Diuretics
Thiazide Diuretics (e.g., Bendroflumethiazide)
Absolute Contraindications
- Severe renal or hepatic impairment
- Addison’s disease
- Hypercalcaemia or hyponatraemia
Main Side Effects
- Electrolyte disturbances (e.g., hypokalaemia, hyponatraemia)
- Hyperuricaemia (may precipitate gout)
- Increased glucose/cholesterol levels
Main Interactions
- NSAIDs (reduced efficacy, nephrotoxicity)
- Lithium (increased risk of toxicity)
Main Monitoring Requirements
- Electrolytes and renal function
Pregnancy & Breastfeeding
- Generally avoided, safer alternatives available
Loop Diuretics (e.g., Furosemide)
Absolute Contraindications
- Severe hypokalaemia or hyponatraemia
- Anuria
Main Side Effects
- Electrolyte imbalance
- Ototoxicity (at high doses)
- Hypovolaemia
Main Interactions
- Aminoglycosides (ototoxicity risk)
- Lithium (toxicity risk)
Main Monitoring Requirements
- Electrolytes and renal function
- Fluid balance
Pregnancy & Breastfeeding
- Use only if benefits outweigh risks
Potassium-Sparing Diuretics (e.g., Spironolactone, Eplerenone, Amiloride) Absolute Contraindications
- Hyperkalaemia (serum potassium >5.0 mmol/L)
- Severe renal impairment or anuria
- Addison’s disease (adrenocortical insufficiency)
- Concomitant use of potassium supplements Main Side Effects
- Spironolactone:
- Gynaecomastia (common with long-term use)
- Menstrual irregularities
- Hyperkalaemia (can lead to arrhythmias) 2.Eplerenone:
- Fewer endocrine side effects compared to spironolactone
- Hyperkalaemia, dizziness 3.Amiloride:
- •Nausea, diarrhoea
- Hyperkalaemia
Main Interactions
- ACE inhibitors/ARBs (increased risk of hyperkalaemia)
- NSAIDs (risk of renal impairment and hyperkalaemia)
- Potassium supplements (additive risk of hyperkalaemia)
- Digoxin (risk of toxicity due to potassium disturbances)
Main Monitoring Requirements
- Serum potassium levels (before initiation and regularly thereafter)
- Renal function (baseline and periodically)
- Blood pressure
Pregnancy & Breastfeeding
- Spironolactone: Avoid due to anti-androgenic effects; alternative diuretics preferred.
- Eplerenone: Avoid unless essential; limited safety data.
- Amiloride: Avoid unless benefits outweigh risks.