This document summarizes diuretic drugs. It discusses how diuretics work by increasing urine output through inhibiting sodium reabsorption in the kidneys. The main types of diuretics covered are loop diuretics, thiazide diuretics, and osmotic diuretics. Specific diuretic drugs discussed include furosemide, hydrochlorothiazide, and mannitol. The document also reviews the mechanisms and side effects of different classes of diuretic medications.

1. DIURETIC DRUGS
Clarise Elefante
Shirley Garay
Daniel Alexei Garcia

2. Diuretic Drugs
• Medications that augments “Diuresis”
• Commonly known as Water Pills
• Homeopathic remedies or foods that
help to prevent or treat fluid retention
• Used to treat heart failure, liver
cirrhosis, hypertension and
certain kidney diseases.

3. Diuresis
• Process involved in the
administration of the drugs
• Condition in which body
loses water through excess
urination
• Leads advantage and
disadvantage of taking
diuretic drugs.

4. Why the need to lose fluids?
• Failure to excrete excess fluid from the body.
• If there are renal, cardiovascular, or
metabolic disorders
• Congestive Heart Failure Patients- reduction
of fluid in blood, reduces pressure on the
heart, so that its efficiency of pumping blood
is increased.

5. Why the need to lose fluids?
• Hypertensive Patients- the loss of sodium,
chlorine and water which helps in lowering of
blood pressure.
• To ease the discomfort of patients suffering
from edema
• Get rid of the body’s excess salts
• May reduce blood volume.

6. Side Effects
• Frequent urination • Blurred vision
• Dehydration • Unusual bleeding or
• Severe potassium bruising
deficiencies • Loss of appetite
• Electrolyte imbalance • Weight loss
• Extreme weakness • May induce breast
• Fatigue enlargement in men
(Pot. Sparing Diuretics)

7. Mechanism of action
• Most diuretics produce diuresis by
inhibiting the reabsorption of sodium at
different segments of the renal tubular
system
• This is accomplished by altering how the
kidney handles sodium.
• If the kidney excretes more sodium, then
water excretion will also increase

8. • passes into glomerular capillaries
located within the cortex (outer zone
of the kidney)
• 20% of the plasma that enters the
glomerular capillaries is filtered
• 65-70% of the filtered sodium is
removed from the urine found within
the proximal convoluting tubule (PCT)
• thick ascending limb has a cotransport
system that reabsorbs sodium,
potassium and chloride at a ratio of
1:1:2
• more sodium is reabsorbed and more
potassium and hydrogen ion are
excreted
• water is reabsorbed in the collected
duct through special pores
• sodium originally filtered is reabsorbed
by the kidney, so that less than 1% of
originally filtered sodium remains in
the final urine.

9. Types of Diuretic Drugs
Osmotic Diuretics
Carbonic Anhydrse Inhibitor
Benzothiazide
Loop Diuretics
Potassium Sparing Diuretics

10. Osmotic Diuretics
• Helps to prevent the reabsorption of
water and sodium in the body
• Increase the amount of blood
flowing into the kidneys
• Prevent the urine to get
concentrated
• Used during heart problems

11. Mannitol
(2R,3R,4R,5R)
-Hexan-
1,2,3,4,5,6-
hexol

12. • used to treat patients with oliguric renal
failure
• increases water and sodium excretion,
thereby decreasing extracellular fluid volume
• used clinically in osmotherapy to reduce
acutely raised intracranial pressure
• first drug of choice for the treatment of
acute glaucoma in veterinary medicine

13. BRAND NAMES MANUFACTURER
Osmitrol Baxter
Resectisol B. Braun
Aridol Pharmaxis

14. Ammonium Chloride
- used as a mild diuretic,
an expectorant, a weight-
reducing agent and a
urine acidifying Azanium chloride
agent.
- combination: used to
control a cough
associated with a cold or
other respiratory illnesses

15. Brand Name Manufacturer
Summer’s Eve Feminine Blooming Fields
Powder, Feminine Wash,
Feminine Bath and
Feminine Cleansing Cloth

16. Carbonic Anhydrase Inhibitor
• decrease bicarbonate (HCO3-) reabsorption in
the proximal tubule by decreasing the amount
of H+ secreted into the lumen.
• inhibitors are established as hypotensive
agents, diuretics and antiepileptics, with
additional use in the management of gastric
and duodenal ulcers, neurological disorders
and osteoporosis.

17. Acetazolamide
N-(5-Sulfamoyl-1,3,4-
thiadiazol-2-yl)-acetamide

18. • used to treat glaucoma
• used with other medicines to reduce edema (excess
water retention) and to help control seizures in
certain types of epilepsy
• also used to reduce the severity and duration of
symptoms
Brand names Manufacturer
Cetamid Sea Pharmacom
Zolmide Vista Pharma (Dist.)

19. Benzothiazide
• Frequently are first line drugs for treating mild to
moderate hypertension
• Mainly inhibit reabsorption of Na+ and Cl- via action at
the Na+-Cl- symporter
• Used extensively to treat edema associated with
congestive heart failure (CHF) and cirrhosis of the liver.
• Very often combined with other antihypertensive
agents
• Usually given orally
• Most thiazides are excreted unchanged.

