Diuretics (diuretics): use, classification, action, indications and contraindications, side effects

Drugs that speed up the excretion of urine from the body are called diuretics. These drugs reduce the ability of the kidneys to reabsorb electrolytes, against the background of increasing concentrations of which fluid is released.

The first diuretic used by man was mercury. In the 19th century, this substance was used in the treatment of syphilis. It turned out to be practically powerless against this disease, but the diuretic effect of mercury did not escape the attention of doctors. Later, safer compounds appeared, the improvement of which made it possible to obtain effective and non-toxic diuretics.

What are diuretics

Diuretic tablets contain substances that act on the body, stimulating the removal of fluid from it. Their composition varies in chemical structure, but the principle of action is the same.

It is important to understand, when understanding the mechanism of action of a diuretic, that such a drug can suppress the reabsorption (reabsorption) of electrolytes that occurs in the renal tubules. Due to this, fluid is removed in increased quantities. And along with it, salts and toxins actively leave the body.

It is logical that diuretics are taken for renal pathology. But their ability to stop the reabsorption of water and salts can be valuable in the fight against cardiovascular diseases and in the treatment of the liver. Thanks to the best diuretics, fluid is actively removed from the body, which, due to pathology, can accumulate both in tissues and in cavities.

In medicine, there is a branched classification of diuretics according to their mechanism of action. Therefore, doctors select a diuretic individually, prescribing a drug that will be most effective for edema of a certain etiology.

It is not recommended to buy tablets without a prescription. Even the safest diuretic can be addictive and can also lead to a catastrophic lack of minerals and salts in the body if taken uncontrollably.

Terminology

Common people are more familiar with the name diuretic drugs, but they are diuretics by definition. Since in medicine the process of formation and excretion of urine is diuresis, accordingly, the tablets are called diuretic. The drug stimulates fluid secretion, that is, urine output. This effect is called diuretic.

Understanding what it is, it will be easier to understand the instructions for diuretics. For example, it states that the effect of a diuretic is observed within six hours. This means that this is how long a person will observe increased urination.

Herbal diuretics

To reduce swelling, which is not a consequence of chronic diseases, but is caused by excessive consumption of salty foods, it is recommended to use natural diuretics. Such means have a number of advantages:

have a noticeable diuretic effect;
suitable for long-term use;
do not cause renal or extrarenal side effects;
suitable for use by children and pregnant women;
combine well with other medications.

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Some drugs related to diuretics are of natural origin. Herbal diuretics include many herbs, as well as some fruits and vegetables. Here are some examples of such natural remedies:

strawberries;
yarrow herb;
chicory root;
birch leaves, buds;
lingonberry leaves;
rose hip;
watermelons;
cucumbers

The effect of taking diuretics

Pharmacological companies carefully develop the composition of the diuretic. Depending on the combination of chemical components, diuretic tablets vary in effectiveness.

There are drugs that start working literally after 30 minutes. Such diuretics are usually called fast. Sometimes your doctor will prescribe a medicine that will start working within two hours. If the diuretic effect is delayed, such a diuretic is called intermediate in speed of action.

You also need to know that, depending on the composition, the drugs have different durations of action. There are medications that stimulate the removal of excess fluid from the body over several days. Others work for several hours.

Efficiency is also expressed in the volume of fluid removed. Depending on how strong the diuretic effect is, medications are powerful, medium or weak. The best diuretics will be those that are selected individually by the doctor, taking into account the patient’s condition. Only a specialist will be able to prescribe a remedy that will remove the required amount of water from the body without unpleasant consequences.

It’s not just the side effects that are dangerous, which manufacturers immediately warn about in the instructions. Due to the unauthorized use of diuretics, there may be health consequences that a person is not even aware of, because he does not take into account his own chronic diseases and pathologies.

general information

Based on their origin, they are divided into organic and inorganic types.

Organic include decoctions and infusions of plants, widely known throughout human history. Inorganic are chemicals that have a diuretic effect.

The first inorganic diuretics were used already at the beginning of the 9th century. These were mercury compounds. Today, mercury diuretics are not used due to their high toxicity.

Over time, in parallel with the development of chemistry and the progress of pharmacology, many substances with diuretic properties were synthesized. They have firmly occupied their niche in the list of drugs.

Any medicinal substance, once in the body, acts on certain receptors. This means that its influence leads to a strictly specific reaction.

The blood vessels dilate or, on the contrary, constrict, the number of heartbeats increases or slows down, and nervous activity is activated or suppressed.

One of these reactions to the administered substance is a diuretic effect. The term comes from an ancient Greek word meaning “urination.” From the name it follows that the effect of this drug is diuretic.

Indications for use are excess fluid in the body.

Indications for use

Diuretics are taken to eliminate sodium retention in the body. This condition is observed with ascites, renal or heart failure. Elderly patients often need to take diuretics to treat hypertension. Also indications for the use of diuretics are:

osteoporosis;
congenital Liddle syndrome;
high intraocular pressure;
glaucoma;
cirrhosis of the liver.

Sometimes you have to take diuretic tablets for prophylactic purposes. For example, thiazide diuretics are prescribed to prevent stroke.

Most often, indications for use are conditions accompanied by fluid retention in the body. But you can also use diuretic tablets for an antispasmodic effect. They tend to relax smooth muscles in various organs - arteries, bronchi, bile ducts.

Even if they are based on light components of plant origin, diuretics are used only as prescribed by a doctor. The specialist will have to decide individually, based on the patient’s condition, whether he needs active or supportive therapy.

In the first case, a potent drug is usually prescribed, only in a moderate dose. And in the second, you have to take diuretics regularly, but they are usually gentler on the body.

Indications for the use of diuretics

Diuretic pharmacological agents are prescribed for pathologies that are accompanied by fluid retention, a strong increase in blood pressure, and intoxication . These conditions include:

chronic renal failure;
heart failure;
hypertensive crises;
glaucoma;
liver dysfunction;
excess synthesis of aldosterone.

For hypertension

Arterial hypertension uncomplicated by renal failure can be treated with diuretics . The drugs reduce the volume of circulating blood and systolic output, due to which the pressure decreases gradually. Long-term therapy leads to a decrease in the diuretic effect and stabilization of blood pressure using its own compensatory mechanisms (increased levels of the hormones aldosterone and renin). For arterial hypertension the following is prescribed:

Hydrochlorothiazide. The active substance is hydrochlorothiazide. The drug belongs to the group of thiazide diuretics of medium strength. Depending on the clinical picture, 25-150 mg per day is prescribed. The effect of Hydrochlorothiazide occurs within an hour and lasts approximately a day. The medicine is suitable for long-term use and prevention of hypertensive crises.
Chlorthalidone. A drug of the thiazine-like group, the active ingredient is chlorthalidone. Chlorthalidone begins to act 40 minutes after oral administration, the duration of the effect is 2-3 days. Prescribe the drug 25-100 mg in the morning, before meals. The disadvantage of chlorthalidone is the frequent development of hypokalemia.
Indapamide. This diuretic is a thiazide-like diuretic and increases the excretion of sodium, potassium, and chlorine. The effect of the drug occurs after 1-2 hours and continues throughout the day.

