretics are prescribed in small quantities. Drugs (a list of only the most popular ones is given in the article) from this group are “Ezidrex”, “Hydrochlorothiazide”, “Chlorthalidone”, “Indapamide”, “Hypothiazide”, “Arifon”.
2. Loop means. They remove salt and fluid from the body due to their effect on kidney filtration. These medications have a rapid diuretic effect. Loop diuretics do not affect cholesterol levels and do not create preconditions for the occurrence of diabetes mellitus. However, their biggest drawback is the many side effects. The most common drugs are Torasemide, Furosemide, Ethacrynic acid, Bumetanide.
3. Potassium-sparing agents. Quite an extensive group of drugs. Such medications help increase the excretion of chloride and sodium from the body. At the same time, the removal of potassium is minimized by such diuretic tablets. List of the most popular drugs: Amiloride, Triamterene, Spironolactone.
4. Aldosterone antagonists. These diuretics block the natural hormone that retains salt and moisture in the body. Drugs that neutralize aldosterone promote fluid removal. At the same time, the potassium content in the body does not decrease. The most popular representative is “Veroshpiron”.

Medicines for edema

For good effect, potent agents can be used. The following diuretic tablets are used for edema:

• "Torasemide";
• "Furosemide";
• "Piretanide";
• "Xipamide";
• "Bumetanide".

Medium-strength diuretic tablets can also be used for edema:

• "Hydrochlorothiazide";
• "Hypothiazide";
• "Chlorthalidone";
• "Klopamide";
• "Polythiazide";
• "Indapamide";
• "Metro salon."

Such drugs are used for a long time and continuously. The recommended dose is determined by the attending physician. As a rule, it is about 25 mg per day.

For minor edema, potassium-sparing diuretics, such as Spironolactone, Amiloride, and Triamterene, are more suitable. They are taken in courses (2-3 weeks) at intervals of 10-14 days.

Medicines for hypertension

Diuretic medications that are used for high blood pressure fall into two categories:

1. Remedies that have a quick effect. Such drugs are used during a hypertensive crisis, when there is a need to quickly reduce blood pressure.
2. Products for daily use. Medicines help maintain optimal blood pressure levels.

Potent medications can stop a hypertensive crisis. The most popular drug is Furosemide. Its price is low. The following remedies are no less effective during a crisis:

• "Torasemide";
• "Bumetanide";
• "Ethacrynic acid";
• "Piretanide";
• "Xipamide."

The duration of taking the above medications can be 1-3 days. After stopping the crisis, they switch from such potent drugs to medications that can maintain blood pressure at the required level every day.

• "Indapamide";
• "Hydrochlorothiazide";
• "Hypothiazide";
• "Klopamide";
• "Metro salon";
• "Polythiazide";
• "Chlorthalidone."

These medications are taken daily as prescribed by your doctor. They perfectly maintain the optimal pressure level.

Drugs for heart failure

As a result of this pathology, fluid retention in the body often occurs. This phenomenon creates stagnation of blood in the lungs. The patient has many unpleasant symptoms, such as shortness of breath, swelling, enlarged liver, the appearance of wheezing in the heart.

For people with diabetes, the doctor must introduce a diuretic into their therapy. It perfectly prevents severe consequences in the lungs, cardiogenic shock. At the same time, diuretics increase patients' tolerance to physical activity.

For patients with the first and second degrees of the disease, a good diuretic is a thiazide drug. In case of more serious pathology, the patient is transferred to a strong drug - a loop diuretic. In some cases, the drug Spironolactone is additionally prescribed. It is especially important to take this medication if the patient has developed hypokalemia.

If the effect of using the drug Furosemide weakens, cardiologists recommend replacing it with the drug Torasemide. It has been noted that the latter remedy has a more beneficial effect on the body in severe forms of heart failure.

The drug "Furosemide"

The medicine is a fast-acting diuretic. Its effect occurs after taking it for 20 minutes. The duration of the drug's effect is about 4-5 hours.

This remedy is effective not only for stopping a hypertensive crisis. According to the instructions, the medicine helps with heart failure, swelling of the brain and lungs, and chemical poisoning. It is often prescribed for late toxicosis during pregnancy.

However, the product also has strict contraindications. The drug is not used in the first trimester of pregnancy. It should not be used by patients with renal failure, people who have hypoglycemia, or urinary tract obstruction.

