Dr. Rose's Peripheral Brain--DIURETICS

DIURETICS

Category	Agent	Dosing	Comments (apply to all agents w/in category)
Thiazides	Chlorothiazide Chlorthalidone Hydrochlorothiazide Indapamide Metolazone	125-500mg QD 12.5-50mg QD 12.5-50mg QD 1.25-5mg QD 0.5-1.0mg QD	May increase cholesterol levels May increase glucose levels* Lowers serum levels of K, Na, and Mg Decreases renal excretion of Ca and may reduce risk of Osteoporosis Associated with pancreatitis, sexual dysfunction, and photosensitivity May increase Lithium levels in pts on Lithium
Loop	Bumetanide Ethacrynic acid Furosemide Torsemide	0.5-5mg divided BID-TID 25-100mg divided BID-TID 20-320mg divided BID-TID 5-20mg divided QD-BID	Shorter t-1/2 than thiazides Less effective for HTN than thiazides May increase cholesterol levels May increase glucose levels Lowers serum levels of K, Na, and Mg
Potassium-sparing	Amiloride Eplenerone (Inspra) Spironolactone Triamterine	5-10mg QD-BID 50mg QD-BID 12.5-100mg QD-BID 50-150mg QD-BID	Blocks the effect of Aldosterone Weak antihypertensive effect when used alone Used often in conjunction w/thiazide to avoid hypokalemia Can cause hyperkalemia and hyponatremia Use with caution in combination w/ACEIs Spironolactone can cause gynecomastia in men & irregular menses in women Eplenerone has less anti-androgenic effect than spironolactone

*--Evidence to support:

In the ALLHAT Study, prevalence at 4y of new-onset DM (as defined by fasting glucose > 125 in pts with baseline fasting glucose < 125) was sig. higher in chlorthalidone group than amlodipine and lisinopril groups (11.6% vs. 9.8% and 8.1%, respectively). Total serum cholesterol levels were sig. higher in chlorthalidone group than amlodipine and lisinopril groups at 4y, though not by much (197.2 vs. 195.6 and 195.0, respectively)
In a study using data from the Nurses' Health Study and Health Professionals Follow-Up Study, in which about 75,000 pts with HTN but no DM were followed for 8-16y, incidence of new-onset DM (after adjustment for potential counfounders) was sig. higher in users of thiazide diuretics c/w non-use (RR 1.2-1.5 depending on the cohort). (Diab. Care 29:1065, 2006--JW)