In case of intoxication

In case of severe poisoning, they resort to forced diuresis using diuretics to remove toxins and poisons from the blood. Diuretics are used for intoxication with water-soluble substances, which include:

alcohol;
salts of heavy metals;
narcotic substances;
inhibitory substances;
potent medications (barbiturates).

Forced diuresis is performed in a hospital setting. In this case, hydration and dehydration are performed simultaneously with minimal changes in the composition and quantity of blood. Diuretics help to achieve an increase in the filtration capacity of the nephrons for the rapid, effective removal of toxic substances. To perform forced diuresis use:

Furosemide. The medicine has a rapid but short-lived diuretic effect. For forced diuresis, a 1% solution is prescribed in an amount of 8-20 ml parenterally. The effect of the drug begins after 5-7 minutes and lasts 6-8 hours.
Ethacrynic acid. It has slightly less activity than Furosemide. In case of intoxication, parenteral administration of 20-30 ml of solution is indicated. The action of ethacrynic acid begins after 30 minutes and lasts 6-8 hours.

For diseases of the cardiovascular system

Diuretics are prescribed for chronic heart failure to eliminate edema . As a rule, minimum dosages of drugs are indicated. It is recommended to start treatment of heart failure with thiazide or thiazide-like diuretics:

Clopamid. The drug has a pronounced natriuretic effect. For heart disease, a dosage of 10-40 mg is indicated daily in the morning before meals. Clopamide begins to act after 1-2 hours, the duration of the effect lasts for a day.
Diuver. Loop diuretic, active ingredient - torasemide. The medication inhibits the reabsorption of sodium and water ions. The effect of the drug reaches its maximum 2-3 hours after oral administration, the diuretic effect persists for 18-20 hours.

For kidney diseases

Kidney pathologies lead to insufficient blood filtration, accumulation of metabolic products and toxins. Diuretics help compensate for the insufficient filtering capacity of the nephron. Indications for the use of diuretics are renal failure, chronic infectious lesions in the acute stage, and urolithiasis . As a rule, in these cases they use:

Mannitol. Osmodiuretic, increases filtration and osmotic pressure of plasma. The drug has a moderate natriuretic effect. The diuretic effect begins in the first minutes after parenteral administration (about 5-10 ml of a 15% solution) and lasts 36-40 hours. The medication is used for forced diuresis in glaucoma or cerebral edema.
Oxodollin. The main active ingredient is chlortolidone. Oxodolline inhibits sodium reabsorption. The action begins 2-4 hours after ingestion and lasts 26-30 hours. The dosage for kidney diseases is 0.025 g once a day.

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For swelling

Swelling often occurs without the presence of a disease and is a consequence of excessive consumption of salt, sweets, and alcoholic beverages. To eliminate this unpleasant symptom, diuretics are indicated:

Amiloride. A medication from the group of potassium-sparing diuretics. Amiloride begins to act 2 hours after oral administration, the effect lasts for 24 hours. The approximate single dosage is 30-40 mg.
Diacarb. The active ingredient is acetazolamide. Diacarb has a weak but long-lasting effect. After oral administration (250-500 mg), the effect occurs after 60-90 minutes and lasts up to 2-3 days.

For weight loss

Diuretics will help reduce body weight by 1-3 kg in a few days, but will not affect the fat content in the body. When you stop using diuretic drugs, the weight will return, so it is not recommended to use such drugs for weight loss for more than 2-3 days. Long-term use of diuretics to reduce body weight can lead to impaired kidney function, including kidney failure. The following medications are suitable for short-term weight loss:

Lasix. The active component of the drug is furosimide. Lasix has a rapid diuretic effect and inhibits the reabsorption of sodium, chlorine and potassium. The recommended single dosage is 40-50 mg. The action of Lasix begins 30-40 minutes after ingestion and lasts 6-8 hours.
Uregit. A fast-acting diuretic, it contains ethacrynic acid, which slows down sodium transport. the effect occurs 30 minutes after ingestion and lasts for 10-12 hours. A single dosage is 25-50 mg.

Contraindications

Like any other medications, diuretics should be taken only as prescribed by a doctor. But in any case, it is better to additionally make sure that there are no contraindications to diuretics. Because for many pathologies and chronic ailments, such drugs cannot be taken. It is also very important to correctly determine which pills are acceptable and which can lead to unpredictable consequences.

If the patient is treated with lithium salts or cardiac glycosides, he may be prescribed diuretics, but with great caution. It is definitely forbidden to drink diuretics for the following ailments:

liver cirrhosis in decompensated form;
hypokalemia;
respiratory failure;
acute renal failure.

For diseases such as ventricular arrhythmias, diuretics can be prescribed, but very carefully and carefully selecting the drug according to the mechanism of action. When a patient has cardiac insufficiency, osmotic diuretics can harm him.

Separately, it should be emphasized that doctors categorically do not approve of people who take diuretics to lose weight. Firstly, because this can lead to unpredictable consequences if a person does not take into account the state of his health. Secondly, although a diuretic leads to getting rid of extra pounds, it does not affect fat reserves. It removes water along with beneficial microelements, and this in itself is fraught with harm to health.

Contraindications to taking diuretics

Contraindications to the use of diuretics are:

hypokalemia;
diabetes;
renal and respiratory failure;
decompensated cirrhosis.

These drugs should not be taken by patients who have an individual intolerance to sulfonamide derivatives. Thiazide group drugs, for example, Methyclothiazide, Bendroflumethiazide, Cyclomethiazide, Hydrochlorothiazide, can cause a sharp increase in blood sugar levels.

Edema - kidney and heart. Blood pressure and edema. Hypotension and hypertension

In patients suffering from ventricular arrhythmia, taking diuretics can cause a worsening of the condition and is strictly under medical supervision. Combining diuretic therapy with the use of lithium salts and cardiac glycosides requires maximum caution. Patients with heart failure are not prescribed osmotic diuretics.

Side effects

No matter how safe diuretics are, this does not mean that after taking them there are guaranteed to be no adverse events. Although, with the proper choice of a diuretic by the attending physician, side effects and risks are minimized.

How strong and long-lasting the side effects caused by taking diuretics will be depends largely on the type of drug. In any case, uncontrolled intake is fraught with a decrease in the level of potassium and other valuable microelements, and this in itself leads to failures in various organs.

It is better to play it safe and once again consult with a specialist. Because diuretics can cause:

hypertensive crisis;
swelling in the lungs and brain;
renal failure;
cirrhosis of the liver.

Fortunately, such consequences are extremely rare. But nausea and headaches, pain in the sternum and cramps are more common. There is such a possibility even when the patient takes medications as prescribed by the doctor. If side effects are suddenly observed, you should definitely notify a specialist. He can choose other drugs.