The cost of the drug "Furosemide" is low. The price is approximately 19 rubles.

The drug "Torasemide"

The medicine is a fast-acting remedy. The drug "Furosemide" undergoes biotransformation in the kidneys, so it is not suitable for all patients. A more effective medicine for people suffering from kidney diseases is the drug "Torasemide", since it undergoes biotransformation in the liver. But with pathologies of this body the medicine may cause serious harm.

After just 15 minutes, the effect on the body begins (as reported by the product accompanying the drug, the price of the product varies from 205 to 655 rubles.

Long-term studies have confirmed the high effectiveness of the drug in heart failure. In addition, the drug perfectly removes salts and liquid. At the same time, the loss of potassium by the body is insignificant, since effective remedy blocks the hormone aldosterone.

The drug "Indapamide"

The medicine is very effective for hypertension (severe and moderate). The product perfectly reduces blood pressure and maintains its optimal level throughout the day. In addition, it prevents an increase in this indicator in the morning.

You need to take the medicine once a day, 1 tablet, as evidenced by the instructions included in the drug “Indapamide”. The price of the product varies on average from 22 to 110 rubles.

Before taking it, you should familiarize yourself with the contraindications, since this excellent remedy is not suitable for all patients suffering from hypertension. The drug is not intended for people who have problems with the kidneys or liver. Pregnant and nursing mothers are prohibited from taking the medicine. In case of failures cerebral circulation, anuria, hypokalemia, the drug is contraindicated.

The drug "Triamterene"

The medicine is a mild diuretic. It is recommended to use it in combination with another diuretic drug, Hydrochlorothiazide. Thanks to this combination, it is possible to reduce the loss of potassium by the body. The drug Triamterene has a beneficial effect. The instructions position it as a potassium-sparing agent.

The medicine should be used strictly according to the prescribed dosage. People with impaired kidney function may experience an unpleasant side effect - increased level potassium Sometimes the product can lead to dehydration. When interacting with folic acid The medicine helps increase red blood cells.

The cost of the product is 316 rubles.

The drug "Spironolactone"

The medicine is a potassium- and magnesium-sparing agent. At the same time, it effectively removes sodium and chlorine from the body. After starting to take the drug, the diuretic effect occurs approximately 2-5 days.

The medicine can be prescribed for hypertension, chronic heart failure, liver cirrhosis. The use of Spironolactone is effective for swelling in the 2nd and 3rd trimester of pregnancy.

The drug is not intended for people diagnosed with diabetes mellitus, renal or liver failure, or anuria. It is forbidden to use the product in the first trimester of pregnancy. In case of hyponatremia, hyperkalemia, hypercalcemia, the drug is contraindicated. It should not be administered to people with Addison's disease.

Side effects may also occur when taking the medicine. In some cases, the drug provokes urticaria, itching, drowsiness, headache, diarrhea or constipation.

The cost of the product is about 54 rubles.

Diuretics or diuretics are often used to treat various pathological conditions caused by excessive fluid accumulation in the body. Their action is based on slowing down the absorption of salts and water in the renal tubules, thereby increasing the amount of urine and the rate of its excretion. Diuretics are big list drugs that help reduce fluid content in tissues and relieve swelling in various diseases, including arterial hypertension.

Diuretics are drugs of synthetic or herbal origin that are intended to increase urine output by the kidneys. Thanks to the action of diuretics, the removal of salts from the body is significantly enhanced, and the amount of fluid in tissues and cavities is reduced. These drugs are widely used in the treatment of hypertension, mild heart failure, liver and kidney diseases associated with circulatory disorders.

However, despite the wide range of pathologies that diuretics help to cope with, it is not recommended to take them without a doctor’s prescription. An incorrect dosage regimen or frequency of administration can lead to serious complications. Below is a list of diseases and pathologies in the treatment of which diuretics are used:

• hypertension;
• cardiac edema;
• cirrhosis;
• glaucoma;
• acute renal or heart failure;
• high secretion of aldosterone;
• diabetes mellitus;
• metabolic disorders;
• osteoporosis.

Mechanism of action of diuretics

The effectiveness of diuretics in hypertension is directly related to their ability to reduce sodium levels and dilate blood vessels. It is maintaining vascular tone and reducing fluid concentration that helps relieve hypertension. Diuretic tablets for high blood pressure are most often prescribed to elderly patients.

