Johns Hopkins Diabetes Guide
Diuretics
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INDICATIONS
FDA
- Hypertension
- Congestive heart failure
- See Table Diuretic Class Review for diuretic specific FDA indications
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% | Rating B | Generic available. |
Chlorothiazide | Management of mild to moderate HTN; adjunct treatment for edema | A: poor. | Rating C, but most experts do not recommend as it crosses placenta | Generic tablets available. Oral suspension still brand. 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% | Rating B | Generic available 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% | Rating C (teratogenic in animal studies) | Generic available |
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 | Rating C | No generic available. |
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 | Pregnancy rating C, crosses placenta but has been used to treat heart failure in pregnancy | 10 mg/mL (60 mL): $10.40 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 | Pregnancy Rating C | 0.5 mg: $0.99 |
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/PAP/pdf/rx_outreach_0209.pdf ** Information gathered by Heather Tran and Gladimir Elysee | ||||
A = absorption; M = metabolism; E = excretion
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INDICATIONS
FDA
- Hypertension
- Congestive heart failure
- See Table Diuretic Class Review for diuretic specific FDA indications
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% | Rating B | Generic available. |
Chlorothiazide | Management of mild to moderate HTN; adjunct treatment for edema | A: poor. | Rating C, but most experts do not recommend as it crosses placenta | Generic tablets available. Oral suspension still brand. 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% | Rating B | Generic available 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% | Rating C (teratogenic in animal studies) | Generic available |
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 | Rating C | No generic available. |
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 | Pregnancy rating C, crosses placenta but has been used to treat heart failure in pregnancy | 10 mg/mL (60 mL): $10.40 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 | Pregnancy Rating C | 0.5 mg: $0.99 |
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/PAP/pdf/rx_outreach_0209.pdf ** Information gathered by Heather Tran and Gladimir Elysee | ||||
A = absorption; M = metabolism; E = excretion
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