Review of the best potassium-sparing diuretics of the latest generation, mechanism of action of the drugs, indications for use and side effects

Diuretics

Diuretics or diuretics are medications that increase the rate of blood filtration by the kidneys, thereby removing excess fluid, lowering blood pressure, and accelerating the removal of toxic substances from the body . Depending on the localization of action, the following types of diuretics are distinguished: extrarenal and renal (loop, acting on the proximal or distal tubules of the nephron).

After taking diuretics in the body, blood pressure decreases, the absorption of water and electrolytes in the renal tubules decreases, and the rate of urine excretion from the body increases. Under the influence of drugs in the blood, the concentration of potassium and sodium decreases, which can negatively affect the patient’s well-being: convulsions, tachycardia, loss of consciousness, etc. often develop, so you should strictly adhere to the regimen and dosage of the medication.

Thiazide diuretics list of drugs

List of drugs in Europe

The following drugs are common in Europe:

• Generic Lozol
• Thalitone generic: chlorthalidone
• Zaroxolyn generic: metolazone
• Aquatensen generic: methyclothiazide
• Aquazide H generic: hydrochlorothiazide
• Diuril generic: chlorothiazide
• Diuril Sodium generic: chlorothiazide
• Enduron generic: methyclothiazide
• Esidrix generic: hydrochlorothiazide
• Microzide generic: hydrochlorothiazide
• Mykrox generic: metolazone
• Naturetin generic: bendroflumethiazide
• Saluron generic: hydroflumethiazide
• Renese generic: polythiazide

According to some data, the following drugs are also actively used abroad:

• metolazone,
• hydroflumthiazide,
• chlorothiazide,
• benzthiazide,
• polythiazide,
• methyclothiazide,
• bendroflumethiazide,
• trichlormethiazide,
• quinetasone,
• thienylic acid, etc.

List of drugs in Russia and Belarus

List of drugs with the active ingredient indapamide (Indapamidum) :

• Acripamide
• Acripamide retard
• Akuter-Sanovel
• Arindap
• Arifon
• Arifon retard
• Vero-Indapamide
• Indapamide
• Indapamide Long Richter
• Indapamide MV Stada
• Indapamide retard
• Indapamide retard-OBL
• Indapamide retard-Teva
• Indapamide Sandoz
• Indapamide-OBL
• Indapamide-Verte
• Indapamide-Teva
• Indapres
• Indapsan
• Indap
• Indipam
• Indiur
• Inspra
• Ionic
• Ionic retard
• Ipres long
• Lorvas
• Lorvas SR
• Pamid
• RavelSR
• Retapres
• SR-Indamed
• Tenzar

List of drugs with the active substance hydrochlorothiazide (Hydrochlorothiazidum) :

• Hydrochlorothiazide
• Hydrochlorothiazide
• Hydrochlorothiazide-SAR
• Hypothiazide

Due to the fact that these drugs are widely used to treat hypertension, this list is far from complete, but contains the main trade names of these compounds.

Classification of diuretics

Each representative of diuretics has its own characteristics of action, contraindications and side effects. The use of potent compounds provokes active removal of important electrolytes, rapid dehydration, headaches, and hypotension. Urinary agents are classified according to the mechanism and localization of action:

1. Loopbacks.
2. Thiazide and thiazide-like.
3. Carbonic anhydrase inhibitors.
4. Potassium-sparing (aldosterone antagonists and non-adolsterone).
5. Osmodiuretics.

Loop

The mechanism of action of loop diuretics is due to relaxation of vascular muscles, acceleration of blood flow in the kidneys by increasing the synthesis of prostaglandins in endothelial cells. Loop diuretics begin to act after approximately 20-30 minutes when administered orally and after 3-5 minutes when administered parenterally. This property allows the use of drugs of this group in life-threatening conditions. Loop diuretics include:

• Furosemide;
• Ethacrynic acid;
• Britomar.

