Diuretics is a topic covered in the Johns Hopkins Diabetes Guide.

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INDICATIONS

FDA

Diuretic Class Review

Thiazide Diuretics

FDA indication


Pharmacokinetics

Pregnancy Risk Category/ 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

Category B

Enters breast milk/use caution

Generic available.

12.5 mg (30 cap): $36.71

25mg (100 tab): $12.99

50mg (100 tab): $15.99

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.

Category C, but most experts do not recommend.

Enters breast milk / use caution

Generic tablets available. Oral suspension still brand.

250 mg (30 tab): $12.99

500 mg (30 tab): $13.99

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

Category B

Enters breast milk/ not recommended.

Generic available

2.5 mg (30 tab): $42.99

5 mg (30 tab): $37.37

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.

Category C (teratogenic in animal studies)

Enters breast milk

Generic available

25 mg (30 tabs): $15.99

50 mg (30 tabs): $21.99

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

Category C

No data available in breast-feeding

No generic available.

Brand: Dyrenium®

50 mg (30 caps): $44.09

100 mg (30 caps): $67.24

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

Category C

Enters breast-milk/use caution

Generic available, in both tablet and solution form.

10 mg/mL (60 mL): $17.99

10 mg/mL (120 mL): $15.98

20 mg (100 tabs): $13.99

40 mg (100 tabs): $13.99

80 mg (30 tabs): $12.99

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% absorbed

M: partially hepatic

E: urine

t½: 1-1.5 hrs

Category C (per manufacturer); D (per expert analysis)

Excretion in breast milk unknown; use caution

Generic available

0.5 mg (90 tabs): $17.00

1 mg (90 tabs): $28.97

2 mg (30 tabs): $20.99

2 mg (100 tabs): $82.39

**Patient Assistant Program:

https://www.rxhope.com…

** Information gathered by Heather Tran and Gladimir Elysee

A = absorption; M = metabolism; E = excretion

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Last updated: September 26, 2013