Diuretics

Diuretics, also known as water pills, belong to a class of medications that remove excess salt and water from the body. They are often used to treat hypertension, or high blood pressure. High blood pressure can be a contributing factor in the development of various forms of heart disease.

When chosen as a treatment for hypertension, diuretics have proven to be effective in preventing heart attack and stroke in many individuals. Certain foods and herbs also possess diuretic effects, helping you to urinate more often to excrete excess fluids and sodium.

Pharmaceutical Diuretics

Prescription diuretic medications are grouped into three main types.

Thiazide

Thiazide diuretics help treat hypertension by causing the blood vessels to widen and the body to remove any extra fluid. Examples of thiazides include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide).

Loop Diuretics

Loop diuretics remove excess fluid by causing the kidneys to produce more urine. These include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).

Potassium-Sparing

Potassium-sparing diuretics encourage the body to get rid of fluids and sodium. However, they do this without causing a loss of potassium, which is a vital nutrient. Examples of potassium-sparing diuretics include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).

Each of the three types of diuretic medication increases the amount of sodium you excrete through urination, but they affect different areas of your kidneys. Your kidneys are the filters through which toxins and excess fluids are flushed from your body. When you take a diuretic medication, the drug signals to your kidneys that you need to get rid of more sodium. Water binds to the sodium and is then removed during urination, leaving you with a lower blood volume. The reduction in blood volume slows the rate at which blood flows through your blood vessels, helping to decrease your blood pressure.

Thiazide and loop diuretics may also cause you to lose potassium in addition to water and sodium. Potassium is an important mineral that maintains healthy fluid levels and regulates heart and muscle function. Your doctor may advise you to take a potassium supplement or to eat foods rich in the nutrient to combat low potassium levels. Potassium-rich foods include:

  • bananas
  • avocados
  • raisins
  • beans
  • dark leafy greens, such as kale and spinach
  • squash
  • mushrooms
  • potatoes
  • yogurt
  • fish

Potassium-sparing diuretics don’t pose as much as a threat to your potassium levels. However, they aren’t as effective in treating hypertension as the other types of diuretic medications, so they are often prescribed along with other drugs.

Thiazide diuretics are the primary treatment method for people who have hypertension-related heart disease. However, your doctor will tailor your drug regimen to your specific health concerns. Your specific medication may contain more than one type of diuretic agent in a single pill or dose.

Risks and Side Effects

Diuretics are generally safe for most people when taken as prescribed.

The most common side effect of diuretics is increased urination. Your potassium, glucose, and cholesterol levels may fluctuate depending on the type of diuretic you’re taking. Your doctor may run blood tests to measure your levels throughout treatment.

Other side effects may include:

  • headaches
  • dizziness or lightheadedness
  • difficulty sleeping
  • muscle weakness or cramping
  • increased thirst
  • irregular menstruation
  • impotence, or difficulty achieving and maintaining an erection
  • gout, or conditions that cause swelling and pain in the joints of the foot

Side effects are likely to decrease over time. Make sure to notify your doctor if you experience uncomfortable or prolonged side effects while taking a diuretic. Your doctor may adjust your dosage or switch you to a different type of diuretic medication.

Natural Diuretics

Certain foods and herbal supplements can have a diuretic effect on your body, increasing your urine output. Examples of natural diuretics include:

Ginger Root

When brewed into a tea or used as a spice in cooking, it can stimulate the body to remove surplus salt and water. Ginger root can also ease stomach upset.

Celery

With its high water content, celery can help increase urine production and aid in the removal of excess sodium and fluids.

Dandelion Root

This herbaceous root encourages the excretion of urine by helping the kidneys to flush out extra sodium and other toxins.

Natural diuretic aids may be beneficial for your high blood pressure, but they should be used with caution. Taking a natural diuretic, even unintentionally through your normal diet, along with a pharmaceutical medication could lead to dehydration and other potentially harmful drug interactions. Speak with your doctor to learn more about which natural diuretics are appropriate to use for treating your condition.

You Asked, We Answered

  • Should certain people avoid taking diuretics for hypertension?
  • Women who are pregnant should avoid taking natural or prescription diuretics but a prescription diuretic may be necessary to treat serious medical conditions as determined by the doctor. Hydrochlorothiazide (Microzide) has been used in infants and children and is generally considered safe for all ages, unless they are allergic to hydrochlorothiazide.

    - Alan Carter, PharmD