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Heart Disease in Women
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ACE Inhibitor Drugs
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|What Are Diuretics?
Diuretics, also called water pills, are drugs which remove excess water and sodium from the body by increasing the amount lost through urination. In the normal filtering process of the kidneys some water and salt ends up being urinated out of the body; but most is returned back into the bloodstream. Diuretics interfere with this process and reduce the amount of water and sodium returned into the blood stream. This in turn reduces the amount of fluid flowing through the blood vessels which reduces pressure on the walls of the arteries. There are 3 main types of diuretics: Loop, thiazide and potassium-sparing diuretics, each of which work on a different part of the kidney and produce a different effect. Which diuretic you are recommended will depend on the condition being treated and your general health.
When Are They Prescribed?
Diuretics are primarily used to treat hypertension (high blood pressure) and congestive heart failure. However they are used to treat a wide range of other conditions, including:
Edema: Fluid buildup or swelling in tissues in the body.
Glaucoma: Eye disorder. Diuretics reduce pressure by decreasing fluid levels in the eye.
Kidney Disorders: Nephrotic syndrome and kidney stones.
Diabetes Insipidus: This condition is characterized by the need to urinate frequently.
Cirrhosis: Diuretics reduce the amount of fluid buildup in the liver associated with this disease.
Hirsutism: Hirsutism is a term to describe excess facial and body hair growth in women associated with polycystic ovary syndrome (PCOS). It can be treated with potassium sparing diuretics.
Osteoporosis: Some drugs may reduce the risk of hip fractures.
How Do They Work?
Medications include: furosemide, torsemide and bumetanide.
These drugs work by blocking the kidney's ability to reabsorb sodium. This causes the kidneys to excrete significantly more sodium and water in the urine than it normally would. Loops medications are fast acting powerful drugs that are usually used as an emergency treatment of heart failure.
Medications include: Chlorthalidone, hydrochlorothiazide and metolazone.
These drugs also cause the kidney to excrete extra sodium and water. However because they work on a different part of the kidney they only cause a moderate increase in urine production. They are primarily used as a treatment for high blood pressure.
Potassium Sparing Diuretics
Medications include: Spironolactone and eplrenone.
As loop and thiazide drugs cause the body to lose significant amounts of potassium, they may be used in combination with potassium sparing diuretics. Symptoms of low potassium levels include fatigue and leg cramps. Low levels can also affect heart rhythms. As the name implies, potassium sparing meds preserve potassium levels. They do this by blocking the kidneys from dumping supplies of the mineral into urine along with the water and sodium for excretion.
Treating High Blood Pressure
Thiazide diuretics are often used as a primary treatment for high blood pressure. In fact extensive research shows that they lower blood pressure just as well as more expensive alternatives like ACE inhibitors, beta blockers and calcium channel blockers. Additionally they are more likely to prevent stroke and heart attacks in women and men. However, many doctors still prefer to prescribe the alternatives (ACE inhibitors etc), particularly in patients with symptoms of coronary heart disease, high blood sugar or high cholesterol levels. Yet recent research, including one major study concluded that diuretics were superior in all cases.
Treating Heart Failure
Most people with heart failure suffer from edema, that is, an accumulation of fluid in the feet (peripheral edema), lungs (pulmonary edema) and abdomen (ascites). This happens because the body tries to compensate for a failing heart by clinging onto extra water and salt. Loop drugs force the kidneys to dump excess levels of fluid which reduces swelling and discomfort and reducing fluids in the lungs helps the person breath more easily. Because one of the side effects is loss of potassium, patients on loop meds are usually told to eat foods rich in potassium including orange juice, bananas, grapefruit, apricots, prunes, prune juice and cantaloupe. Although loop diuretics make heart failure patients more comfortable, they do not increase their life span. On the other hand, potassium sparing diuretics have been shown to increase survival rates in patients with advanced heart failure. While eplerenone and spironolactone (potassium sparing drugs) are not used for getting rid of excess fluids from the body, they can slow down the deterioration of the heart.
