Diuretics: Therapeutic use, Treatment. Diuretics rehab.

Last modified: Sunday, 31. May 2009 - 1:50 pm

Official names: Acetazolamide, amiloride, bendroflumethiazide, benzthiazide, bumetanide, chlorothiazide, chlorthalidone, dichlorphenamide, dorzolamide, ethacrynic acid, flumethiazide, furosemide, glycerin, isosorbide, hydrochlorothiazide (HCT), hydroflumethiazide, mannitol, methyclothiazide, metolazone, polythiazide, quinethazone, spironolactone, torsemide, triamterene, trichlormethiazide
Street names: Water pills
Drug classifications: Not scheduled

 

Key terms

ANOREXIA: An eating disorder characterized by a refusal to maintain body weight at a minimal normal weight for age and height, an intense fear of gaining weight, and a distorted sense of self-image.
BULIMIA: An eating disorder characterized by binge eating and then excessive behavior (such as vomiting, laxative or diuretic abuse, or exercising excessively) to rid the body of the food and/eaten.
CIRRHOSIS: A chronic liver disease that is caused by alcohol abuse, toxins, nutritional deficiency, or infection. A main symptom of cirrhosis is portal hypertension.
EDEMA: Water retention in the tissues that causes swelling.
ELECTROLYTE IMBALANCE: Improper proportions of acids, bases, salts, and fluids in the body. Electrolytes include the salts sodium, potassium, magnesium, chloride chlorine. They can conduct electricity, and therefore are essential in nerve, muscle, and heart function.
NEUROTRANSMITTER: Chemical in the brain that transmits messages between neurons, or nerve cells.
OSTEOPOROSIS: A loss in total bone density that may be the result of a chronic calcium deficiency, early menopause, certain endocrine diseases, advanced age, endocrine diseases, certain medications, or other risk factors.
PANCREATITIS: Inflammation of the pancreas, an essential part of both the endocrine and the digestive systems. The pancreas secretes juices that aid in digestion, and a number of hormones (including insulin).
PELVIC TONING EXERCISES: Exercises that focus on tightening the muscles of the pelvic floor to relieve urinary stress incontinence. Also known as Kegel or PC muscle exercises.

 

Overview

Diuretics are a class of drugs that increase urine output. In healthcare, they are used to treat conditions that cause edema, or water retention. They are also prescribed for several chronic conditions, including asthma, heart disease, and hypertension (high blood pressure).
Because diuretics cause an overall water weight loss, they are often abused by individuals with eating disorders such as anorexia and bulimia. They may also be misused (and sometimes abused) by athletes to “make weight” for certain classes of competition (i.e., wrestling).
Diuretic use in sports may also be prompted by the belief that a lower weight will improve athletic performance. However, the side effects experienced from long-term diuretic abuse typically offset any temporary gains in ability. Diuretics are considered a banned substance by the International Olympic Committee (IOC), the United States Anti-Doping Agency (US ADA), the World Anti-Doping Agency (WADA), the National Collegiate Athletic Association (NCAA), and a number of other national and international sporting authorities.
The term diuretics comes from the Greek diuresis, meaning “to urinate.” In medieval medicine, diuretics were used to restore the body’s humors (blood, bile, and phlegm) to balance, along with other “therapeutic” methods such as blood-letting and induced vomiting.
William Withering, an English physician with a strong interest in botany, was the first to introduce the diuretic digitalis (from the foxglove plant Digitalis purpurea) into common medical practice for the treatment of dropsy. Dropsy, a now-obsolete term for edema (fluid retention or swelling), was frequently related to congestive heart failure and was a common cause of death at the time for lack of an effective treatment.
Although there had been accounts of the use of foxglove in medicine since classical times, Withering was the first to standardize its use and establish digitalis as a legitimate medical therapy. He learned of the botanical therapy from local folk medicine, and began treating patients with it. Ten years after Withering began using the drug, he published An Account of the Foxglove and Some of Its Medical Uses; With Practical Remarks on Dropsy and Other Diseases (1785), in which he described his experiences with the drug and experiments with different preparations and dosages. Digitalis remains a treatment for heart failure today.
In the 1920s, researchers discovered the diuretic effects of substances known as organic mercurials that were used to treat a heart disorder related to syphilis. They were quickly employed as a treatment for congestive heart failure (CHF). While they helped edema, their long-term usefulness was limited since they became ineffective with regular use and, more importantly, they could be highly toxic to the heart and nervous system over time.
The antibiotic class of sulfonamides was introduced in 1936. Although not designed as a diuretic, the drug caused increased urinary output in patients who used it. Over a decade later, Dr. William Schwartz tried the drug on three heart patients and found it was effective for lowering blood pressure and relieving the symptoms of congestive heart failure, but also concluded that the drug could not be safely used for any length of time.
In 1957, researchers John Baer, Karl Beyer, James Sprague, and Frederick Novello formulated the drug chlorothiazide, the first of the thiazide diuretics. This groundbreaking discovery marked a new era in medicine as the first safe and effective long-term treatment for chronic hypertension and heart failure.
Loop diuretics, the next class of diuretic drugs to be developed, are also the most potent. Their introduction was a major advance in the treatment of congestive heart failure. Furosemide (Lasix), the first of the loop diuretics, debuted in 1965.
Over-the-counter diuretic formulations became available around this time as well. Pamabrom, a medication that relieves the fluid retention and bloating associated with a woman’s menstrual cycle, is still the active ingredient in a number of over-the-counter preparations (e.g., Aqua-Ban, Pamprin).
There are also many drugs and dietary supplements that may have diuretic action as a side effect, but have a different primary purpose. For example, the supplement creatine is an ergogenic (energy-enhancer), but it also promotes fluid loss with regular use.

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