Diuretics - Adverse effects
Apart from their adverse effects directly linked to the diuretic effect: hyperkalemia or hypokalemia, diuretics can elicit dehydration in the elderly.
According to epidemiologic studies hypokalemia induced by diuretics could increase the risk of cardiac mortality. They should be prescribed at low dose and, if possible, combined with a hyperkalemic drug such as an ACE inhibitor.
Their combination with certain drugs is disadvised: those which are eliminated by the kidney (lithium, aminoglycosides) and those for which the adverse effects are raised by an hypokalemia (certain antiarrhythmics sometimes at the origin of torsades de pointes).
Notice
- Antagonists of antidiuretic hormone could theoretically increase the aqueous diuresis without modifying that of the electrolytes. One of the first drug of this new class is conivaptan.
- Uricosuric d rugs increase the urinary elimination of uric acid by inhibiting its tubular reabsorption and are used as antigout drugs.
Probenecide was the first drug inhibiting uric acid reabsorption. In addition, it inhibits the tubular secretion of organic acids, decreases their urinary elimination and increases their plasma concentration. It was used to reduce penicillin elimination and to increase its efficacy while using a lower dosage.
Benzbromarone increases the urinary elimination of uric acid by decreasing its tubular reabsorption and can cause uric acid calculi. It increases also its intestinal elimination. It is used for gout treatment but its hepatic toxicity has been reported and it has been withdrawn in many countries were it was marketed as Désuric*.
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