Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DIURETICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed2002

Diuretics in the treatment of patients who present congestive heart failure and hypertension.

The main operational objective of diuretic therapy in patients who present congestive heart failure and hypertension is to reduce or to suppress excess bodily fluid. Effective diuretic therapy decreases cardiac size when the heart is dilated, and it reduces lung congestion and excess water. Consequently, external respiratory work diminishes and cardiac output would be redistributed in favour of systemic vascular beds other than that of the respiratory muscles; dyspnoea decreases markedly and there is a slight reduction in fatigue. This clinical improvement and the fall in body weight caused by diuretics entail an increase in effort capacity. Subsequent exercise training ameliorates the abnormal ventilatory response to physical effort and the skeletal muscle myopathy that occur in heart failure, and thereby it attenuates dyspnoea and decreases fatigue further. Loop and/or thiazide-type diuretics may be used to augment natriuresis in patients with congestive heart failure and hypertension. The state of renal function, the existence of certain co-morbid conditions, potential untoward drug actions, and possible interactions of diuretics with nutrients and with other drugs are some of the factors that must be considered at the time of deciding on the diuretic drug(s) and dose(s) to be prescribed. Spironolactone has been found to increase life expectancy and to reduce hospitalisation frequency when added to the conventional therapeutic regimen of patients with advanced congestive heart failure and systolic dysfunction. Therefore, spironolactone should be the drug of choice to oppose the kaliuretic effect of a loop or of a thiazide-type diuretic.

Diuretics↗
PubMed1999

The influence of frusemide formulation on diuretic effect and efficiency.

AIMS: Changes in drug delivery rate may result in clinically important changes in drug effects. For the loop diuretic frusemide, it would be desirable to develop controlled release preparations, that could maintain an effective urinary excretion rate over a prolonged period of time. The aim of this study was to investigate the influence of frusemide formulation on frusemide recovery, diuretic effect and efficiency. METHODS: Twelve subjects were given 60 mg of four different frusemide controlled release formulations in a single-dose, double-blind, randomized 4-way cross-over design. The formulations were three study drugs with different extended dissolution rates (ER1Tab, ER2Tab and ER3Caps ) and one reference drug (LR). Urinary volume and contents of frusemide in urine were measured in samples collected over 24 h. RESULTS: Substantial differences in frusemide recovery and diuretic efficiency were observed between LR and all other formulations. At 24 h, mean total frusemide recoveries of ER1Tab, ER2Tab and ER3Caps were 52%, 36% and 57% lower, respectively, compared with LR (P<0.01). Also at 24 h, mean total diuretic efficiency for ER1Tab, ER2Tab and ER3Caps was 83%, 31% and 135% higher, respectively, compared to LR. The rapid dissolution and absorption of LR resulted in a high diuretic response from 0 to 3 h after dosing. However, from 0 to 24 h, there were no differences in diuretic response between the formulations. CONCLUSIONS: Controlled release formulations of frusemide with a low and extended rate of dissolution lead to a more prolonged absorption and subsequent diuresis, but still maintain a similar cumulative response, due to their higher diuretic efficiency.

Adolescent↗
PubMed2006

Risk factors for acute renal insufficiency induced by diuretics in patients with congestive heart failure.

BACKGROUND: In patients with congestive heart failure (CHF), continuous diuretic therapy may result in acute renal insufficiency (ARI). This study examines factors contributing to this complication. METHODS: We analyzed clinical data from 318 consecutive patients who were hospitalized for CHF. All were treated with diuretics and had echocardiography performed within 4 days of hospitalization. Systolic left ventricular (LV) dysfunction is defined as an ejection fraction less than 50%, and diastolic LV dysfunction, as an ejection fraction of 50% or greater in the presence of LV hypertrophy and a reversed E/A ratio. RESULTS: ARI, defined as a 25% increase in serum creatinine level, occurred in 110 patients (35%) after diuretic therapy. Risk factors for ARI on univariate analyses were older age, higher baseline serum creatinine level, lower baseline serum sodium level, lower mean arterial pressure (MAP) during diuretic therapy, and greater doses and longer duration of diuretic therapy. In multivariate analyses, ARI occurred more frequently in patients with systolic (40%) than diastolic dysfunction (28%). The use of digoxin in patients with systolic LV dysfunction was observed to decrease the risk for ARI by 61%, independent of other agents used for the treatment of patients with CHF. CONCLUSION: Age, baseline renal function and serum sodium concentration, MAP, and intensity of diuretic therapy can identify individuals at risk for ARI while receiving diuretic therapy for CHF. This complication is observed more often in individuals with systolic dysfunction, and its risk may be decreased with the use of digoxin.