20. Benzothiazide
5 4
6 3
7 2
1
8

21. Structure Activity Relationship
• C-7 MUST have an unsubstituted sulfonamide and it must be
directly attached to the aromatic ring
• N-2 can be substituted with a small alkyl group
• C-6 electron withdrawing group here increases activity
electron donating groups at C-6 will cause a decrease in
activity (Most clinically-used thiazides have a Cl at C-6 and a
few have a CF3
• 3,4-dihydro derivatives (hydrothiazides) this reduction usually
results in a ~10x increase in potency compared to the oxidized
thiazide ring
• The lipophilicity of the C-3 substituent governs potency and
duration

22. Hydrochlorothiazide
6-chloro-1,1-dioxo-3,4-dihydro-
2H-1,2,4-benzothiadiazine-7-
sulfonamide

23. • used to treat high blood pressure
• can lessen symptoms such as shortness of breath or swelling in
your ankles and feet.
• Weakness, dizziness, or a spinning sensation
• Increased blood sugar (hyperglycemia)
Brand Names Manufacturer
Blopress Plus Zuellig
CoAprovel Metro Drug
Combizar United Lab
Hytaz United Lab
Hytzaar Zuellig
Micardis Plus Metro Drug
Pritor Plus Zuellig

24. Chlorothiazide
6-chloro-2 H-1,2,4-
benzothiadiazine-7-sulfonamide 1,1-
dioxide

25. • used to treat fluid retention (edema) that is caused by
congestive heart failure, severe liver disease (cirrhosis),
kidney disease, or from treatment with a steroid or hormone
medicine.
• also used alone or together with other medicines to treat
high blood pressure (hypertension)
Brand Names Manufacturer
Diuril Lundbeck Inc.

26. LOOP DIURETICS
A T Y P E O F
D I U R E T I C T H AT A C T S
IN THE LOOP OF
HENLE.
M O S T L Y U S E D F O R
HYPERTENSION AND
EDEMA.
M A I N F U N C T I O N S :
INHIBITION OF NKCC2
AND NKCC1

27. Loop
I. Anthranilic Acid derivative with Sulfanilamide
Substance
- Furosemide
- Bumetanide
II. Potassium Sparing Diuretics
- Ethacrynic Acid

28. Loop Diuretics
• Adverse Effect:
• Hypokalemia
• Metabolic alkalosis
• Hypomagnesemia
• Hyperuricemia
• Dehydration (hypovolemia), leading to hypotension
• Dose-related hearing loss (ototoxicity)
• Drug Interaction Effects:
• Hypokalemia potentiates digitalis toxicity
• Non-steroidal Anti-inflammatory Drugs: reduced diuretic efficacy
• Corticosteroids: Enhance Hypokalemia
• Aminoglycosides: enhance ototoxicity, nephrotoxicity

29. FUROSEMIDE
 Also known as frusemide
 Most popular brand is Lasix® by Sanofi-Aventis
 Banned by the World’s Anti-doping Agency in sports
due to being a masking agent.
 It has also been used to
prevent Thoroughbred and Standard bred race horses
from bleeding through the nose during races.

30. MECHANISM OF ACTION
• It acts by inhibiting NKCC2,
the luminal Na-K-2Cl
symporter in the thick
ascending limb of the loop of
Henle

31. USES:
For the treatment of:
• Edema associated with heart failure,
hepatic cirrhosis, renal impairment, nephrotic syndrome
• Hypertension
• Adjunct in cerebral/pulmonary edema where
rapid diuresis is required (IV injection)
ADVERSE EFFECTS:
• Ototoxicity
• Gout
• Hypokalemia
• In large amounts, dehydration
• Sulfa allergy

32. 4-chloro-2-(furan-2-ylmethylamino)- 5-sulfamoylbenzoic
acid

33. BRAND NAME MANUFACTURER
Diumide-K Pascual/Zuellig
Diuspec Hizon
Edemann Littman
Flexamide Doctors
Fremid Euro-Med
Fretic Vendiz
Frusema LR Imperial
Furide Duopharma (M) Sdn Bd
Furolink Tai Yu
Furoscan Tai Yu
Fusimex SM Pharma
Lasix Sanofi-Aventis
Phil Pharmawealth/Atlantic Furosemide Atlantic Lab
Phil Pharmawealth/Kamataka Furosemide Kamataka
Pisamor Flamingo
Rasitol Yung Shin
Rofunil Rotexmedica

34. BUMETANIDE
• Known under the brand name Burinex™ by LEO
Pharma/Zuellig
• 40 times more potent than furosemide
• Once used as a weight loss agent.

35. MECHANISM OF ACTION
In the brain, bumetanide blocks
the NKCC1 cation-chloride co-
transporter

36. OTHER USES:
Possible anti-epileptic
ADVERSE EFFECTS:
• In large amounts, dehydration
• Dizziness
• Sulfa allergies

37. MECHANISM OF ACTION
It acts by inhibiting NKCC2, the luminal Na-K-
2Cl symporter in the thick ascending limb of
the loop of Henle

38. 3-butylamino-4-phenoxy-5-sulfamoyl-benzoic acid

39. ETHACRYNIC ACID
• - Etacrynic acid is a phenoxyacetic acid derivative
containing a ketone and a methylene group
• - Known under the tradename Edecrin™
• - Not a sulfonamide

40. USES:
For the treatment of:
• Edema associated with heart failure, hepatic cirrhosis, renal
• impairment, nephrotic syndrome
• Hypertension
• Potent inhibitors of glutathione S-transferase family members
ADVERSE EFFECTS:
• Ototoxicity
• Hypokalemia
• In large amounts, dehydration
• Diarrhea
• In high doses, causes intestinal bleeding

41. [2,3-dichloro-4-(2-
methylenebutanoyl)phenoxy]acetic acid