Finally, the most harmless medicine can cause harm if the dosage is arbitrarily changed. The consequences of unauthorized course extension are unpredictable and dangerous.

Diuretics of natural origin

There are many natural diuretics that are inferior in action to artificial analogues, but were used by humans long before the advent of synthetic diuretics. The lower effectiveness of traditional methods is compensated by its harmlessness and gentleness. Correctly selected dosage allows you to use decoctions for quite a long time without any side effects or harm. You should take natural diuretics, as well as synthetic drugs, only after finding out the true reason why fluid is retained in the body.

If fluid retention is caused by swelling and heart failure, drink a decoction made from birch leaves or strawberries. Birch leaves are used as compresses for swelling of the upper and lower extremities. Inflammations of the bladder and kidneys are treated with tansy, lingonberry, and shepherd's purse. Flaxseeds, bearberry, rose hips, and orthosiphon are most often used in the treatment of swelling. Rosehip tea is taken during long-term antibacterial treatment and recovery after surgery.

Orthosiphon is a traditional kidney tea that has both a diuretic and antispasmodic, anti-inflammatory effect. Natural diuretics are not only herbs, but also other vegetables. The removal of fluid is facilitated by the use of pumpkin, melons, celery, and parsley. Instead of fresh herbs, you can use cucumber and dandelion leaves to make a salad that reduces swelling.

Classification and types

In pharmacies, diuretic tablets are presented in a large assortment. But choosing them correctly on your own is almost impossible: each group of drugs has its own characteristics of composition and effects.

Diuretics are of natural origin. These are herbal decoctions and teas. Some foods have a diuretic effect. By tradition, they are considered gentle and even safe. However, natural diuretics can also cause harm.

Medicines produced by pharmacological enterprises are presented in the form of tablets and injection solutions. They, in turn, are divided into three broad groups according to the purpose of their application:

Modern “ceiling” diuretics are capable of acting very quickly, which is sometimes necessary for the rapid elimination of edema, rapid reduction of pressure, and accelerated removal of toxic substances from the body.
Effective diuretics prescribed for long-term complex therapy.
Drugs that are taken for certain ailments to control diuresis. These are mild diuretics prescribed, for example, for gout and diabetes.

Classification

To understand how a particular diuretic works, it is necessary to know the mechanism of urine formation.

Urine in the body occurs during the filtration of blood by special kidney structures - nephrons. In this case, the liquid part of the blood, plasma, passes through the nephron membrane and enters the renal tubules.

In these biological tubular formations, a liquid substance (the so-called primary urine) is formed and thickened. Water and nutrients return to the bloodstream, and toxins are removed from the body.

The human body contains about 2 million nephrons. Approximately 200 liters of fluid passes through the renal glomeruli per day. During the same period, about 1.5 - 2 liters of urine are released.

To increase the amount of urine, you can speed up filtration in the glomeruli or reduce the absorption of primary urine in the renal tubules.

According to the mechanism of their effect, the following classification of diuretics is currently accepted:

loop;
thiazide;
potassium-sparing;
osmotic;
combined.

The need to classify diuretics arose due to differences in their mechanism of action.

Loop

This type of drug acts on one of the areas of urine formation called the “loop of Henle”. Loop diuretics include drugs such as Furosemide, Bumetanide, and Ethacrynic acid.

By acting on epithelial cell receptors, a loop diuretic slows down the absorption of sodium and chlorine ions. This leads to an increase in fluid excreted by the kidneys. In addition to being a diuretic, this group of substances also has a powerful hypotensive effect.

An unfavorable effect of the drugs is excessive excretion of potassium from the body, which is negative for the function of the cardiovascular system. This type of diuretic belongs to the group of strong drugs. The effect comes quickly and lasts from 10 to 18 hours.

Thiazide

The name comes from the substance benzothiadiazine, of which this group is a derivative. It is called thiazide diuretics. The drugs also act on the area of the loop of Henle.

They reduce the active reabsorption of chlorine and the passive absorption of sodium. According to the severity of the effect, they belong to the middle group.

The diuretic effect occurs within a period of 30 minutes to 1 hour and lasts up to 10 hours.

Among the disadvantages of thiazide-like ones, the deficiency of potassium and magnesium ions should be noted. At the same time, thiazides contribute to the accumulation of uric acid derivatives in the body, which is unacceptable in people suffering from gout and can lead to an increase in gout attacks.

Most often, these drugs are used to medically reduce swelling in ascites. In combination with antihypertensive drugs, they are used to treat arterial hypertension.

Potassium-sparing

The next group of drugs used to reduce fluid in the body are potassium-sparing diuretics. These include aldosterone antagonists and sodium channel blockers. A typical representative of the first group is Spironolactone.

Its diuretic effect is weakly expressed and develops only towards the end of the second day. Meanwhile, a decrease in the excretion of potassium ions in the urine appears already in the first hours after administration. One of the sodium channel blockers is Triamterene.

Its effect is also weakly expressed. It develops within the next 1-2 hours after administration. The action lasts up to 10-16 hours. There is a well-pronounced effect of potassium preservation.

Osmotic

These include low molecular weight chemicals that achieve a diuretic effect by increasing osmosis in the liquid component of the blood. Due to this, there is an influx of fluid from the tissues into the vessels, followed by excretion in the form of urine.

Representatives are osmotic drugs mannitol, urea, glycerin. Their use does not cause hypokalemia and acid-base imbalance. Osmotic diuretics are used as solutions for intravenous infusion.

Combined

What does this term mean? Combined drugs are considered to be drugs consisting of several diuretic substances with different mechanisms of action. Today these drugs are considered very good. The conditions for the combination of active ingredients are as follows:

supplementing each other's active ingredients;
reduced risk of side effects when combined;
enhanced effect when used together.

Examples of such a combination: thiazide diuretic and potassium antagonist, aldosterone inhibitor and potassium antagonist. A combination of different groups is often used to treat severe forms of hypertension.

Chemical composition

Pharmacology produces different types of diuretics, classifying them according to their chemical composition. And on this basis, it is generally unrealistic to choose a drug for yourself without having a medical education, relevant knowledge and experience.

The principle of action of different groups of diuretics is similar, but the mechanism may differ. For example, the effectiveness of some diuretic drugs is based precisely on the maximum effect on the tubules, where the drug stops reabsorption. But sometimes it is more relevant for the patient to prescribe diuretics from the list of drugs that affect renal hemodynamics.

The difference may lie not so much in the mechanism of action, but in stimulating the removal of specific substances from the body. For example, diuretics from the list of saluretic drugs remove not only sodium from the body, but also chlorine.

When developing a therapeutic regimen, a specialist takes into account not only the patient’s diagnosis. The best diuretics for a particular patient will be drugs that can act as effectively as possible, but with a low risk of side effects. Sometimes it is more convenient and practical to prescribe combined diuretics. For example, in the treatment of hypertensive patients, gentle diuretics that have a hypotensive effect are in demand.