Acute Kidney Injury↗
PubMed1986

Biochemical and clinical correlates of diuretic therapy in the elderly.

To estimate the frequency of diuretic-related electrolyte disorders in the elderly, 561 consecutive admissions to three acute geriatric units were studied. For the 287 admissions to one unit, discharge/death diagnoses were also examined in relation to admission diuretic therapy. Sodium concentrations were significantly lower, and urea and creatinine significantly higher, in patients on diuretics, though the size of the differences was small. Comparing different preparations sodium concentrations were significantly lower on Moduretic than on Dyazide or Navidrex K and on frusemide when combined with a potassium-retaining diuretic rather than a potassium supplement. Potassium concentrations were significantly lower on Bendrofluazide alone compared to Navidrex K or Moduretic. Diuretics were positively associated with cardiac failure, ischaemic heart disease, airflow obstruction and obstructive large bowel disorders but negatively with Parkinson's disease. No significant association was found with falls, immobility or confusion. Major electrolyte disorders on diuretics appear to be unusual but important differences exist between preparations. Similarly major illness resulting from diuretic therapy is rare but minor morbidity may be more common.

Aged↗
PubMed1977

The effects of discontinuing long-term diuretic therapy in the elderly.

The effects of discontinuing long-term diuretic therapy were investigated by means of a double-blind randomized controlled trial. A total of 141 elderly patients in the long-stay wards of six hospitals were found to be taking maintenance diuretics, and for 33 of these the drugs were judged to be mandatory. Of the remaining patients, 52 continued to receive diuretics while 54 were given matching placebo tablets. Eight in the latter group required diuretic therapy to be resumed during the following 12 weeks. The main change observed in patients who completed the trial was a slight increase of ankle oedema in the placebo group. Plasma potassium levels below 3.5 mEq/1 were found in some patients taking diuretics but not when the drugs had been withdrawn for 12 weeks. Blood pressure rose slightly in the placebo group and plasma urea rose slightly in the diuretic group. It was concluded that old people receiving long-term diuretic therapy without obvious current indication should have the drugs withdrawn under careful supervision so that those needing them could be identified.

Aged↗
PubMed1992

Effect of diuretics on the plasma lipid profile.

Hypertension, dyslipidaemia, glucose intolerance (associated with insulin resistance and compensatory hyperinsulinaemia) and other abnormalities are complementary coronary risk factors which often occur in association. A familial trait for essential hypertension seems to coexist commonly with defects in carbohydrate and lipoprotein metabolism which can be detected before the appearance of hypertension. Diabetes mellitus as well as obesity promotes the development of hypertension and dyslipidaemia. Moreover, certain drugs used for antihypertensive therapy can further modify lipoprotein and glucose metabolism. Thiazides in high dosage and loop-diuretics can increase serum low-density-lipoprotein cholesterol (LDL-C) and/or very-LDL-C and the total C/high-density lipoprotein cholesterol (HDL-C) ratio, while HDL-C is largely unchanged; triglycerides (Tg) are also often elevated. Premenopausal women may be protected from this side effect. Whether diuretic-induced dyslipidaemia is dose-dependent and low thiazide doses (i.e. hydrochlorothiazide < or = 12.5 mg daily) are less active, awaits clarification. The diuretic-antihypertensive agent, indapamide, given at a dose of 2.5 mg.day-1, seems to exert no relevant effect on serum lipoprotein or glucose metabolism. The potassium-sparing diuretic, spironolactone, also may be largely neutral with regard to lipids. Moreover, potassium sparing diuretics may possibly counteract, at least in part, a dyslipidaemic influence of potassium-loosing diuretics in medium dose. Drug-induced dyslipidaemia, as well as glucose intolerance, represent potentially adverse influences. In the hypertensive population, effective blood pressure control with traditional drug therapy based on thiazide-type diuretics in high dosage led to a distinct decrease in cerebrovascular morbidity and mortality, but a lesser decrease in coronary events.(ABSTRACT TRUNCATED AT 250 WORDS)

Diuretics↗
PubMed1992

Comparative efficacy of diuretics: benefit versus risk: results of clinical trials.