In addition, taking diuretics helps relax the myocardium, improves blood microcirculation, reduces platelet aggregation, and reduces the load on the left ventricle of the heart. Due to this, the myocardium requires less oxygen to function properly. Also, diuretics can have an antispasmodic effect by relaxing the smooth muscles of the bronchi, arteries, and bile ducts.

Classification and types of diuretics

What diuretics are is now clear, but you should understand what types of diuretics exist. Conventionally, they are classified according to several criteria: by effectiveness, duration of action, and also by the speed of onset of the effect. Depending on the patient’s condition and the complexity of the disease, the doctor selects the most suitable drug.

By efficiency:

• strong (“Lasix”, “Furosemide”);
• medium (“Hygroton”, “”, “Oxodolin”);
• weak (“Diakarb”, “Veroshpiron”, “Triamterene”);

By speed of action:

By duration of action:

• long-term (about 4 days) - “Veroshpiron”, “Eplerenone”, “Chlorthalidone”;
• medium-long (no more than 14 hours) - “Hypothiazide”, “”, “Indapamide”, “Clopamide”;
• short-acting (less than 8 hours) - Furosemide, Lasix, Manit, Ethacrynic acid.

Depending on what pharmacological action the drug provides, there is a separate classification.

Thiazide diuretics

This type of diuretic tablets is considered one of the most common. They are prescribed most often because the therapeutic effect is achieved within a few hours. The average duration of their action is 12 hours, which allows for a one-time daily dose. These drugs are absorbed fairly quickly in the intestine and are well tolerated by patients. One of the advantages of such diuretics is that they maintain the acid-base balance of the blood.

The action of thiazide diuretics is as follows:

• the reabsorption of sodium and chlorine is suppressed;
• the excretion of magnesium and potassium is significantly increased;
• the secretion of uric acid decreases.

Thiazide diuretics - list of effective drugs:

• "Chlorthalidone";
• "Indap";
• "Hypothiazide";
• "Cyclometazide";
• "Indapamide";
• "Clopamide".

They are prescribed for various diseases of the liver and kidneys, essential hypertension, glaucoma and other pathologies associated with excessive fluid content in the body.

Potassium-sparing drugs

This type of diuretic is considered more gentle because it promotes potassium retention in the body. They are often prescribed together with other medications to enhance the effect of the latter. This type of diuretics effectively reduces systolic blood pressure, so they are used for the treatment of hypertension in combination with other drugs. Their use is also indicated in cases of edema of various etiologies and heart failure.

Potassium-sparing drugs include: Aldactone, Amiloride. Such diuretics should be taken with caution, as side effects occur due to their hormonal effects. Male patients may develop impotence, and female patients may experience failure. menstrual cycle, pain in the mammary glands, bleeding. With a long course of high doses, hyperkalemia may occur - a large amount of potassium enters the blood. This condition can cause cardiac arrest or lead to paralysis.

Important: The use of potassium-sparing diuretics in patients with renal failure and diabetes mellitus is especially dangerous. These medications should only be taken under medical supervision.

Loop diuretics

Loop diuretics are considered the most powerful diuretics. They act on the loop of Hengle - a renal tubule directed towards the center of the kidney and performing the function of reabsorption of fluids and minerals. These diuretics work as follows:

• reduce the reabsorption of magnesium, potassium, chlorine, sodium;
• increase blood flow in the kidneys;
• increase glomerular filtration;
• gradually reduce the volume of extracellular fluid;
• relax the vascular muscle.

The effect of loop diuretics occurs quite quickly, after just half an hour, and lasts up to 6-7 hours. This type of drugs is rarely prescribed, only in particularly critical cases, since they have many side effects.

Loop diuretics, list of the most popular:

Osmotic diuretics

The effect of diuretics of this kind is to reduce pressure in the blood plasma, which leads to a decrease in swelling and the removal of excess fluid. At the same time, the movement of blood in the renal glomeruli becomes higher, which helps to increase filtration. Below are the names of diuretic tablets that work according to this principle:

• "Mannitol";
• "Mannitol";
• "Urea";
• "Sorbitol".

“Mannitol” has a long-lasting effect, which cannot be said about other drugs in this group. Medicines of this series are used exclusively in acute cases. They are prescribed if the patient has developed the following pathological conditions:

Osmotic diuretics are potent drugs. That is why they are prescribed one-time, and not as a course of therapy.