Thiazide

Thiazide diuretics are considered to have a moderate effect, their effect occurs in approximately 1-3 hours and lasts throughout the day. The mechanism of action of such medications is aimed at the nearby nephron tubules, due to which chlorine and sodium are reabsorbed. In addition, thiazide drugs increase potassium excretion and retain uric acid . The side effects that are observed as a result of taking these drugs are expressed by metabolic disorders and osmotic pressure.

Thiazide drugs are prescribed to eliminate edema with high blood pressure and heart failure. The use of diuretics for joint diseases, pregnancy, and breastfeeding is not recommended. Thiazide medications include:

• Diuril;
• Dichlorothiazide;
• Chlorthalidone.

Potassium-sparing

This type of diuretic drugs reduces systolic blood pressure, reduces tissue swelling, and increases the concentration of potassium in the blood. The diuretic effect of potassium-sparing medications is weak , since little sodium is reabsorbed in the distal nephron of the kidney. Medicines in this group are divided into sodium channel blockers and aldosterone antagonists. Indications for the use of potassium-sparing drugs are:

• tumor of the adrenal cortex;
• arterial hypertension;
• potassium deficiency;
• poisoning with lithium drugs;
• the need to normalize eye pressure in glaucoma;
• increased intracranial pressure;
• diastolic and systolic heart failure.

Contraindications to the use of potassium-sparing agents include Addison's disease, hyponatremia, hyperkalemia, and menstrual irregularities. With long-term use of this group of drugs, the development of hyperkalemia, diseases of the gastrointestinal tract, paralysis, and disturbances in skeletal muscle tone is possible. Among the most popular potassium-sparing products are:

• Veroshpiron;
• Triamterene;
• Amiloride;
• diazide;
• Moduretic.

Mechanism of action

The latest generation of potassium-sparing diuretics are of the following types:

• aldosterone antagonists;
• sodium channel inhibitors.

These medications have the following mechanism of action:

• They act in the distal tubules, in which Na+ and K+ exchange occurs. Here the process of filtration and reabsorption occurs, during which the most important substances from primary urine are returned back into the bloodstream.
• Sodium channel inhibitors selectively change the permeability of the epithelium that covers the distal tubules, as a result, the level of Na + ions decreases, and they accumulate in the lumen of the tubules, which causes an increase in diuresis. They are recommended when aldosterone levels in the body are normal.
• Aldosterone receptor antagonists have the same structure as steroid hormones, so they can bind to them and suppress the function of mineralocorticoids. As a result, aldosterone cannot retain sodium in the body and excrete potassium in the urine. Due to treatment with drugs of this group, sodium and water are removed from the body through the kidneys, and potassium is retained.
• Daily diuresis increases due to the fact that sodium attracts fluid and removes it from the body.
• Diuretics do not allow Na+ ions to be absorbed back into the bloodstream, but make sure that they migrate into the tubule, and K+ ions, on the contrary, do not accumulate here and are not excreted from the body, which helps prevent hypokalemia.

Herbal diuretics

To reduce swelling, which is not a consequence of chronic diseases, but is caused by excessive consumption of salty foods, it is recommended to use natural diuretics. Such means have a number of advantages:

• have a noticeable diuretic effect;
• suitable for long-term use;
• do not cause renal or extrarenal side effects;
• suitable for use by children and pregnant women;
• combine well with other medications.

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Some drugs related to diuretics are of natural origin. Herbal diuretics include many herbs, as well as some fruits and vegetables. Here are some examples of such natural remedies:

• strawberries;
• yarrow herb;
• chicory root;
• birch leaves, buds;
• lingonberry leaves;
• rose hip;
• watermelons;
• cucumbers

Scientific review[edit | edit code]

Herbal diuretics are promoted as natural weight loss supplements. There is currently some evidence that the use of medicinal herbs such as taraxacum officinale, verbena officinalis, lithospermum officinale, equisetum arvense, arctostaphylos uva-ursi, arctium lappa and silene saxifrage promote diuresis in animals.[1][2] In 2001, the American College of Sports Medicine published 2 studies that compared the effect of taking herbal diuretics and specialized medications. It was found that taking medicinal herbs promotes tissue dehydration (by about 0.3% per day), but at the same time, their effectiveness is not comparable to traditional drugs (about 3.1% per day). Thus, the potential value of herbal diuretics for weight loss is limited. New research is required to draw definitive conclusions.