Although several large trials have been conducted with the aim of establishing the need for, and the best approach to, the treatment of hypertension, none have specifically addressed the question of the best use of diuretics. Analysing the trials to obtain specific answers about diuretics is therefore difficult, and particularly so because of differences in trial design and in the medications used. Comparisons between active treatment and no therapy have tended to show that active treatment is associated with a significant reduction in the incidence of strokes and a small reduction in myocardial infarction and death. Comparisons of treatment strategies, as opposed to comparisons of particular drugs, are hard to interpret and some conclusions that have been drawn about a harmful effect of diuretics are probably misleading. Trials comparing diuretics and beta-blockers suggest that these types of drug have similar effects on clinical events although the most recently published study suggests that diuretics are more effective than beta-blockers in preventing myocardial infarction. Therefore, it seems that what matters is blood pressure reduction, not the means by which this is achieved. The biochemical effects of diuretics are probably not important, but only one trial has investigated the use of a low dose of diuretics.

Blood Pressure↗
PubMed1992

Diuretics in hypertension: clinical experiences.

Diuretics have long been used in the treatment of hypertension and are outstandingly efficacious when used either alone or in combination with other antihypertensive compounds. Blood pressure is controlled with diuretics alone in over 50% of patients and in over 80% in combination with other drugs. Thiazide diuretics were used singly and in combination in the early VA Co-operative studies that demonstrated decrease in cardiovascular morbidity with blood pressure control. Subsequent studies have confirmed these early findings and clearly demonstrated that the thiazide diuretics are as effective in lowering blood pressure as other currently available antihypertensive compounds. Diuretics, like all other antihypertensives, have side effects, of which the most important ones are hypokalaemia, alterations of the plasma lipid profile, hyperuricaemia and glucose intolerance. Diuretic-induced hypokalaemia may be hazardous in the presence of digitalis, but does not appear to have any inherent propensity to induce life-threatening arrhythmias. Diuretics remain amongst first-line drugs in the treatment of high blood pressure due to their efficacy, especially in blacks and the elderly, the potentiation of the antihypertensive efficacy of other compounds, their low side effect profile and their low cost.

Arrhythmias, Cardiac↗
PubMed1992

Adverse reactions to diuretics.

Diuretics can result in various undesired biochemical changes, such as impotence, skin rashes, nausea, dizziness and lethargy as well as subjective side effects. The side effects are mostly predictable, their effects depending on both the circulatory blood volume and on the transport of water and solute in the renal tubules. Two of the commonest side effects are mild hypovolaemia, when any diuretic is used, and mild hypokalaemia when the non-potassium-sparing diuretics, such as thiazides and frusemide are used. Its occurrence is dose dependent and can be corrected by potassium supplements, but potassium-retaining diuretics, which also correct the often associated fall in serum magnesium, are preferable. Many reports link hypokalaemia with cardiac arrhythmias, but some dispute this association in the absence of the concomitant use of digoxin. Hyponatraemia rarely occurs, but can be life threatening. Calcium excretion is markedly reduced, but unlike other electrolyte disturbances from diuretics, this may be valuable: some suggest diuretics have an anti-osteoporotic action. Diuretics increase glucose and insulin resistance and should be used sparingly in diabetics. They rarely cause a non-ketotic hyperosmolar coma. Urate is raised, but clinical gout is not common. Cholesterol elevation has been reported in some studies, but long-term studies indicate that lipid changes are minor. Other rare side effects are not predictable from their pharmacological actions and these include the occurrence of skin rashes, thrombocytopenia, pancreatitis and interstitial nephritis; and ototoxicity from frusemide.

Blood Volume↗
PubMed1988

Serum potassium values in relation to the use of diuretics in patients with unstable angina pectoris.

Transient hypokalaemia may occur in acutely ill patients and is associated with an increased incidence of life-threatening arrhythmias. Therefore, we performed a retrospective analysis of the serum potassium values of 538 patients with unstable angina included in the Holland Interuniversity Nifedipine/metoprolol Trial in relation to the use of diuretics. On admission, 113 of these patients used diuretics. Potassium sparing diuretics had been used in 65 patients (group A) and non-potassium sparing diuretics in 48 patients (group B). From the 425 patients not on diuretics a random sample of 56 (group C) was drawn. Blood samples were taken routinely on admission to the coronary care unit. The serum potassium values found for group A, B and C were 3.77 +/- 0.55, 3.44 +/- 0.69 and 4.14 +/- 0.48, respectively, and the prevalence of hypokalaemia (less than 3.6 mmol) 40, 65 and 14% respectively. Rate ratio [95% confidence interval (CI)] for hypokalaemia when compared to group C was 2.6 (1.2-5.6) for group A and 4.9 (2.4-10.1) for group B. The prevalence of hypokalaemia was higher for women than for men (rate ratio, 95% CI: 1.4, 0.9-2.2). Patients already on beta-blocker therapy showed a 10% lower prevalence of hypokalaemia (rate ratio, 95% CI: 0.7, 0.5-1.1). These data were compared with serum potassium values of 104 patients with stable angina, who reported to the outpatient clinic. These patients were also divided into three groups according to the use of diuretics. Only in 15% of the patients using non-potassium sparing diuretics was hypokalaemia observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMedDate not supplied

Detection of diuretics in horse urine by GC/MS.