When studying the numerous names of tablets at the pharmacy, it is important to understand that each drug belongs to one group or another. Accordingly, the key question when choosing a medicine is what substance is active in its composition. The effect of the product directly depends on this.

Classification of diuretics

There are several types of diuretic drugs, differing in their mechanism of action, used in the treatment of various pathologies.

There are three types of diuretics:

Affecting the functioning of the epithelial tissue of the renal tubules . The group of these drugs includes the following: Triamterene, Hydrochlorothiazide, Bumetanide, Cyclomethiazide, Chlorthalidone, Bendroflumethiazide, Ethacrynic acid, Clopamide, Methyclothiazide, Amiloride, Metolazone, Furosemide, Indapamide, Torsemide.
Calcium-sparing, related to aldosterone (mineralocorticoid) receptor antagonists . Diuretics of this type include Spironolactone, which is known under the trade name Veroshpiron.
Osmotic , for example, Mannitol (Monitol).

Diuretics are classified not only by their mechanism of action, but also by the degree of sodium leaching:

highly effective (washing out over 15%);
average efficiency (10%);
ineffective (5%).

Potassium-sparing

Doctors repeatedly emphasize that it is extremely dangerous to take diuretics on your own for one reason only: they wash away beneficial substances from the body. And for some conditions this can be critical.

For example, in case of heart disease, the release of potassium is very dangerous, which occurs together with the removal of sodium and chlorine salts under the influence of a wide group of drugs. If a patient has hypocalcemia, he will be prescribed a diuretic that does not remove valuable calcium from the body.

Returning to potassium-sparing diuretics, it should be noted that such drugs are taken very carefully. On the one hand, diuretics that do not remove potassium have a positive effect on the heart muscle. On the other hand, an excess of such a chemical element is fraught with dangerous consequences, even critical:

muscle paralysis;
heart failure.

The dose should be prescribed individually, and the treatment process is monitored by both a cardiologist and a nephrologist. They are the ones who select the diuretic that will be best for a particular patient, taking into account the specifics of his condition. The diuretic effect of this group of drugs is considered mild, and in parallel, the drugs help reduce systolic blood pressure.

Triamterene

This drug is considered gentle, so it is prescribed even to children. Manifestations of diuretic action are observed two hours after administration. By retaining potassium, the medicine effectively removes sodium.

Since its diuretic properties are mild and gentle, long-term use with increasing doses is acceptable. However, there are negative consequences.

Depending on the duration of treatment, there is a possible risk of kidney stones. This is due to the fact that the drug does not dissolve well.

What are diuretics used for?

Diuretics are mainly used for:

reducing edema in heart and vascular failure;
for kidney diseases;
reducing high blood pressure;
removal of toxins in case of poisoning.

Edema can be a consequence of various diseases of the heart, vascular and urinary systems. This pathology is associated with sodium retention in the body. Diuretics remove excess sodium from the body, thereby reducing swelling.

With high blood pressure, excess sodium affects the tone of the vascular muscles, which contract and narrow. Diuretics, used as antihypertensives, flush sodium from the body and allow blood vessels to dilate, which leads to a decrease in blood pressure.

The kidneys remove some of the toxic substances during poisoning. In order to speed up this process, diuretics are used. In practical medicine, this method is called “forced diuresis.” Patients are first injected intravenously with a large volume of solutions, and then injected with a highly effective diuretic drug, which quickly expels toxins from the body along with the fluid.

Thiazide

These drugs are based on benzothiadiazine. Their diuretic effect is moderate. These diuretics differ in that they do not remove calcium from the body. Therefore, they can be drunk by children, the elderly, and other patients for whom it is important to prevent the leaching of this chemical element.

The mechanism of action of such diuretics is as follows: they act on the distal tubules of the kidneys, reducing the degree of reabsorption of magnesium and sodium salts. As a result, the production of lactic acid decreases. It must be taken into account that such diuretics are potassium-removing drugs.

Indapamide

It is typical to prescribe this medicine to patients with acute heart failure. It is very quickly absorbed in the body, lowers blood pressure and reduces the load on the heart.

Taking this drug can cause constipation and blurred vision. Other side effects sometimes include cough and dehydration. Since the diuretic leads to a decrease in blood pressure, it is not prescribed to hypotensive patients.

Amiloride

The drug included in the radar under this name is one of the diuretics that demonstrate a weak but long-lasting effect. It is well absorbed and prevents the excretion of potassium from the body.

The drug is prescribed for nephrotic pathology, accompanied by swelling. It is also typical to use the drug for hypertension, when by removing excess fluid it is possible to normalize blood pressure and maintain cardiac output within normal limits.

Diuretics and weight loss

The desire to get rid of hated kilograms pushes people to rather dubious experiments. Diuretic drugs also suffered this fate. Many people mistakenly believe that these drugs help you lose weight. This misconception is caused by the fact that ninety percent of adipose tissue consists of water.

Diuretics have an antiatherogenic effect. It lies in the ability to destroy cholesterol plaques. A drug such as Indapamide lowers the level of bad cholesterol in the blood. This in no way means that taking diuretics will help you lose fat. It stays in place, only the liquid leaves. The positive effect of the drug is that it reduces the risks of stroke, atherosclerosis, and heart failure.

Diuretics affect various systems, but mostly the urinary system. If medications are taken exclusively as directed, they normalize the balance of water and electrolytes. Uncontrolled use of diuretics, on the contrary, leads to numerous health problems, even death is possible.

It is impossible to remove fluid from the body without loss of ions. The latter regulate the functioning of each internal organ. Consequently, weight loss does not occur as a result of a decrease in body fat, but due to dehydration, which is accompanied by an ionic imbalance. Against this background, cardiac arrhythmia, hypotension develops, vision decreases, a general state of weakness is felt, and attacks of dizziness occur. With a severe overdose, hallucinations and collapse are possible.

How to use diuretics correctly? Sergey Yugay.

Those wishing to use diuretics for the purpose of losing weight should remember that these drugs are included in the category prohibited for athletes. The reason for this was the death of an athlete who abused diuretics in order to get sculpted muscles. Only people far from medicine can recommend these drugs for weight loss.

Osmotic

These diuretics are the most powerful. They act effectively on the body, but are only applicable in acute conditions. Therefore, there are practically no contraindications to them. Such powerful diuretics are prescribed when it comes to the fight for a person’s life:

with cerebral edema of any etiology;
with pulmonary edema due to toxic substances;
with swelling of the larynx;
in case of barbiturate poisoning;
if incompatible blood was transfused;
in shock, sepsis, osteomyelitis or peritonitis;
after poisoning with hemolytic poisons.

If it is urgently necessary to relieve swelling in an acute condition, doctors do not think about whether there will be side effects or whether the drug washes out trace elements. As soon as the critical moment has passed, these powerful diuretics are immediately discontinued.

Mannitol

This strong diuretic drug causes plasma levels to increase while inhibiting reabsorption. The drug significantly increases the amount of urine excreted. Sodium salts are washed out along with it, and potassium losses are not the most significant.