Indications for the use of diuretics

Diuretic pharmacological agents are prescribed for pathologies that are accompanied by fluid retention, a strong increase in blood pressure, and intoxication . These conditions include:

• chronic renal failure;
• heart failure;
• hypertensive crises;
• glaucoma;
• liver dysfunction;
• excess synthesis of aldosterone.

For hypertension

Arterial hypertension uncomplicated by renal failure can be treated with diuretics . The drugs reduce the volume of circulating blood and systolic output, due to which the pressure decreases gradually. Long-term therapy leads to a decrease in the diuretic effect and stabilization of blood pressure using its own compensatory mechanisms (increased levels of the hormones aldosterone and renin). For arterial hypertension the following is prescribed:

1. Hydrochlorothiazide. The active substance is hydrochlorothiazide. The drug belongs to the group of thiazide diuretics of medium strength. Depending on the clinical picture, 25-150 mg per day is prescribed. The effect of Hydrochlorothiazide occurs within an hour and lasts approximately a day. The medicine is suitable for long-term use and prevention of hypertensive crises.
2. Chlorthalidone. A drug of the thiazine-like group, the active ingredient is chlorthalidone. Chlorthalidone begins to act 40 minutes after oral administration, the duration of the effect is 2-3 days. Prescribe the drug 25-100 mg in the morning, before meals. The disadvantage of chlorthalidone is the frequent development of hypokalemia.
3. Indapamide. This diuretic is a thiazide-like diuretic and increases the excretion of sodium, potassium, and chlorine. The effect of the drug occurs after 1-2 hours and continues throughout the day.

In case of intoxication

In case of severe poisoning, they resort to forced diuresis using diuretics to remove toxins and poisons from the blood. Diuretics are used for intoxication with water-soluble substances, which include:

• alcohol;
• salts of heavy metals;
• narcotic substances;
• inhibitory substances;
• potent medications (barbiturates).

Forced diuresis is performed in a hospital setting. In this case, hydration and dehydration are performed simultaneously with minimal changes in the composition and quantity of blood. Diuretics help to achieve an increase in the filtration capacity of the nephrons for the rapid, effective removal of toxic substances. To perform forced diuresis use:

1. Furosemide. The medicine has a rapid but short-lived diuretic effect. For forced diuresis, a 1% solution is prescribed in an amount of 8-20 ml parenterally. The effect of the drug begins after 5-7 minutes and lasts 6-8 hours.
2. Ethacrynic acid. It has slightly less activity than Furosemide. In case of intoxication, parenteral administration of 20-30 ml of solution is indicated. The action of ethacrynic acid begins after 30 minutes and lasts 6-8 hours.

For diseases of the cardiovascular system

Diuretics are prescribed for chronic heart failure to eliminate edema . As a rule, minimum dosages of drugs are indicated. It is recommended to start treatment of heart failure with thiazide or thiazide-like diuretics:

1. Clopamid. The drug has a pronounced natriuretic effect. For heart disease, a dosage of 10-40 mg is indicated daily in the morning before meals. Clopamide begins to act after 1-2 hours, the duration of the effect lasts for a day.
2. Diuver. Loop diuretic, active ingredient - torasemide. The medication inhibits the reabsorption of sodium and water ions. The effect of the drug reaches its maximum 2-3 hours after oral administration, the diuretic effect persists for 18-20 hours.