The use of diuretics in horses subject to doping control is prohibited. Thus, a sensitive screening procedure is required to identify the chemically different diuretics. We communicate here a method to detect three commonly employed acidic diuretics: bumetanide, ethacrynic acid, and furosemide. A liquid-liquid extraction on Extrelut 3 was performed at weak acidic and basic conditions using ethyl acetate as organic solvent. For analysis by GC, the diuretics were methylated on-column in the presence of MSTFA/TMAH, avoiding the commonly employed highly toxic derivatizing agent methyl iodide. For identification of diuretics, we used a mass selective detector operating in the SIM (selected ion monitoring) mode. Confirmation analysis may be obtained with a full scan run. Recoveries for the individual drugs ranged from 31 to 48% at the 100-ng/mL level for 3 mL urine, using calibration curves of drug standards with linearity from 2.5 to 20 ng injected. The limit of detection amounts to 40 ng/mL for the three diuretics. The method permits rapid and sensitive detection of diuretics in horse urine and is recommended for doping control.

Animals↗
PubMed1994

Use of diuretics and other antihypertensive medications in relation to the risk of renal cell cancer.

In a population-based case-control study of the association between use of diuretics and renal cell cancer, 120 white men whose cancer was diagnosed during the years 1980-1991 and 86 white women diagnosed in 1960-1991 were identified among members of the Kaiser Permanente Northwest health plan. Controls were plan members who had been individually matched to cases on sex, race, age, and time period in the plan. Data on diuretic use and other selected variables were abstracted from outpatient and inpatient medical records. In an analysis confined to exposures present at least 2 years before case diagnosis, the odds ratios associated with any use of a diuretic drug were 2.2 (95% confidence interval 1.2-3.9) for men and 1.8 (95% confidence interval 1.01-3.2) for women. Increased duration of diuretic use was associated with an increased risk of renal cell cancer. This association was not restricted to one class of diuretic and was not confounded by cigarette smoking or body mass. Both hypertension and use of nondiuretic antihypertensive drugs were closely associated with diuretic use, and it was impossible to disentangle fully the effects of these three separate exposures. These results, together with those of prior studies, are generally compatible with the view that there is an association between diuretic use and the incidence of renal cell cancer, but the interpretation of that association remains in question.

Aged↗
PubMed2006

Diuretics: a modern day treatment option?

The choice of drugs to initiate therapy for the management of hypertension remains contentious and diuretics are central to this controversy. Because most of the major trials involve complex treatment algorithms and allow diverse background treatments, one of the greatest challenges lies in separating out true class-specific effects - for example, separating true class-specific effects of diuretics from those of beta blockers. Despite these difficulties, the evidence confirms that diuretics are at least as effective as the newer first line groups in preventing cardiovascular events. The main area of doubt lies in relation to the risk of renal outcomes and of metabolic outcomes, such as new onset diabetes - where the evidence suggests that drugs that inhibit the renin-angiotensin system may be more protective than all other drug classes. These issues are reflected in the most recent international guidelines, all of which include diuretics among the first-line drugs for the treatment of hypertension, although they do differ on the role of diuretics in the initiation of therapy. Diuretics remain important for treating hypertension, especially in combination with other drug classes. The particular place of diuretics in the rank order of drugs must be tailored to suit the clinical situation in the individual patient. This will vary from a preferred option, as in black patients or elderly patients with systolic hypertension, to a second-line option in patients at high risk of developing new onset diabetes.

Diuretics↗
PubMed1980

Myotonia as a side effect of diuretic action.

1. Commonly used loop diuretics produce side effects in man which are similar to chemically induced myotonia. These diuretics have structural affinity with known myotonic agents. 2. We have observed EMG myotonia in vivo in leg muscles of rats treated with intravenous frusemide. 3. In the presence of several different diuretics, rat isolated diaphragm, soleus and extensor digitorum longus muscles as well as frog sartorius muscles produce typically myotonic contractions with relaxation times up to several seconds. 4. Intracellular recording of action potentials from diuretic-treated muscles reveals long lasting after-discharges following a brief electrical stimulus, again typical of chemically induced myotonia. 5. Having demonstrated a myotonic action of several diuretics we suggest a need for caution in using these drugs in persons with hereditary myotonia and a need to be aware of possible provocation of myotonia in subclinical cases. Myopathies and neuropathies which are known to result from chronic exposure to myotonic agents also need to be considered. 6. In our study, the diuretic, acetazolamide, unmasked subthreshold myotonia. This seems to be at variance with reports of its usefulness in the treatment of myotonia. 7. Diuretics should probably not be employed in the treatment of herbicide intoxication where their myotonic activity would be expected to add to the known myotonic activity of the herbicide.

