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  • GLB.IRB.06.12.01 Thiazide/thiazide-like diuretics : They promote diuresis by inhibiting sodium and chloride ion reabsorption at the beginning of the distal convoluted tubule . This results in an increase in excretion of sodium and chloride ions, which in turn promotes water loss. A reduction in blood volume reduces cardiac preload, cardiac output and consequently blood pressure. 2. Loop diuretics : They act on the ascending limb of Henle’s loop , increasing the excretion of sodium, potassium, calcium and chloride ions. As a result, reabsorption of water from the collecting system is virtually abolished and large volumes of water are excreted. 3. Potassium-sparing diuretics : They inhibit the exchange of sodium for potassium ions in the distal convoluted tubule of the nephron. They bring about this effect in one of two ways: * triamterene/amiloride: decreases the permeability of the distal luminal membrane to sodium ions spironolactone (aldosterone antagonist): inhibits the effects of aldosterone on the kidneys. This leads to an increased excretion of sodium ions and water, but a decreased loss of potassium ions. References: Adapted from Oparil S and Weber MA. Hypertension.Elsevier/Sanders 2nd ed. 2005 L ip G and Bakris G. Handbook Hypertension Management. CMG 2006

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  • 1. The 3 Classes of Diuretics and Their Primary Sites of Action in the Nephron For Internal Use Only Adapted from: Oparil S and Weber MA. Hypertension.Elsevier/Sanders 2nd ed. 2005; L ip G and Bakris G. Handbook Hypertension Management. CMG 2006
  • 2. Thiazide Diuretics
    • Duration of action of 12–24 hours
    • Blood pressure lowering effect with low doses
    • Additive blood pressure lowering effect when used in combination with other antihypertensive drugs
    • Main side effects:
    • - hypokalemia
    • - hyponatremia
    • - hyperglycemia
    • - altered plasma lipid concentration
    • - hyperuricemia or gout
    • - impotence (reversible on withdrawal of treatment)
    Bendroflumethiazide 1.25-2.5 mg once daily Chlorthalidone 12.5-25 mg once daily Hydrochlorothiazide 12.5-25 mg once daily Indapamide 2.5 mg once daily or 1.5 mg of sustained release (SR) preparation For Internal Use Only Lip G and Bakris G. Handbook Hypertension Management. CMG 2006
  • 3. Loop Diuretics
    • Bumetanide 0.5 – 2 mg/d
    • Furosemide 20 – 80 mg/d
    • Torsemide 2.5 – 10 mg/d
    • Most commonly used for powerful diuresis (renal failure, severe heart failure with oedema)
    • Rapid onset of action:
    • - 1 hour after oral administration
    • - peak at 30 min after intravenous administration
    • Useful when blood pressure require extremely rapid lowering (brisk diuresis)
    • Main side effects:
    • Hypokalemia
    • hyponatremia
    Lip G and Bakris G. Handbook Hypertension Management. CMG 2006 For Internal Use Only
  • 4. Diuretics that Cause Potassium Retension
    • Triamterene 50 - 100 mg/d
    • Amiloride 5 – 10 mg/d
    • Spironolactone 25 – 100 mg/d
    • Weak diuretics
    • Little effect on blood pressure
    • Cause retention potassium
    • Combined to thiazide or loop diuretics to prevent or remedy hypokalemia
    • Main side effects:
    • - hyperkalemia
    • - hyponatremia
    • - rashes
    Lip G and Bakris G. Handbook Hypertension Management. CMG 2006 For Internal Use Only