Type of Drug:

Diuretics or “water pills.”

How the Drug Works:

Thiazides and related diuretics reduce water in the body and increase urine flow.

Uses:

To treat high blood pressure, either alone or in combination with other high blood pressure medications.

To treat edema (excess fluid accumulation in the tissues) associated with congestive heart failure, kidney problems and during estrogen or corticosteroid therapy.

Unlabeled Uses: Occasionally doctors may prescribe thiazide diuretics for calcium kidney stones, osteoporosis and diabetes insipidus (not diabetes mellitus).

Preacutions:

Diabetes: Thiazide diuretics may increase blood sugar levels. Insulin requirements may need to be adjusted.

Gout attacks may occur in patients with or without a history of gout.

Potassium loss: By increasing urine production, thiazide diuretics may cause an increased loss of electrolytes, especially potassium.

Low potassium levels may be prevented or treated by eating foods and drinking liquids high in potassium content (eg, citrus juice, bananas, dates, raisins, melons and tomatoes). If dietary changes do not increase potassium to a normal level, it may be necessary for your doctor to prescribe a potassium supplement medication to replace lost potassium.

Pregnancy: Thiazides cross the placenta. Use only when clearly needed and when potential benefits outweigh the Possible hazards to the fetus.

Breastfeeding: Thiazides appear in breast milk. Stop nursing if tizzies diuretics are necessary. Consult your doctor before you begin breast feeding.

Children: Metolazone is not currently recommended for use in children Safety and effectiveness have not been established for hydroflumenthiazied or trichlomethiazide.

Tartrazine: Some of these products may contain the dye tartrazine (FD & C Yellow No.5) which can cause allergic reactions in certain individuals. Check package label when available or consult your pharmacist or doctor if you are sensitive to tartrazine.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over ­the-counter or prescription medications with your diuretic. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with thiazide diuretics.

• Cholestyramine (Questran)
• Colestipol (Colestid)
• Corticosteroids (eg, hydrocortisone)
• Cough, cold, sinus or hayfever medications
• Diazoxide (Proglycem)
• Digoxin (eg, Lanoxin)
• Furosemide (eg, Lasix)
• Lithium (eg, Eskalith)
• Oral diabetic drugs (eg, Orinase )

Side Effects:

Every drug is capable of producing side effects. Many thiazide diuretic users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Potassium loss: Dry mouth; thirst; irregular heartbeat; confusion and mood changes; nausea; vomiting; unusual tiredness; weakness; weak pulse; muscle cramps; joint pain or spasms; heaviness in limbs.

Digestive Tract: Loss of appetite; stomach upset; bloating; diarrhea; constipation.

Nervous System: Dizziness; lightheadedness; headache; tingling of toes and fingers; yellow or blurred vision; depression; nervousness; sleeplessness.

Circulatory System: Orthostatic hypotension (fall in blood pressure upon standing which may cause dizziness, fainting and blurred vision); chest pain.

Skin: Sensitivity to sun; rash; hives; itching; dry skin; flushing; yellowing of skin or eyes; unusual bruising.

Respiratory System: Cough; sinus congestion; sore throat; difficult or painful breathing.

Other: Frequent urination; impotence; reduced sexual drive; electrolyte (eg, potassium) imbalance; blood sugar imbalance; muscle cramps; joint pain; fever; chills; weight loss; bloody nose; gout attack.

Guidelines for Use:

• Take exactly as prescribed.
• If a dose is missed, take it as soon as passed or if it is nearing time for the to catch up, unless advised to do so dose is missed or it is necessary to establish a new contact your doctor or pharmacist.
• Increases urination, therefore take early in the day.
• May cause stomach upset. May be taken with food or milk.
• May cause loss of potassium. If signs of potassium ness,.cramps, nausea, dizziness, etc, contact your doctor about foods containing potassium.
• Mayihcrease blood sugar levels in diabetics.
• May cause gout attacks. Contact your doctor if significant pain OCcurs.
• Do not. take other medications without your includes nonprescription medicines for cough, hayfever or sinus.
• Diuretics are usually given as a single daily dose as directed by your doctor. The daily dose varies depending on individual needs. Do not adjust the dose without pharmacist or doctor.

Type of Drug:Diuretics or “water pills.”