Spironolactone is a potassium sparing diuretic which is usually used for treating heart failure or hypertension (in combination with other drugs). In higher doses it may help prevent excess facial and body hair growth (hirsutism) in women with PCOS. It does this by decreasing the production of the male hormone androgen and by blocking the conversion of testosterone to dihydrotestosterone (DHT). It is one of the least expensive PCOS treatment options but it should be noted that while most patients have a good response, some remain unaffected. One of the main disadvantages is that it can lead to raised levels of potassium in the blood, a condition called hyperkalemia. This can cause heart arrhythmia and even paralysis. Spironolactone is usually prescribed in 50 to 200mg tablets to be taken daily on days 4 to 21 of the menstrual cycle.
Generally diuretics (particularly loop diuretics) cause the body to lose water along with other essential minerals, most notably potassium, calcium and magnesium. This means that people who use the drugs are at a higher risk of bone fracture (as lack of calcium causes brittle bones). However, to confuse matters, one large-scale study published in the New England Journal of Medicine (1983) found that people who took thiazide diuretics had higher bone density than those who did not. Another large survey showed that thiazide diuretic therapy was associated with a 30 percent reduction in hip fracture. As such diuretics may be viewed as a treatment for osteoporosis, particularly in those who also have high blood pressure.
Useful: Know the Risk Factors for Heart Disease and Heart Disease Statistics
What Are The Side Effects?
Most people who take diuretics do not experience any problems or side effects, outside of the need to urinate more frequently. Below however is a list of most of potential complications.
One of the most inconvenient aspects is the need to urinate more frequently. Generally loop drugs act quickly so the greatest urgency to urinate should be over within 2 to 3 hours of taking the pill. Thiazides tend to last longer, for up to 6 hours. This can make planning a day's activities frustrating as access to a toilet will be necessary. Learning how a diuretic affects you will be important. As it usually works the same way each time you take it, you can learn to take it when it least affects your daily activities. If it does become annoying talk to your doctor about adjusting your dosage. Loops can also cause dangerously low levels of potassium, magnesium and electrolytes so people taking these medications will have to have their blood checked regularly. These medications can also cause dehydration if they are over-used.
As with all blood pressure medications, there is a risk of lowering blood pressure too much (hypotension). This can be checked by regular blood pressure monitoring. Other possible side effects include excessively low levels of sodium and potassium and high levels of calcium.
Potassium Sparing Diuretics
These can cause potassium levels to reach dangerously high levels. They may also cause breast enlargement in some men (gynecomastia) as well as impotence.
Other Side Effects
Or extreme tiredness. This should become less of a problem as the body adjusts to the medication. If symptoms do not improve, your medication dose may need adjusting.
Muscle Cramps or Weakness
This may be linked to potassium levels, so check with your doctor about a potassium supplement.
If you feel thirty try sucking on a towel soaked in ice water or a sugarless hard candy. If you become extremely thirsty this could be a sign of dehydration, particularly if accompanied by urine turning a darker color, less urine being excreted and/or constipation. Talk to your doctor if any of these symptoms occur.
If you feel nauseous or start vomiting ensure you take your medication on a full stomach and take a potassium supplement if prescribed.
When to Call the Doctor Immediately
If you experience any of the following:
• Skin Rash
• Sore throat
• Severe persistent headaches, blurred vision and/or confusion
• Ringing in the ears
• Unusual bleeding or bruising
Questions To Ask Your Doctor
If you doctor prescribes diuretics, you may find the following list of questions to discuss with him useful:
1. Why am I taking this drug?
2. How often and for how long should I take it?
3. Is there anything I need to know, any special instructions for taking this drug?
4. Do I only take it at mealtime?
5. Is there any activity I need to avoid while taking it?
6. What potential side effects are there and what are the symptoms?
7. Is there a way to avoid side effects?
What Are Natural Diuretics?
Some herbs and dietary supplements such as ginger, juniper and dandelion may act as a natural diuretic. That is, they may help the body excrete excess water. While this may be attractive to some people seeking rapid weight loss results, the results are usually short-lived. If you think you are suffering from water retention, discuss this with your doctor because there may be an underlying medical cause.
List of Common Medications
All drugs have a generic name and usually also one or more brand name.
|Generic Drug Name
||American Brand Names
||UK Brand Names
||Capozide; Hyzaar; Dyazide; Maxzide; Lopressor HCT; Prinzide