Τόμος 3 (1985) – Τεύχος 4 – Άρθρο 5 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 3 (1985) – Issue 4 – Article 5 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

Diuretics: Adverse Reactions and interactions

STAVROS T. PLESSAS

^{Τμήμα Επιστημονικής Πληροφόρησης}

3: 203-218 (1985)

PHARMAKON-Press: Epitheorese Klin. Farmakol. Farmakokinet.

3: 203-218 (1985)

Diuretics, Adverse Reactions, Interactions

Diuretics are one of the most widely used groups of drugs, with an incre­asing number of available agents each year. Serious side effects from diuretics are uncom­mon; these drugs have established a remarkab­ly good safety record. The major clinical pro­blems with diuretics include: (1) intravascular volume depletion and dehydration, (2) hypo­natraemia, (3) idiopathic cyclic oedema, (4) hy­pokalaemia that seldom is a problem in pa­tients with uncomplicated hypertension (pro­phylaxis not required), and frequently occurs with high dose of diuretics (prophylaxis requir­ed), (5) hyperkalemia, a potentially fatal condi­tion that follows excessive use of either distal tubule potassium-conserving agents or potas­sium supplements (N.B. avoid the use of these medication in combination and in renal fai­lure), (6) alkalosis, (7) hypercalcaemia (rarely symptomatic), (8) impaired carbohydrate intole­rance (diuretics rarely produce frank diabetes, but glucose tolerance is often worsened in diabetics and prediabetics), (9) hyperuricemia (acute gout may necessitate withdrawal of the medication), (10) lipid changes: significant in­creases in serum triglycerides and LDL-chole­sterol and a decrease or no change in HDL­ cholesterol (elevated serum cholesterol concen­tration is not a risk during long term treatment because the almost unanimous experience has been that elevation is not persistent after 6 or 12 months of treatment), (11) hypersensitivity reactions (uncommon). Other side effects re­ported (fortunately rare): bone marrow depres­sion (also in utero), haemolytic anaemia, skin rashes and photosensitivity, vasculitis, nausea, vomiting and diarrhea, small bowel ulceration, acute haemorrhagic pancreatitis, and acute li­ver, renal and respiratory failure. Spironolactone has been known to produce Raynaud’s phenomenon, gynaecomastia, impotence, ame­norrhoea, menorrhagia, muscle cramps, parae­sthesia and alopecia. The most clinically im­portant pharmacodynamic and pharmacokinetic interactions with diuretics include: (1) diuretics reduce renal lithium excretion, (2) diuretic-in­duced hypokalemia potentiates digoxin action and increases toxicity, (3) loop diuretics in large doses or in renal failure increase the risk of nephrotoxicity and ototoxicity from many anti­biotics (e.g. gentamicin, cephalothin, methicillin); (4) thiazides can antagonise the action of oral hypoglycaemic agents (sulphonylureas) and alter renal excretion of uricosuric drugs (e.g. probenecid); (5) furosemide may antagonise the action of indomethacin (and vice versa); (6) spi­ronolactone blocks the ulcer-healing properties of carbenoxolone.

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