Such a strong diuretic is prescribed only for acute edematous conditions. An overdose can lead to hallucinations, dehydration, and dyspeptic disorders.

Side effects and possible harm

Any medicinal substance can both heal and cause irreparable harm to the patient. Diuretics are no exception.

Loop group drugs significantly reduce the amount of potassium in the body, which negatively affects the health of patients with chronic heart disease.

A side effect of thiazides is an increase in sugar levels, which is undesirable in diabetes mellitus.

This group of drugs causes an increase in the concentration of uric acid derivatives, which is a contraindication for use in patients with gout.

Diuretics should be prescribed to pregnant women very carefully. The use of diuretics during pregnancy is limited if possible. In the first three months of pregnancy, it is recommended, if possible, to abstain from any medications altogether.

The side effects of many medications are an absolute contraindication here. If necessary, it is better to use herbal diuretics.

At later stages, diuretics are prescribed only for the treatment of life-threatening and health-threatening complications. This is acceptable for nephropathies accompanied by edematous syndrome. For mild edema, pregnant women are recommended to follow a salt-free diet.

Loop

The diuretic effect of drugs in this group occurs due to their effect on the loop of Hengle. This loop-shaped formation is a renal tubule, which is directed to the center of the organ. The mechanism of action is such that the diuretic effect can be observed literally within half an hour after taking the medicine.

The group of loop drugs includes saluretics - drugs that remove both sodium and chlorine. Despite the fact that they are the most powerful, diuretics in this category are prescribed only in emergency cases.

Having a powerful effect on the kidneys, medications can be dangerous. Because the likelihood of serious complications is high:

hypertensive crisis;
swelling of the brain or lungs;
excess potassium;
renal failure;
heart failure;
severe liver damage.

Furosemide

This strong diuretic drug is very popular. It is prescribed for high blood pressure and swelling of various etiologies.

Acting literally within 20 minutes after administration, the drug leads to the removal of liquid with sodium and chlorine salts. The diuretic effect is observed for up to six hours.

Bumetanide

The drug is one of the new generation diuretics. It removes fluid from the body along with potassium, calcium and magnesium salts. The effect is quick but short-lived.

Torasemide

These are yellow tablets that have a moderate diuretic effect. They are prescribed for swelling caused by high blood pressure and heart failure. The medicine is not recommended for hypotensive patients.

Popular diuretic drugs and their effect on the body

Diuretics, which affect the functioning of the kidney tubules, prevent sodium from entering the body back into the body and excrete it in the urine. Thiazide-like diuretics (Cyclomethiazide, Bendroflumethioside, Methyclothiazide) hinder the absorption of not only sodium, but also chlorine. In connection with this effect, they are also called saluretics (from the English word salt).

Moderately effective diuretics (hypothiazide) are prescribed mainly for swelling, heart failure or kidney disease. Hypothiazide is especially often prescribed as an antihypertensive agent. The drug removes excess sodium and lowers blood pressure. In addition, diuretics of moderate effectiveness can enhance the effect of drugs for arterial hypertension. If a higher dose of such diuretics is prescribed, fluid excretion may increase without changing blood pressure. In addition, hypothiazide is used for urolithiasis and diabetes insipidus. The active substances of this diuretic reduce the concentration of calcium ions and prevent the formation of salts in the kidneys.

Arifon (Indapamide) differs from other diuretic drugs in its ability not only to remove excess fluid, but also relieves spasms and dilates blood vessels. One of the most effective diuretics is Lasix or Furosemide. When this drug is administered intravenously, the effect begins within 10 minutes. It is widely used for acute left ventricular failure, accompanied by pulmonary edema, arterial hypertension, peripheral edema, and to remove toxins. In terms of its action, Uregit (ethacrynic acid) is close to Lasix, but lasts a little longer.

Aldosterone antagonists (Veroshpiron, Aldactone) interfere with the absorption of sodium ions and reduce the secretion of potassium and magnesium ions. Drugs in this group are prescribed for congestive heart failure, edema and hypertension. Osmotic diuretics practically do not penetrate membranes. The most popular diuretic, Monitol, is administered intravenously. It increases plasma osmotic pressure and reduces intraocular and intracranial pressure. In this regard, the drug is effective for oliguria, which has caused acute blood loss, burn or injury. Indications for the prescription of osmotic diuretics are: cerebral edema, attacks of glaucoma and surgery for glaucoma.

Vegetable

In comparison with special diuretics proposed by pharmacology, products of natural origin are weak. But sometimes you need a light diuretic that will have a gentle effect on the body.

If we are talking about the treatment of a serious disease, a serious condition, herbal diuretics are prescribed as auxiliary therapy. However, in case of a functional disorder, a safe diuretic of natural origin can initiate diuresis in an amount that is sufficient for the patient.

But the selection of weak diuretics should be carried out by a doctor of appropriate qualifications. Because some herbal compositions are good for heart failure, others are good for diseases of the genitourinary system.

Targeted teas

Harmless diuretics include decoctions and infusions of medicinal herbs. Typically, each composition has a narrowly targeted effect:

Rosehip – suitable for relieving post-operative swelling. Tea made from dried fruits is not considered a harmful diuretic, so even children can drink it.
An infusion based on cat's whiskers is a drink that has a diuretic effect. It is recommended to take it for kidney diseases.
A decoction of birch leaves is a diuretic that will help relieve swelling in heart and kidney pathologies.
Dandelion leaves are used to make a diuretic infusion. This remedy has a beneficial effect on the kidneys.

Herbal tablets

Not only kidney tea or herbal decoction is used in therapy. Also on sale you can find diuretic drugs of plant origin in tablets. You should consult your doctor regarding their use.

If these diuretics are prescribed, then at the initial stage of the disease or for mild swelling. They also complement complex therapy.

Diuretic products

A pronounced diuretic effect is achieved by consuming certain foods. These are watermelons and cucumbers, melons and pumpkins, strawberries and celery. They rid the body of excess fluid, while simultaneously saturating it with useful vitamins and microelements.

However, the diuretic effect is achievable provided that the product has not undergone heat treatment. These natural gifts are used both in their natural form and in juice form. A big plus is that the products cause a diuretic effect, but without leading to unpleasant side effects.

Natural Diuretics

Before substances with a diuretic effect were discovered, people used natural methods. They are weaker than artificial diuretics, but much gentler and harmless. If you choose the dosage of decoctions, you can use them for a long time without unwanted effects. But even before using folk remedies, it is necessary to find out the cause of fluid retention.

For example, if there is a disturbance in the functioning of the heart and swelling, it is recommended to drink a decoction of strawberries or birch leaves. Compresses made from birch leaves are used for swelling of the limbs. The healing properties of shepherd's purse, lingonberry, and tansy help with inflammation of the kidneys and bladder. Popular remedies for edema are flax seeds, rose hips, bearberry, and orthosiphon. After surgery, to prevent drainage or during long-term antibiotic therapy, it is recommended to drink rosehip tea.