For kidney diseases

Kidney pathologies lead to insufficient blood filtration, accumulation of metabolic products and toxins. Diuretics help compensate for the insufficient filtering capacity of the nephron. Indications for the use of diuretics are renal failure, chronic infectious lesions in the acute stage, and urolithiasis . As a rule, in these cases they use:

1. Mannitol. Osmodiuretic, increases filtration and osmotic pressure of plasma. The drug has a moderate natriuretic effect. The diuretic effect begins in the first minutes after parenteral administration (about 5-10 ml of a 15% solution) and lasts 36-40 hours. The medication is used for forced diuresis in glaucoma or cerebral edema.
2. Oxodollin. The main active ingredient is chlortolidone. Oxodolline inhibits sodium reabsorption. The action begins 2-4 hours after ingestion and lasts 26-30 hours. The dosage for kidney diseases is 0.025 g once a day.

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For swelling

Swelling often occurs without the presence of a disease and is a consequence of excessive consumption of salt, sweets, and alcoholic beverages. To eliminate this unpleasant symptom, diuretics are indicated:

1. Amiloride. A medication from the group of potassium-sparing diuretics. Amiloride begins to act 2 hours after oral administration, the effect lasts for 24 hours. The approximate single dosage is 30-40 mg.
2. Diacarb. The active ingredient is acetazolamide. Diacarb has a weak but long-lasting effect. After oral administration (250-500 mg), the effect occurs after 60-90 minutes and lasts up to 2-3 days.

For weight loss

Diuretics will help reduce body weight by 1-3 kg in a few days, but will not affect the fat content in the body. When you stop using diuretic drugs, the weight will return, so it is not recommended to use such drugs for weight loss for more than 2-3 days. Long-term use of diuretics to reduce body weight can lead to impaired kidney function, including kidney failure. The following medications are suitable for short-term weight loss:

1. Lasix. The active component of the drug is furosimide. Lasix has a rapid diuretic effect and inhibits the reabsorption of sodium, chlorine and potassium. The recommended single dosage is 40-50 mg. The action of Lasix begins 30-40 minutes after ingestion and lasts 6-8 hours.
2. Uregit. A fast-acting diuretic, it contains ethacrynic acid, which slows down sodium transport. the effect occurs 30 minutes after ingestion and lasts for 10-12 hours. A single dosage is 25-50 mg.

List of the most common diuretic herbs

A natural diuretic helps not only get rid of excess fluid, but also eliminate tissue swelling. In addition, it is effective in the treatment of hypertension and kidney pathologies due to its versatile effects.

Strong diuretic plants and herbs can cope with swelling, but it is important to pay attention to contraindications and possible adverse reactions.

In addition, you should understand which herbs have a diuretic effect and are diuretics, and whether treatment with them is allowed for a specific type of disease.

People whose use of diuretic plants is accompanied by a deterioration in their general health should stop treatment and seek advice from a specialist.

Hawthorn, for example, is not a very strong diuretic herb, but with its help you can strengthen the myocardium and blood vessels.

The list of plants that eliminate swelling is quite extensive, so it is important to choose the most effective and safe remedy. It is necessary to know their properties in cooking for preparing side dishes and desserts.

Chamomile

Chamomile is considered a healing diuretic of plant origin, which is often used in the treatment of various inflammatory processes. The herb is effective in the treatment of skin lesions, nervous disorders, ulcers and colds.

It is possible to cope with swelling of the extremities using diuretic tea prepared according to the following recipe:

• Brew 10 grams of crushed plant flowers in 200 ml of boiling water;
• Carefully cover the resulting mixture with a lid and filter after 10 minutes.

To improve the taste, you can add a little honey to the prepared tea. Diuretic herb for severe edema helps not only to remove excess fluid, but also to improve the general condition of the body.

Rose hip

A plant such as rose hips is a crop with a gentle diuretic effect. The fruits serve as a remedy with a general strengthening effect, which is endowed with immunomodulatory and mild hypotensive effects.