Carbonic anhydrase inhibitors

One of the drugs in this group is Diacarb. Under normal conditions, carbonic anhydrase helps form carbonic acid in the kidneys from carbon dioxide and water. Diacarb blocks the production of this enzyme, promoting the leaching of sodium, which in turn draws water with it. At the same time, potassium loss occurs.

Diacarb gives a weak effect that develops relatively quickly. Its duration of action can be about 10 hours. This medicine is used if the patient has:

• increased eye pressure;
• gout;
• poisoning with barbiturates or salicylates.

Aldosterone antagonists

This type of drug helps block aldosterone receptors, as a result of which the hormone ceases to act on the kidneys. As a result, the reabsorption of water and sodium is impaired, which leads to a diuretic effect. A frequently used remedy of this type is Spironolactone (Veroshpiron, Veroshpilakton). It is used in combination with loop or thiazide diuretics.

Thanks to recent research, a new direction in the use of this drug has been discovered. Blocking aldosterone receptors located in the myocardium helps stop cardiac remodeling (replacement muscle tissue connecting). The use of spironolactone as part of complex therapy reduces mortality after myocardial infarction by 30%.

Another interesting feature of the drug is its ability to block testosterone receptors, which can lead to the development of gynecomastia and even impotence in men. In female patients, this property of drugs is used in the treatment of diseases caused by high levels of testosterone.

Please note: Diuretics containing spironolactone are potassium-sparing.

Herbal remedies

Along with medications, herbal diuretics are often used. Their effect on the body is milder, and there are practically no side effects. Diuretics of plant origin not only help remove excess fluid, but also help saturate the body with mineral salts, vitamins, and have a mild laxative effect. Among vegetables and fruits, parsley, celery, watermelon, cucumbers, pumpkin and many other products have a diuretic effect. You can also get rid of excess fluid with the help of diuretic infusions of strawberries, birch leaves, lingonberries, tansy and shepherd's purse.

However, despite the fact that herbal diuretics are significantly inferior in effectiveness to medications, before using them it is also necessary to consult a doctor to find out the cause of the pathology. Depending on the etiology of edema, the doctor will select the most suitable option.

Treatment with decoctions and infusions of herbs is often necessary for renal edema. In addition to being a diuretic, these drugs have anti-inflammatory and antibacterial effects. This is especially important in the presence of diseases of the urinary system. Among other things, herbal remedies are approved for use in pregnant women and children.

Drink herbal teas necessary in short courses. Long-term use may cause addiction, and the effectiveness of therapy will gradually decrease. Also, with long-term use, important trace elements potassium and sodium may be removed from the body. Therefore, herbal diuretics should also be used under the control of blood counts.

Side effects

Another reason why only a doctor should prescribe diuretics is the balance between the benefits and harms of drugs. Depending on the severity of the pathology, the doctor will decide whether to use certain medications. A careful approach when choosing medications will minimize the risk of developing unpleasant side effects.

The most common problems encountered when taking diuretic tablets were:

• decline blood pressure, sometimes to very low levels;
• general weakness, increased fatigue;
• dizziness or headaches;
• sensation of “goosebumps” on the skin;
• photosensitivity;
• development of anorexia;
• increased blood sugar;
• the appearance of dyspeptic symptoms;
• nausea, vomiting;
• cholecystitis;
• pancreatitis;
• changes in blood composition (decrease in platelets, increase in lymphocytes and monocytes);
• decreased sexual function.

Even if the patient has not previously reported any side effects while taking diuretics, you still should not take these drugs without a doctor’s prescription. Uncontrolled reception of such medications can lead to serious and often irreversible complications.

Contraindications

The use of diuretics must be treated very carefully. These medications have many contraindications listed in the instructions for them. They should absolutely not be accepted if:

• there is intolerance to one of the components of the drug;
• pregnancy confirmed;
• diagnosed with diabetes;
• swelling is caused by decompensated cirrhosis of the liver;
• there is renal or respiratory failure;
• hypokalemia is observed.

Relative contraindications are:

• ventricular arrhythmia;
• insufficient activity of the heart;
• taking lithium salts;
• use of cardiac glycosides.

In addition, it is recommended to be careful when combining diuretic tablets for high blood pressure with ACE inhibitors. When receiving data simultaneously medicines the effect of diuretics is significantly enhanced, which can lead to a sharp drop in blood pressure and dehydration.

Still have questions? Ask them in the comments! A cardiologist will answer them.