The traditional tea for kidneys that is prescribed is orthosiphon. It not only has a diuretic effect, but also acts as an antispasmodic and anti-inflammatory agent. In addition to medicinal herbs, melons, pumpkin, parsley, and celery are used to remove fluid. As an alternative to green salad for puffiness, you can make a salad of dandelion leaves and cucumber.

Diuretic to normalize blood pressure

To prevent and treat arterial hypertension, cardiologists prescribe diuretics to patients. Thiazide-like diuretics for blood pressure have a sufficient effect with moderate increases in blood pressure. In small doses, Indapamide retard and Hydrochlorothiazide reduce left ventricular hypertrophy. Since thiazides remove potassium, potassium-sparing drugs (Veroshpiron, Amiloride) are prescribed in combination.

Prescribing thiazides in combination with potassium-sparing diuretics significantly improves the prognosis of the disease and reduces the risk of coronary complications (heart attack, stroke). One of the requirements of therapy to normalize blood pressure is the selection of the most effective drug and its dosage.

Thiazides are not effective for the treatment of patients with arterial hypertension and renal failure. Such patients are shown loop diuretics for blood pressure (Furosemide, Trifas, Lasix). They are prescribed in small doses to prevent heart attacks. In emergency cases of hypertensive crisis, loop diuretics, when administered intravenously, can quickly reduce blood pressure.

Reabsorption of NaCl in the kidneys[edit | edit code]

The nephron is the smallest functional unit of the kidney. Primary urine is formed by ultrafiltration of plasma through the capillaries of the kidney into Bowman's capsule. In the proximal tubules, as a result of the absorption of NaCl and water, about 70% of the filtered liquid is reabsorbed. In the thick portion of the loop of Henle on the ascending limb, only NaCl is transported without water. The different properties of the two limbs of the loop of Henle, along with the parallel rectal vessels, create the conditions for the implementation of the principle of countercurrent urine flow, which allows maintaining a very high concentration of NaCI in the renal medulla. In the distal tubules and in the collecting duct, Na+ is reabsorbed. The secretion of K+ is also associated with this. Adiuretin increases the permeability of the collecting duct wall to water, facilitating the penetration of aquaporin molecules into the luminal membrane. As a result of hyperosmolarity, water rushes into the medulla and remains in the body. The concentrated urine eventually enters the renal pelvis and may leave the kidneys. The efficiency of this suction mechanism leads to the fact that from 150-180 liters of primary urine per day, 1.5 liters of final urine are released.

Na+ transport through tubular cells occurs in different parts of the nephron according to the same principle. The intracellular concentration of Na+ is significantly lower than in primary urine, since the Na-K-ATPase of the basolateral membrane constantly pumps Na+ ions out of cells into the interstitium. Na+ enters the cytosol of tubule cells along a concentration gradient. There is a special membrane mechanism for transporting Na+. This releases energy that is used to transport other substances against the concentration gradient. Na+ is transported from the cell to the extracellular space by Na-K-ATPase with the expenditure of energy (ATP breakdown). This enzyme is located on the basolateral membrane but is absent from the luminal membrane, which prevents the passage of Na+ from the cell back into the urine. Diuretics block Na+ transport. In principle, it is possible to influence both the input and output of Na+.

Is it possible to take diuretics during pregnancy?

Expectant mothers need to know that it is prohibited to drink diuretics without permission during pregnancy! Prescribing even “harmless” herbal preparations to yourself can lead to electrolyte imbalance and cause significant harm to mother and baby. Diuretics lead to disruption of the uteroplacental circulation, thrombosis of placental vessels, disruption of fetal development, etc. Synthetic drugs can be prescribed in extreme cases in recent months. For example, to relieve a hypertensive crisis at risk of pulmonary edema.

If necessary, doctors prescribe Canephron to pregnant women, which is made from medicinal herbs (rosemary, lovage, centaury). Phytolysin is also used, but only if the pregnant woman does not have inflammation in the kidneys. Under the supervision of a doctor, for edema, take the bronchodilator drug Eufillin, which has a diuretic effect.

Pregnant women should also take herbal decoctions with caution. It is forbidden to drink juniper tea, which can cause uterine contractions. Plants such as parsley and strawberry leaves are contraindicated. It is allowed to take tea from lingonberry leaves, horsetail, birch leaves and buds.

Conclusion

Diuretics are diuretic medications that are used for diseases accompanied by increased swelling. These are powerful drugs that are recommended to be taken only as prescribed by a doctor. Uncontrolled use of diuretic medications can lead to dangerous consequences for the body.

Diuretics

(from the Greek διούρησις - urination; diuretics [1]) - agents of various chemical structures that inhibit the reabsorption of water and salts in the kidney tubules and increase their excretion in the urine;
increasing the rate of urine formation and thus reducing the fluid content in tissues and serous cavities. Diuretics that reduce sodium reabsorption and increase natriuresis are called saluretics
.

Diuretics are used mainly for arterial hypertension and for diseases of the cardiovascular system, liver and kidneys, accompanied by edema - but not for all diseases with edema, and only as prescribed by a doctor. The doctor prescribes them in the absence of contraindications for pathologies (especially chronic heart failure) in cases where the patient has a positive sodium balance (that is, the amount of sodium taken with food exceeds its excretion). The removal of sodium from the body is accompanied by a decrease in edema. Therefore, the most important are those diuretics that increase, first of all, natriuresis and chloruresis (saluretics - from the Latin name for table salt).

Natriuretics are diuretics that cause a particularly strong release of sodium ions. Based on their action, diuretics are divided into renal

(that is, acting directly on the kidneys), giving the greatest effect, and
extrarenal
, that is, having a diuretic effect indirectly, through other systems of the body. Renal diuretics also have effects on other body systems.

Non-medicinal products

Diuretics for edema are called diuretics. Manufacturers produce such drugs in different forms: tablets, capsules, injections, droppers.

Doctors advise taking a closer look at folk remedies, for example, diuretic herbs that help quickly remove water from the body. The list of diuretics is huge, but leave the choice of this or that medicine to your therapist.

Diuretic tablets for edema

People suffering from hypertension or high blood pressure experience swelling in their legs in the evening. When taking medications, the amount of fluid in the blood will go away.

As a result, the osmotic pressure on the walls of blood vessels and the heart will decrease and the person will feel relief. Loop diuretics and other types of diuretics are endowed with these qualities.

Diuretic tablets for edema can not only relieve external symptoms, but also get rid of the cause of their occurrence.

Drugs

Decades ago, doctors did not have a wide selection of strong diuretics to prescribe to patients. Old versions of the tablets had a number of contraindications and, in addition to the results, brought with them many negative side effects: vomiting, dizziness, hearing loss.

Such a drug is the inexpensive Furosemide, which, when removing urea from the body, washes out potassium, calcium, magnesium and other substances, bringing with it a deficiency of essential microelements. The modern generation of drugs are more gentle.