Animals↗
PubMed1982

The human erythrocyte Cl-dependent Na-K cotransport system as a possible model for studying the action of loop diuretics.

1 The recent demonstration of the chloride-dependence of the red cell Na-K cotransport system suggests an analogy between this process and the active Cl- absorption in the ascending loop of Henle, which is the target transport system for loop diuretics. 2 Using red cell K influx, four known loop diuretics, six experimental frusemide analogues, two thiazides, two K-retaining diuretics and one organomercurial were compared for inhibitory potency on the red cell Na-K cotransport system. 3 Except for mersalyl, whose exact mode of action in the kidney is still in doubt, the inhibition of the red cell system by various loop diuretics was consistent with both published whole body diuretic data and isolated perfused tubule studies, while the system did not respond to the thiazides or the K-retaining diuretics. 4 It is concluded that the human red cell Na-K cotransport system is a possible valid model process on which to study the activity of loop diuretics.

Biological Transport, Active↗
PubMed1984

Metabolic side effects of diuretics and beta-adrenoceptorblockers.

A review is made of the metabolic side effects of diuretics and beta-adrenoceptorblockers. The review is based on results from a population study, performed by the author, of women and on a survey of the literature. While diuretics give rise to hypokalemia, which may be of clinical importance, beta-adrenoceptorblockers tend to increase the serum potassium levels. This does not, however, seem to be of clinical significance. Both diuretics and beta-adrenoceptorblockers increase serum uric acid levels. Beta-adrenoceptorblockers increase serum triglycerides, which is not observed when diuretics are used. Total cholesterol in serum is usually not changed either by diuretics or by beta-adrenoceptorblockers. These drugs seem to have no influence on body weight when studied during long-term treatment. A further deterioration of glucose tolerance may be expected in subjects with an initially impaired glucose tolerance when diuretics are administered, while results from studies on glucose tolerance in subjects taking beta-adrenoceptorblockers have been controversial. Diabetes mellitus seems to be more common among subjects on diuretics as well as among subjects on beta-adrenoceptorblockers, but as yet it cannot be stated whether this is an effect of the antihypertensive drugs or of the hypertension per se or of some other factor or factors.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Diuretic renal scintigraphy in normal dogs.

Diuretic renal scintigraphy is commonly used in human medicine to differentiate obstructive from nonobstructive pyelectasia. In order to determine normal parameters, 99mTc-DTPA renal scintigraphy was performed twice in 20 healthy adult Mongrel dogs. Each dog was injected with either 3.0 mg/kg furosemide or an equivalent volume of saline 4.5 min following injection of the radiopharmaceutical. The following parameters were evaluated: (1) global and individual glomerular filtration rate (GFR); (2) time of peak (TOP) of the time-activity curve (TAC); (3) shape of the TAC; (4) individual kidney excretion half-time (T1/2); (5) proportion of maximum activity measured at end of study (8 min); (6) time of onset; and (7) duration of the effect of the diuretic. Most TAC in the diuretic renography group showed a steep drop in the curve following administration of the diuretic compared with a gradual slope in the saline control group. There was a statistically significant difference in T1/2 between the control renograms (median 10.25 min, range 4.41-18.07 min) and the diuretic renograms (median 4.16 min, range 3.62-5.90 min). There was a statistically significant difference in percentage maximum activity between the control renograms (median 65.25%, range 48.27-93.68%) and the diuretic renograms (median 48.54%, range 35.64-58.76%). Median time of onset of the diuretic effect was 1.10 min (0.20-2.40 min), and median duration was 0.83 min (0.30-2.35 min).

Animals↗
PubMed1976

Effects of various diuretic agents in the mouse.

Diuretic effects of seven orally-acting diuretic agents have been examined in the mouse. The following compounds, examples of various types of orally active compound available, produced their characteristic diuretic effects: bendrofluazide, frusemide, ethacrynic acid, acetazolamide, triamterene, aminophylline and Su 15049A. The diuretic effects of the various agents were demonstrated under both water and saline-loading conditions. After allowing for differences in baseline sodium excretion, all diuretics except acetazolamide caused a further enhancement of sodium excretion after saline-loading compared with water-loading tests. The mouse possesses several advantages over the more commonly used rat since the range of diuretic responsiveness is greater. These results suggest that the mouse is a suitable species for diuretic testing.

Acetazolamide↗