How the Loop diuretics Works:

Loop diuretics cause electrolytes (especially sodium and chloride) to be excreted in the urine. Water is excreted with the electrolytes

Uses of Loop diuretics:

To treat edema (fluid retention and swelling) due to congestive heart failure, liver disease (eg, cirrhosis), and kidney disease.

Precautions:

Furosemide and torsemide: To treat hypertension (high blood pressure) alone or with other high blood pressure medicine.

Ethacrynic acid: To treat fluid accumulation in the abdomen (ascites) due to cancer, liver failure, and other conditions, and to treat fluid accumulation in children due to congenital heart or kidney disease.

Loop diuretics: Loop diuretics are potent diuretics which can lead to pro­found increase in urine excretion with water and electrolyte depletion when given in large amounts. Careful medical supervision is required. The dose and dose schedule must be adjusted to the individual patient’s needs.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Furosemide appears in breast milk. It is not known if other loop diuretics appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness for use of bumetanide in children younger than 18 years of age have not been established. Safety and effectiveness for use of ethacrynic acid in infants have not been established. Furosemide is indicated for use in pediatric patients. Safety and effectiveness for use of torsemide in children have not been established .

Lab Tests: Lab tests may be required during therapy. Tests may include electrolytes (eg, sodium, potassium, calcium, magnesium), blood counts, blood glucose (sugar), uric acid, urea nitrogen, creatinine, and cholesterol.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with loop diuretics. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with loop diuretics:

• ACE inhibitors (eg, benazepril)
• Sminoglycosides (eg, gentamicin)
• Cholestyramine (eg, Questran)
• Cisapride (Propulsid)
• Cisplatin (eg, Platinol)
• Colestipol (Colestid)
• Digitalis glycosides (eg, digoxin)
• Hydantoins (eg, phenytoin)
• Lithium (eg, Eskalith)
• NSAIDs (eg, ibuprofen)
• Thiazide diuretics (eg, hydrochlorothiazide)

Side Effects of Loop diuretics:

Every drug is capable of producing side effects. Many loop diuretic users experience no, or minor, side effects. The frequency and severity of sid effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Symptoms of Electrolyte Loss: Weakness; dizziness;confusion;appetie loss ;nausea; vomiting;muscle cramps;limb heaviness.

Digestive Tract: Difficulty swallowing; diarrhea (including sudden watery diarrhea); irritation of mouth or stomach; constipation; stomach pain; appetite loss; indigestion; bloating.

Nervous System: Restlessness; tingling or numbness of hands or feet; apprehension; nervousness; headache; insomnia.

Senses: Ringing in the ears; hearing loss (usually reversible).

Skin: Sweating; itching; rash, hives; jaundice (yellowing of skin or eyes); sensitivity to sunlight; unusual bleeding or bruising.

Other: Blood in the urine; dehydration; joint pain; fever; chills; breathing difficulties; yellow vision; blurred vision; premature ejaculation; impotence; difficulty maintaining an erection; dry mouth; excessive urination; rectal bleeding; fluid retention; muscle pain; cold; cough; sore throat; decreased potassium levels; elevated blood sugar.

Guidelines for Use:

• Dosage is individualized .
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist. Use exactly as prescribed.
• Take ethacrynic acid after meals, if necessary.
• Drug will increase urination. Take early in the day to avoid sleep disruption.
• Notify your doctor if muscle weakness, cramps, nausea or dizziness occurs.
• Orthostatic hypotension (dizziness or lightheadedness when arising from a seated or lying position) may occur. Get up slowly.
• Diabetes mellitus patients - May increase blood glucose (sugar) levels.
• Photosensitivity (sensitivity to sunlight) may occur. Use sunscreens and wear protective clothing until tolerance is determined.
• Additional potassium may be required while taking loop diuretics.
• Patients with high blood pressure should avoid medications that may increase blood pressure, including nonprescription decongestant products for cold symptoms and stimulant weight-control products.
• Weight should be monitored throughout treatment with loop diuretics. Loss of fluid should not be excessive within a narrow band of time.
• Lab tests will be required. Be sure to keep appointments.
• Store at room temperature (59 to 86°F) in well closed, light-resistant contain or. Do not freeze.