The type of diuretics prescribed depends on where in the body the fluid accumulates. Often swelling is one of the list of symptoms that the patient complains about. Based on the examination, the doctor will select the appropriate treatment system. While undergoing a course of therapy, the patient must strictly adhere to all instructions regarding the time of taking medications and their dosage.

Swelling on the face brings a lot of trouble to its owner, since this part of the body is always visible. The cause of such trouble as the accumulation of fluid on the face is a large amount of alcohol drunk the day before, fatty foods, fatigue, lack of sleep and pregnancy.

Doctors advise not to take any diuretics for facial swelling without consulting them, as sometimes a more serious problem may be hidden behind it.

When choosing remedies for the treatment of swelling in the legs, you should be especially careful. The lower extremities swell in different ways.

The accumulation of fluid in the legs at the end of the day indicates problems with the heart and circulatory system, while swelling of the limbs in the morning indicates kidney disease. Before prescribing diuretics for swelling of the legs, the doctor will first write a referral for tests and other examination methods.

The cost of diuretics depends on the manufacturer. There are expensive diuretics, and there are very inexpensive ones. To make the choice of such tablets easy, you need to navigate the prices. Below is a table with minimum and maximum prices for popular products in the Moscow region.

Name of diuretic	Minimum price, rub.	Maximum price, rub.
Furosemide (20 tablets, 40 mg each)	21	27
Torsemide (30 tablets, 5 mg each)	90	136
Lisinopril (20 tablets of 10 mg each)	109	123
Canephron (60 tablets)	389	499
Spironolactone (20 tablets, 25 mg each)	39	53

During pressure on the eyes and the whole body, swelling of the legs is observed, what remedy can be used in this case? All medications that are prescribed for high blood pressure and eye pressure are divided into two large categories:

Drugs that relieve hypertensive crisis, rapidly increasing high blood pressure and eye pressure;
Drugs aimed at treating high blood pressure, maintaining it within the normal range.

In fact, medications applied to a sharp decrease in blood pressure are emergency aid; their action allows you to quickly reduce blood pressure and eye pressure. In turn, drugs for long-term therapy are drugs that are prescribed during remission to control and maintain blood pressure at a normal, stable level.

To eliminate a hypertensive crisis, diuretics that have a strong effect are used: Piretanide, Xipamide, Bumetanide, Furosemide, Torsemide and ethacrynic acid. But in practice, all drugs with a pronounced effect are prescribed. They are usually administered intravenously to achieve maximum results.

Treatment with drugs that have a strong effect should not exceed 1-4 days. After stopping the attack, they should be canceled and treatment with drugs from a different group should be prescribed. They are slow-acting, not so powerful and are necessary to maintain pressure at a normal constant level.

To maintain normal blood pressure, mid-level diuretics (thiazide diuretics) are used, including: Metozalone, Indapamide, Clopamide, Chlorthalidone, Hypothiazide. For hypertension, the drug of choice is Indapamide, since its effect is much stronger than other thiazide diuretics.

It is able to reduce blood pressure evenly, maintaining it at a normal level throughout the day, preventing it from increasing in the morning. It is recommended to take the drug for a long time; the duration of treatment can only be determined by a doctor.

Recently, diuretics for weight loss have gained great popularity. The myth that diuretic pills are effective for weight loss has a negative effect on those who believe it.

This misconception even has a scientific basis, since adipose tissue is 90% water. This is where many people believe that diuretic medications for weight loss can be extremely effective.

In fact, diuretics for weight loss work somewhat differently. Diuretic drugs for weight loss really have an antiatherogenic effect, which lies in the destruction of cholesterol plaques.

For example, Indapamide helps reduce cholesterol levels in the blood. But when using diuretics, you can only get rid of fluid in the body, and the fat will remain in the same place.

The drug can have an active effect on blood vessels, reducing the likelihood of developing heart failure, atherosclerosis and stroke.

As you know, diuretics can have an effect on a number of body systems, especially the urinary system. If they are taken correctly, this allows you to restore the electrolyte ratio and water balance in the body. And taking drugs in large doses can lead to negative consequences and even be life-threatening.

Folk diuretics were used long before medications were created. It is completely safe to use such products at home, although they are weaker in action than artificial diuretics, but have a mild effect.

If folk diuretics in decoctions are taken in the correct dosage, then they can be used for a long time without side effects. But even when taking remedies at home, it is recommended to determine the causes of fluid retention in the body.

There is no panacea; each case will require its own diuretic medications. The best diuretic is different for everyone.

When choosing a product, it is necessary to take into account the individual tolerance of its components, proceed from a specific case of disease, pay attention to the general condition of the patient, analyze the intensity of the drug’s effect on the body, etc. It would be appropriate to select the best medicine together with a specialist in order to cope with the disease as quickly and safely as possible.

The most inexpensive diuretic is Furosemide. In addition, the tablets “Indapamide”, “Veroshpiron”, “Hydrochlorothiazide” will not cause damage to your wallet.

You must understand that price is not an indicator of quality; it is prescribed by the pharmacy. There is no need to make a decision to purchase a product based only on pricing policy.

Only a doctor can correctly select a medicine suitable for a particular type of disease - he will expertly select a drug that will be effective and affordable.

Herbal ingredients with a diuretic function include tinctures, teas, decoctions, and food products that enhance the outflow of water. Herbs with medicinal effects are popular.

Natural diuretics have little effect. They are not suitable for combating serious health problems.

But you don’t need a prescription to purchase them and they have no side effects. They are suitable for use as a complex or as a prophylactic agent.

Before using medicinal decoctions, you should consult a specialist in order to choose the most effective diuretic.

The most popular diuretics in bodybuilding

The most common diuretics used in bodybuilding and other sports are:

thiazide diuretics such as Diuril;
loop diuretics such as Furosemide (Lasix) and Bumetanide;
potassium-sparing diuretics such as spironolactone or Aldactone.

It is also common practice for bodybuilders to use combination diuretics such as Aldactazide, which combines the powerful thiazide diuretic with the potassium-sparing Aldactone.

This combination allows the use of lower doses of the drug and partially prevents the loss of potassium that might otherwise occur.

List of the most popular diuretics in bodybuilding
Type of diuretic	Drug name
Thiazide	Diuril (Chlorothiazide/Diuril) Chlorthalidone Hydrochlorothiazide/Microzide Indapamide Metolazone
Loop	Furosemide/Lasix Bumetanide/Bumex Ethacrynic acid/Edecrin Torsemide - (Torsemide/Demadex)
Potassium-sparing	Amiloride Eplerenone/Inspra Spironolactone Triamterene/Dyrenium Aldactone
Osmotic	Mannitol Isosorbide
Combined	Aldactazide

Furosemide (Lasix)

It is one of the most popular and powerful diuretics in the world of bodybuilding. Its popularity is due to its cheap price and availability.