Natural diuretic medicines (such as tea and rosehip decoction) are recommended to be drunk by those people who suffer from pathologies of the heart and kidneys.

To prepare the infusion, you need to brew 2-3 tablespoons of rose hips with 540 ml of boiling water (it is best to do this in a thermos). This way you will preserve all the valuable properties of the plant and achieve a more pronounced diuretic effect.

Diuretic infusions and herbal remedies from rose hips should be used several times throughout the day.

Bearberry

A diuretic herb for severe edema is bearberry, which can be used alone or in combination with other plants.

Bearberry is endowed with a powerful diuretic and antiseptic effect, and also accelerates the healing process of the inflamed mucous membrane of the urinary system.

To prepare herbal diuretic infusions based on herbs you need:

• mix blue cornflower flowers, bearberry leaves and chopped licorice root in a 1:1 ratio;
• Pour a tablespoon of the vegetable mixture into a glass of water, boil the contents and keep on fire for no more than 15 minutes.
• Cool the prepared product and filter;
• Take small portions throughout the day.

To prepare bearberry tea, you need to brew 10 grams of the plant in a glass of hot water and drink this drink 2 times a day.

Herbal diuretics from the bearberry herb are considered effective diuretics and help speed up the removal of fluid from the body and get rid of swelling.

Nettle

Young nettle leaves contain a large amount of vitamin C, and the plant itself has a pronounced diuretic effect.

Products prepared from such a plant are considered relatively harmless and are approved for use in pediatrics.

Diuretics and herbal remedies are recommended for edema caused by infections in the blood vessels, heart and kidneys.

The plant has a mild diuretic effect, so it is included in various herbal preparations.

To obtain a product with a diuretic effect you must:

1. Grind 50 grams of nettles, birch leaves, sloe berries and elderflowers in a blender.
2. Pour 200 ml of hot water into a tablespoon of the resulting mixture.
3. Leave the solution for 10 minutes, then filter and take in the morning after meals.

Milk thistle

The herb milk thistle is considered a mild diuretic, but with too short an effect. It is recommended to drink decoctions based on the plant in small dosages every hour at the very beginning of treatment.

Milk thistle is considered an antispasmodic plant with antioxidant and anti-inflammatory effects. Due to these properties, the herb is often used in the treatment of pathologies of the urinary system and stones.

A diuretic against edema at home can be prepared according to the following scheme:

1. Pour 30 grams of dry seeds into 500 ml of water and simmer over low heat until half of the liquid has evaporated.
2. You should drink a teaspoon of the diuretic herb for swelling every hour for several weeks.

Thyme

Natural diuretic herbs and remedies help quickly remove excess fluid from the body. Thyme can help solve this problem.

The culture is a diuretic, immunomodulator, sedative and analgesic. A herb with a diuretic effect is recommended for blood purification; in the treatment of pathologies of the kidneys and stomach; if there is atherosclerosis.

To prepare a diuretic herbal remedy with a diuretic effect based on thyme, you must:

1. Pour 15 g of dry plant into 1 liter of boiling water and leave for 15 minutes.
2. After a while, the infusion needs to be strained.
3. Drink 200 ml several times during the day.

Linden

Linden seeds, inflorescences, bark and wood have a diuretic effect. This plant contains flavonoids, talicin, carotene and tannins in sufficient quantities. Its decoction is rich in saponins, ascorbic acid and essential oils.

Linden tea is used as a diuretic for bladder damage, urolithiasis and gout.

To prepare a folk natural drink, you need to brew a tablespoon of plant material with a glass of boiling water, cool to room temperature and drink in one go.

Horsetail

Among the herbs that have a diuretic effect, preparations from horsetail stand out, so they are often prescribed for the treatment of diseases of the urinary system.

This natural diuretic can be used to treat elderly patients and children, since it contains a large amount of beneficial substances, acids and flavonoids.

