Diuretics

Also indexed as: Acetazolamide, Carbonic Anhydrase Inhibitors, Diamox®, Mannitol, Methazolamide, Neptazane®

Diuretics are a family of drugs that promote urination. They are used to reduce water accumulation or oedema associated with heart failure, cirrhosis, and corticosteroid therapy, as well as to treat high blood pressure. Diuretics are classified as “potassium-depleting” if they cause loss of potassium in the urine, or “potassium-sparing” if they cause retention of potassium.

Interactions involving diuretics in general are described on this page. For interactions involving a category of diuretics or a specific drug, refer to the highlighted items below.

Carbonic anhydrase inhibitors, Potassium-Depleting

Acetazolamide (Diamox®)
Dichlorphenamide (Daranide®)
Methazolamide (Neptazane®)

Thiazides, Potassium-Depleting

Bendroflumethiazide (Naturetin®)
Benzthiazide (Exna®)
Chlorothiazide (Diuril®)
Chlorthalidone (Hygroton®)
Hydrochlorothiazide (Esidrix®, HydroDiuril®, Microzide™)
Hydroflumethiazide (Diucardin®)
Indapamide (Lozol®)
Methyclothiazide (Enduron®)
Metolazone (Zaroxolyn®, Mykrox®)
Polythiazide (Renese®)
Quinethazone (Hydromox®)
Trichlormethiazide (Naqua®)

Loop diuretics, Potassium-Depleting

Bumetanide (Bumex®)
Ethacrynic acid (Edecrin®)
Furosemide (Lasix®)
Torsemide (Demadex®)

Potassium-sparing

Amiloride (Midamor®)
Amiloride and Hydrochlorothiazide (Moduretic®)
Spironolactone (Aldactone®)
Spironolactone and Hydrochlorothiazide (Aldactazide®)
Triamterene (Dyrenium®)
Triamterene and Hydrochlorothiazide (Dyazide®, Maxzide®)

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Folic acid
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Alder buckthorn Buckthorn
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known
Interactions common to many, if not all, Diuretics are described in this article. Interactions reported for only one or several drugs in this class may not be listed in this article. Some drugs listed in this article are linked to articles specific to that respective drug; please refer to those individual drug articles. The information in this article may not necessarily apply to drugs in this class for which no separate article exists. If you are taking a Diuretic for which no separate article exists, talk with your doctor or chemist.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Folic acid
One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.¹ Homocysteine, a toxic amino acid by-product, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

Interactions with Herbs

Alder Buckthorn, Buckthorn(Rhamnus catartica, Rhamnus frangula, Frangula alnus)
Use buckthorn or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.²

References
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1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866–70.

2. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: University of Exeter, Centre for Complementary Health Studies, 1997.

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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