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 --



Diuretic Class Review

Thiazide Diuretics

FDA indication


Pregnancy Risk Category/ Breastfeeding Risk

Cost and Formulation


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


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


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


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


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


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


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:


** 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: September 26, 2013