To prepare the infusion, you need to grind 4 tablespoons of herbs and brew them with 500 ml of hot water. The resulting mass should be left for half an hour, then filtered and drunk throughout the day shortly before meals.

Flax seeds

Even our great-grandfathers preferred flax seeds to prepare a diuretic. A medicinal decoction prepared from them helps flush out kidney stones.

During therapy with flax seeds, too much fluid is lost, so it is recommended to consume at least 2 liters of water per day. It is especially important to follow this rule for those people who want to lose weight in this way.

To prepare a decoction of flax seeds, you need to pour a few tablespoons of the raw material into a glass of warm water, simmer the mixture over heat for no more than 3 minutes, remove and filter. The prepared decoction should be drunk in several doses before 16.00 hours.

Other diuretics

Particularly popular for diseases of the urinary system are herbal medicines that have a powerful diuretic effect.

Among all this variety, the following tablets and diuretics of herbal origin are considered the most effective:

1. Cyston. The drug has a powerful, versatile effect on the body. Taking the medication allows you to speed up the process of dissolution and removal of formed stones, prevent the accumulation of kidney stones, and also speed up the healing of hyperemic mucosa.
2. Flaronin. The basis of the medication is Astragalus sickle, which activates the kidneys, reduces the concentration of nitrogen-containing products in the blood and increases diuresis. The main contraindication to taking the drug is individual intolerance. The course of therapy is no more than a month.

It is possible to enhance the production of urine and its excretion with the help of certain foods. It is possible to achieve a diuretic effect by consuming the following vegetables and fruits:

• melon;
• watermelon;
• pumpkin;
• zucchini;
• cucumbers;
• grape;
• tomatoes.

Parsley is considered an excellent remedy for urethritis, on the basis of which various medicines are prepared.

It is necessary to thoroughly chop the greens and pour a glass of milk over it. The resulting mixture must be placed in the oven and simmered until the liquid has evaporated by half. After this, squeeze out the leaves. Drink 50 ml of warm milk every hour.

A mixture of cranberries and lingonberries is considered a diuretic and fortified product, which can be used in the treatment of cystitis at home.

To prepare the infusion, add a handful of lingonberries and cranberries to 3 cups of hot water and cook for no more than 10 minutes. The resulting decoction is kept for at least 3-4 hours, filtered and consumed throughout the day in several doses.

Birch sap is considered a simple and proven diuretic, which not only improves the functioning of the digestive system, but also stimulates metabolic processes.

In addition, birch sap helps protect the body from the toxic effects of substances and accelerates the breakdown of stones.

Drug interactions

Diuretic drugs are often prescribed as part of complex drug therapy simultaneously with other medications, so the interaction of diuretics with other drugs should be studied:

1. Diuretics that remove potassium should not be taken with digitalis derivatives, because this increases the risk of developing arrhythmia.
2. Potassium-sparing diuretics do not combine well with potassium preparations: this causes an excess of this ion, which provokes paresis, muscle weakness and respiratory failure.
3. Medicines that reduce blood glucose concentrations enhance the hyperglycemic effect of diuretics.
4. Antibacterial agents of the aminoglycoside and cephalosporin series in combination with loop diuretics can lead to the development of acute renal failure.
5. Nonsteroidal anti-inflammatory drugs and proton pump inhibitors reduce the diuretic effect of diuretics.
6. Benzothiadiazine derivatives in combination with diuretics can disrupt myocardial microcirculation and promote the development of blood clots.

Features of the use of diuretics during pregnancy and lactation

Swelling during pregnancy is a very common phenomenon. As a rule, they occur in the last months, when the uterus with its mass compresses the vena cava. Swelling in expectant mothers cannot be ignored, as this can be a serious signal of renal failure and the development of hystosis. If the diet does not help, you have to prescribe synthetic or natural diuretics.

