DOWNRIVER CARDIOLOGY CONSULTANTS
PATIENT EDUCATION INFORMATION
REGARDING: DIURETICS
Diuretics are utilized to increase the elimination of fluid and salt from the body through your urine. There are different
categories of diuretics. Generally, the thiazide type diuretics such as Hydrochlorothiazide are utilized in the treatment of
hypertension or high blood pressure. Loop diuretics such as Lasix or Bumex are much more potent and are frequently
used in the treatment of congestive heart failure. Both of these types of diuretics have a tendency to lose other salts in the
body such as potassium and magnesium. A separate category of drugs are the potassium-saving drugs such as Aldactone,
Dyridium (as combined in Dyazide or Maxzide) and Midamor.
Diuretics should be utilized in the lowest dose possible to create a beneficial effect. In the treatment of hypertension, the
dose of Hydrochlorothiazide may be as low as 6.25 mg daily. This is present in combination with some pills for
hypertension. Otherwise the only way to take a dose this low is to split in quarters a 25 mg pill. The other option is to
take half of pill at 12.5 mg. It may be necessary to increase the dose to 50 mg for the greatest effect. Usually though in
the treatment of hypertension it is better to use several medications at lower doses in an attempt to reduce side effects and
at the same time have a good effect on the blood pressure. In fact, sometimes adding another low dose medication
provides a greater effect than doubling the original prescription.
In the treatment of congestive heart failure the dosage of diuretic can be reduced once fluid loss is achieved. In some
instances, the medication can be taken on an every other day regime or only when needed based on weight gain or the
observance of fluid retention.
Spironolactone is a diuretic that effects many of the hormone abnormalities that are found in congestive heart failure.
Because of its effect both in this fashion and in saving potassium, it is recommended that everyone with a weakened heart
muscle be placed on Aldactone. A low dose of 25 mg a day seems to be sufficient for this therapy. Higher doses may be
required if correction of a low potassium is necessary.
Generally, diuretics have a low side effect profile. The most frequent adverse effects relate to the loss of other salts in the
body. In particular, a low potassium can be dangerous in relationship to heart rhythm problems. Magnesium may also
play a role in heart rhythm disturbances. The higher dose of diuretic utilized may cause a higher incidence of salt
abnormalities. However, this is not always true and is also related to the amount of salt ingested and lost through other
mechanisms. Many patients will require a potassium supplement. In addition, potassium can be obtained through food
sources such as bananas. However, bananas are not the highest source of potassium and dried fruits have considerably
more potassium. Excessive use of diuretics may cause low levels of sodium and low blood volume leading to weakness
and lightheadedness.
LAB
Sodium
Potassium
Chloride
CO2
Magnesium
1st week
2nd week
3rd week
4th week
6th week
8th week
3 months
If already on a diuretic:
LAB
Electrolytes
Magnesium
3 months
6 months
9 months
12 months