Furosemide is the most powerful and popular diuretic in bodybuilding

Bumetanide

Trade name Bumex is a next generation loop diuretic. Unlike Lasix, which is only 60% absorbed in the small intestine, Bumex is 80% absorbed and can be taken with food.

It is 40 times more powerful than Lasix, which further increases the risk of harm and side effects if used incorrectly.

Bumex turned out to be the secret ingredient in a popular fat burner called StarCaps. It is obvious that the weight lost with this supplement consisted solely of water.

Aldactone

Women who use anabolic steroids often use the diuretic Aldactone, as in addition to its direct effect, it blocks androgen receptors, which reduces androgenic side effects (manifestation of male sexual characteristics), such as facial and body hair growth.

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Thiazide diuretics

These medications and their derivatives (Indapamide, Chlorthalidone and Metolazone) are used quite often. First of all, this is due to their high rate of absorption in the gastrointestinal tract, as well as a good level of tolerability by patients. Thiazide diuretics are less powerful than loop diuretics, but due to their long duration of action, they are indicated for people with chronic diseases such as essential hypertension and mild congestive heart failure. Thiazide diuretics are prescribed for oral administration. Diuresis, as a rule, begins after 1-2 hours, but the therapeutic antihypertensive effect in some cases can be observed only after 3 months of continuous treatment. The founder of this group is chlorothiazide. It is characterized by low fat solubility and, consequently, low bioavailability. Because of this, higher dosages of the drug are required for a therapeutic effect. The drug "Chlorthalidone" is absorbed rather slowly, so its duration of action is somewhat longer. The drug "Metolazone" is often very effective in patients with reduced kidney function, unlike other medications in this category.

Diuretics: classification

There are different types of diuretic medications. Each category has its own strengths and weaknesses. Today there are the following groups of medicines:

• Loop medications. • Potassium-sparing diuretics. • Thiazide medications. • Thiazide-like agents.

These groups will be discussed in more detail below.

Mechanism of action of diuretics

Understanding the mechanism of action of diuretics requires knowledge of the anatomy and physiology of the kidneys. Let's try to do this in simple language, enough to understand how they work and what the risk of serious side effects is associated with.

The kidneys filter unnecessary substances from the blood and control the content of minerals, or rather their ions, in the internal fluids (electrolytes): they can get rid of their excess by discharging them into the urine, or, on the contrary, return them from the urine to the system when necessary.

Electrolytes are internal fluids that fill cells and intercellular spaces and are important for the occurrence of biochemical reactions in the body.

For example, nerve impulses travel from cell to cell due to the transfer of charge across their membranes using an ionic mechanism, which is provided by electrolytes. And muscle contraction is preceded by the passage of a nerve impulse through it.

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— How do diuretics work?

The mechanism of action of almost all diuretics is the same: they stimulate the excretion of sodium from the body.

- Why sodium?

A teaspoon of salt containing sodium holds approximately 2 liters of water in the body. The less sodium in the body, the less fluid, including in the subcutaneous layers.

Diuretics prevent sodium from passing through the kidneys' filters, causing it to remain in the urine and be excreted through urination.

Behind the apparent simplicity and harmlessness of the mechanism of action lies the reason for the colossal harm of diuretics.

— What is the harm of diuretics?

A deficiency of any one ion, or more precisely, a change in the balance between the concentrations of various ions, leads to disruption of vital functions.

Potassium and magnesium deficiency, for example, leads to muscle cramps.

Cramps are not a big problem when it comes to the calf or thigh muscles. It’s another matter when a spasm occurs in the heart muscle...

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The mechanism of action of all diuretics is the same: they stimulate the excretion of sodium, and with it fluid

Sulfonamide diuretics[edit | edit code]

These substances contain a sulfonamide group -SO2NH2; administered orally; They penetrate into the kidneys not only by glomerular filtration, but also by tubular secretion. The concentration of these drugs in urine is higher than in the blood. They influence the tubular epithelium from the luminal membrane, i.e. from the urine. The most potent drugs are loop diuretics. Thiazides are most often prescribed. Carbonic anhydrase inhibitors are not currently used as diuretics; they have a different therapeutic value. Their mechanism of action is discussed here.

Carbonic anhydrase inhibitor

acetazolamide acts primarily in the proximal tubule. The mechanism of action of acetazolamide can be explained as follows. Na+ absorption is reduced because less H+ is available at the Na/H+ antiporter. Result: decreased Na and H20 output. The enzyme carbonic anhydrase (CA) catalyzes the reaction, accelerating the establishment of equilibrium:

H+ + nso3- <-> H2C03 -> H20 + C02

In tubular cells, CA promotes the formation of H+, which, in exchange for Na+, enters the urine, where it binds to HCO3, and in the form of CO2 can penetrate the tubular membrane. HC03~ is formed there again. Thanks to carbonic anhydrase localized in the luminal membrane, H20 and CO2 are again produced, which easily penetrate the cell membrane. H+ and HCO3 are again formed in the cell. When KA is inhibited, these reactions proceed very slowly, and as a result, Na+, HC03 and water do not have time to be reabsorbed from the urine quickly passing through the tubules (there is no reabsorption). Loss of HC03 leads to acidosis. With long-term use, the diuretic effect of CA inhibitors decreases. CA is involved in the formation of moisture in the chambers of the eye. Indications for prescribing CA inhibitors are: acute attack of glaucoma, epilepsy, altitude sickness.

Dorzolamide is used topically for glaucoma to reduce intraocular pressure.

Loop diuretics

: furosemide, pyretanide, etc. Within one hour after oral administration of furosemide, a sharp increase in diuresis is observed, which stops only after 4 hours. The drugs affect the distal node, namely they inhibit the joint transport of Na+, K+ and Cl- in the luminal membrane of tubular cells . The excretion of Ca2+ and Mg2+ through the kidneys also increases. Special side effects: hearing impairment (reversible), increased toxicity of nephrotoxic drugs. Indications: pulmonary edema (in case of left ventricular failure it causes an additional effect - when administered intravenously, the lumen of the veins expands, the preload decreases); when thiazide diuretics are ineffective, for example, in renal failure with reduced creatinine clearance (<30 ml/min); prevention of shock kidney.

Ethacrynic acid, although not a sulfonamide, is also a diuretic.

Thiazide diuretics (benzothiadiazine diuretics), such as hydrochlorothiazide, trichlormethiazide and bugizide. A long-acting analogue of thiazides is chlorthalidone. The drugs act in the middle portion of the distal tubule. The excretion of Ca2+ by the kidneys decreases, and Mg2+ increases. Indications: hypertension, heart failure, edema. Often used in combination with capium-sparing diuretics triamterene and amiloride.

Side effects of sulfonamide diuretics

: a) hypokalemia due to loss of K+ in the terminal portion of the tubule, where Na+ is exchanged for K+; b) hyperglycemia; c) an increase in the concentration of uric acid in the blood (hyperuricemia) with the risk of developing an attack of gout in patients with a predisposition to this disease. Sulfonamide diuretics compete with uric acid in excretion mechanisms.