Most diuretics are contraindicated for pregnant women, so they should never be taken unless prescribed. In the early stages, diuretics of almost all groups are prohibited. At later stages, the prescription of diuretics is done with great caution. By taking medications that remove fluid from the body, a pregnant woman puts herself and her baby at risk. An incorrectly selected diuretic or its dosage can lead to blood disorders, kidney problems, jaundice, hearing and vision impairment.

Traditional diuretics are also not harmless for a pregnant woman, so you need to be very careful with them. Chronic use of renal supplements can lead to electrolyte imbalance and directly affect subsequent pregnancy. Women should exclude parsley root, strawberries, and juniper fruits. The safest herbal diuretics include orthosiphon. Its use is also allowed during breastfeeding.

In cases where diuretics are indispensable, doctors may prescribe the combined drug Canephron in tablets (drops contain alcohol!). It can be taken at almost all stages of pregnancy. Another herbal medicine that can be taken is Phytolysin. It is prescribed in the absence of acute inflammation in the kidneys.

Doctors may prescribe Eufillin instead of diuretics. Despite the fact that this medicine is a brocholytic, it has a diuretic effect. When breastfeeding, before prescribing, the doctor must weigh the need for taking the medication and the possible risk. Eufillin is contraindicated in women with epileptic seizures, hypotension, and heart problems.

Side effects of diuretics

Diuretics, by removing electrolytes necessary for the body, cause some side effects . As a rule, these are the consequences of an imbalance in ionic equilibrium. These include:

• hypokalemia (low potassium levels);
• hypomagnesemia (decreased magnesium concentration);
• leaching of calcium from the body;
• arrhythmia;
• metabolic alkalosis;
• dehydration;
• irritability;
• darkening of the eyes;
• sleep disorders;
• loss of performance;
• tachycardia;
• dyspnea;
• hyponatremia (decreased amount of sodium).

Loop diuretics pose the greatest danger because they have a powerful and rapid effect. Even a slight deviation from the recommended dosage of these drugs can cause a number of unwanted side effects. Less dangerous diuretics are drugs from the thiazide group. They have a long-lasting but gentle effect without dramatically changing the composition of the blood, so they are suitable for long-term use.

Types of diuretics

For various pathologies, certain diuretic drugs are prescribed, which have different mechanisms of action.

Classification of diuretics:

1. Drugs affecting the function of the renal tubular epithelium: Hydrochlorothiazide, Cyclomethiazide, Bendroflumethioside, Methyclothiazide, Chlorthalidone, Metolazone, Clopamide, Indapamide, Flurosemide, Bumetamide, Torsemide, Ethacrynic acid, Amiloride, Triamterene.
2. Potassium-sparing drugs - Spironolactone (Veroshpiron). They are mineralocorticoid receptor antagonists.
3. Osmotic diuretics: Monitol.

Based on the leaching of sodium from the body, diuretics are divided into:

1. Highly effective, removing more than 15% sodium.
2. Moderate effectiveness, removing 10% sodium.
3. Ineffective, removing 5% sodium.

Contraindications

Due to the fact that diuretics have a general effect on the body, i.e. cause changes in the functioning of two or more organ systems; there are some restrictions on their use. Main contraindications for the use of diuretic drugs:

• liver failure;
• pregnancy;
• epilepsy attacks;
• lactation period;
• diabetes;
• hypovolemic syndrome;
• severe anemia;
• atrioventricular block;
• some severe congenital heart defects.

How to choose diuretics

Diuretics of plant, natural origin, infusions, and herbal decoctions are safe for independent use. If you need to use synthetic diuretics, you should consult a doctor who will determine which drug should be taken in your case, the duration of drug therapy and dosage. When selecting a diuretic for a patient, the doctor takes into account the following factors:

• the presence of chronic diseases of the cardiovascular system;
• the presence of endocrine diseases;
• patient's weight and age;
• the need for simultaneous use with other drugs;
• clinical picture of the current disease;
• allergic history.