Loop diuretics

Indications & Dose:

Contraindications:

Anuria . comatose and precomatose states associated with liver cirrhosis renal failure due to nephrotoxic or hepatotoxic drugs . severe hypokalaemia. severe hyponatraemia

Side Effects:

 Very rare Hyperuricaemia 

Frequency not known Acute urinary retention . blood disorders . bone-marrow depression . deafness (usually with high doses and rapid intravenous administration, and in renal impairment) . electrolyte disturbances . hepatic encephalopathy . hyperglycaemia (less common than with thiazides) . hypersensitivity reactions . hypocalcaemia . hypochloraemia . hypokalaemia. hypomagnesaemia . hyponatraemia . leucopenia.

metabolic alkalosis . mild gastro-intestinal disturbances . pancreatitis . photosensitivity . postural hypotension . pruritus . rash . temporary increase in serum-cholesterol and triglyceride concentration . thrombocytopenia . tinnitus (usually with high doses and rapid intravenous administration, and in renal impairment) . visual disturbances

HEPATIC IMPAIRMENT Hypokalaemia induced by loop diuretics may precipitate hepatic encephalopathy and coma—potassium-sparing diuretics can be used to prevent this. Diuretics can increase the risk of hypomagnesaemia in alcoholic cirrhosis, leading to arrhythmias.

RENAL IMPAIRMENT High doses of loop diuretics may occasionally be needed in renal impairment. High doses or rapid intravenous administration can cause tinnitus and deafness.

MONITORING REQUIREMENTS Monitor electrolytes during treatment

Cautions:

Can exacerbate diabetes (but hyperglycaemia less likely than with thiazides) . can excacerbate gout. hypotension should be corrected before initiation of treatment . hypovolaemia should be corrected before initiation of treatment . urinary retention can occur in prostatic hyperplasia

CAUTIONS, FURTHER INFORMATION

% Elderly Lower initial doses of diuretics should be used in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. Diuretics should not be used continuously on a long-term basis to treat simple gravitational oedema (which will usually respond to increased movement, raising the legs, and support stockings).

% Potassium loss Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic.

Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements.In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis.

% Urinary retention If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; an adequate urinary output should be established before initiating treatment.

Precautions:

Interaction:

Appendix 1 (diuretics).

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henlé in the renal tubule and are powerful diuretics.

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: