From the Guidelines
Diuretics can cause significant side effects, including electrolyte imbalances, dehydration, and kidney problems, and patients taking these medications should be closely monitored for these adverse effects, particularly those with pre-existing kidney disease or heart failure, as stated in the most recent study 1.
Common Side Effects of Diuretics
- Increased urination
- Dehydration
- Electrolyte imbalances (particularly low potassium, sodium, and magnesium)
- Dizziness
- Low blood pressure
Specific Side Effects by Diuretic Type
- Loop diuretics (e.g., furosemide, bumetanide): more severe electrolyte disturbances, hearing loss
- Thiazides (e.g., hydrochlorothiazide): less severe electrolyte disturbances, but still a risk
- Potassium-sparing diuretics (e.g., spironolactone): high potassium levels, breast tenderness in men, menstrual irregularities in women
Monitoring and Prevention
- Regular blood tests to check electrolyte levels and kidney function
- Staying adequately hydrated (unless fluid restricted)
- Following prescribed electrolyte supplements
- Monitoring for symptoms like excessive thirst, muscle cramps, irregular heartbeat, severe dizziness, or unusual fatigue The most recent study 1 highlights the importance of monitoring renal function in patients with heart failure taking diuretics, as they can lead to acute kidney injury and worsening renal function over time. Another study 1 also notes that diuretics can lead to acute kidney injury, which is one of the most common causes of hospital admission due to adverse drug reactions. Therefore, it is crucial to closely monitor patients taking diuretics and adjust their treatment plan accordingly to minimize the risk of adverse effects, as recommended in the most recent guidelines 1.
From the FDA Drug Label
PRECAUTIONS General Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients. As with any effective diuretic, electrolyte depletion may occur during Furosemide tablets therapy, especially in patients receiving higher doses and a restricted salt intake Hypokalemia may develop with Furosemide tablets, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives.
PRECAUTIONS Electrolyte and Fluid Balance Status In published studies, clinically significant hypokalemia has been consistently less common in patients who received 12. 5 mg of hydrochlorothiazide than in patients who received higher doses. Nevertheless, periodic determination of serum electrolytes should be performed in patients who may be at risk for the development of hypokalemia.
5 WARNINGS AND PRECAUTIONS
Warnings and precautions 5.1 Hyperkalemia Spironolactone can cause hyperkalemia.
The side effects of diuretics include:
- Electrolyte imbalance: Hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and hypochloremic alkalosis
- Dehydration: Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse
- Hyperkalemia: Spironolactone can cause hyperkalemia, especially in patients with impaired renal function or concomitant potassium supplementation
- Gynecomastia: Spironolactone can cause gynecomastia, especially in male patients
- Hypotension: Excessive diuresis may cause symptomatic dehydration, hypotension and worsening renal function
- Worsening renal function: Worsening of renal function can also occur with concomitant use of nephrotoxic drugs
- Hyperuricemia: Asymptomatic hyperuricemia can occur and rarely gout is precipitated
- Hyperglycemia: Spironolactone can cause hyperglycemia 2, 3, 4
From the Research
Common Side Effects of Diuretics
- Extracellular fluid volume depletion, associated orthostatic hypotension, and prerenal azotemia 5
- Hypokalemia, due to increased potassium secretion secondary to enhanced tubular fluid flow and aldosterone secretion induced by diuretic administration 5, 6
- Metabolic abnormalities, such as hyperglycemia and carbohydrate intolerance, related to diuretic-induced hypokalemia 5
- Mild increase in serum cholesterol concentration, frequently seen during initiation of diuretic therapy 5
Electrolyte and Fluid Imbalance
- Increased clearances of sodium, potassium, chloride, and calcium after a single dose of hydrochlorothiazide or furosemide 7
- Urate and phosphorus clearances show very slight change after a single dose of hydrochlorothiazide or furosemide 7
- Long-term use of hydrochlorothiazide or furosemide can lead to decreased urate excretion and sustained calcium excretion 7
Diuretic-Induced Hypokalaemia
- Prevalence of 7%-56% of hypokalaemia in patients taking thiazide diuretics 6
- Clinical manifestations of hypokalaemia due to diuretics can range from asymptomatic to fatal arrhythmia 6
- Diagnosis of hypokalaemia is based on the level of serum potassium, and ECG is useful in identifying severe consequences 6
Comparative Effects of Diuretics
- Each diuretic has its own benefit and side effect, including fluid, electrolyte abnormalities, and acid-base disturbance 8
- No significant difference among diuretics was observed in terms of hospital readmission and mortality rates 8
- The choice of appropriate diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities 8