Diuretics

Stacy Elder Dalpoas, PharmD, BCPS, Lipika Samal, M.D., Paul A. Pham, Pharm.D.
Diuretics is a topic covered in the Johns Hopkins Diabetes Guide.

To view the entire topic, please or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

Johns Hopkins Guides

-- The first section of this topic is shown below --

INDICATIONS

FDA

Diuretic Class Review

Thiazide Diuretics

FDA Indication


Pharmacokinetics

Pregnancy Risk Rating/ Breastfeeding Risk

Cost and Formulation

Hydrochlorothiazide

Treatment of mild to moderate HTN; treatment of edema in heart failure and nephrotic syndrome

A: ~50-80%

M: minimal metabolism

E: Urine

t½ = 5.6-14.8 hrs

Rating B

Enters breast milk, avoid use in lactation

Generic available.

12.5 mg: $0.42

25mg: $0.08

50mg: $0.16

Chlorothiazide

Management of mild to moderate HTN; adjunct treatment for edema

A: poor.

M: saturable. Single dose 250 or 500 mg has similar systemic absorption

E: urine.

t½ = 1-2 hrs.

Rating C, but most experts do not recommend as it crosses placenta

Enters breast milk / use caution

Generic tablets available. Oral suspension still brand.

250 mg tab: $0.69

500 mg tab: $0.25

500 mg IV: $238

Metolazone

Management of mild-to-moderate hypertension; treatment of edema in heart failure and nephrotic syndrome, impaired renal function

A: 40-65%

M: minimal metabolism

E: urine.

t½ = 20 hrs

Rating B

Enters breast milk/ not recommended.

Generic available

2.5 mg: $2.07

5 mg: $2.35

10 mg: $2.82

Potassium-Sparing Diuretics

Spironolactone

Management of edema associated with excessive aldosterone excretion; hypertension; primary hyperaldosteronism; hypokalemia; cirrhosis of liver accompanied by edema or ascites; nephritic syndrome; severe heart failure (NYHA class III-IV) to increase survival and reduce hospitalization when added to standard therapy

A: 73%

M: hepatic, multiple metabolites

E: urine and feces

t½: 1.3-2 hrs. Active metaboliteâ??s t½ = 10-35 hrs.

Rating C (teratogenic in animal studies)

Enters breast milk

Generic available

25 mg: $0.45

50 mg: $0.82

Eplerenone

Hypertension, heart failure (NYHA II-IV)

A: 70%

M: Hepatic (Cyp3A4)

E: urine and feces

t½: 3-6 hr

Rating B

Unknown whether it enters breastmilk

25 mg: $4.30

50 mg: $4.30

Triamterene

Alone or in combination with other diuretics in treatment of edema and hypertension; decreases potassium excretion caused by kaliuretic diuretics

A: rapid

M: rapid metabolism

E: < 50% by urine, the rest by biliary/fecal

t½: 1-2 hrs

Rating C

No data available in breast-feeding

No generic available.

Brand: Dyrenium®

50 : $11.49

100 mg: $11.49

Loop Diuretics

Furosemide

Management of edema associated with heart failure and hepatic or renal disease; acute pulmonary edema; treatment of hypertension (alone or in combination with other antihypertensives)

A: erratic

M: minimally hepatic

E: urine, feces

t½: 0.5- 2 hrs

Pregnancy rating C, crosses placenta but has been used to treat heart failure in pregnancy

Enters breast-milk/use caution

10 mg/mL (60 mL): $10.40

20 mg: $0.14

40 mg: $0.16

80 mg: $0.43

Bumetanide

Management of edema secondary to heart failure or hepatic or renal disease including nephritic disease; may be used alone or in combination with antihypertensives for treatment of HTN; can be used in furosemide allergic patients.

A: 85-95% bioavailability

M: partially hepatic

E: urine

t½: 1-1.5 hrs

Pregnancy Rating C

Excretion in breast milk unknown; use caution

0.5 mg: $0.99

1 mg: $1.37

2 mg: $2.36

Torsemide

Hypertension; edema secondary to heart failure, cirrhosis, chronic renal failure

A: 80% bioavailability

M: Hepativ primarily via 2C9

E: urine, feces

t1/2: 3.5 hours

Pregnancy Rating B

5 mg: $0.63

10 mg: $0.70

20 mg: $0.82

100 mg: $3.04

**Patient Assistant Program:

https://www.rxhope.com…

** Information gathered by Heather Tran and Gladimir Elysee

A = absorption; M = metabolism; E = excretion

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: August 2, 2017

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diuretics ID - 547040 A1 - Dalpoas,Stacy,PharmD, BCPS AU - Samal,Lipika,M.D. AU - Pham,Paul,Pharm.D. Y1 - 2017/08/02/ PB - Johns Hopkins Diabetes Guide UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547040/all/Diuretics ER -