Diuretics

The Side Effects of Drugs Annuals is a series of volumes in which the adverse effects of drugs and adverse reactions to them are surveyed. The series supplements the contents of Meyler's Side Effects of Drugs: the International Encyclopedia of Adverse Drug Reactions and Interactions. This review of the January 2012 to June 2013 literature covers adverse reactions to diuretics. This includes five different groups of diuretics, carbonic anhydrase (CA) inhibitors (acetazolamide, methazolamide, dorzolamide and brinzolamide); loop diuretics (furosemide, bumetenide, torsemide and azosemide, what about ethacrynic acid?); thiazide and thiazide-like diuretics (hydrochlorothiazide, chlorthalidone and indapamide); aldosterone receptor antagonists (spironolactone and eplerenone) and the osmotic diuretic, mannitol. CA inhibitors are mainly used for ocular indications with local side effects (acetazolamide is very frequently used for oedema as well), and other systemic side effects are described with oral use. Parenteral infusion of furosemide in acute heart failure has shown to be associated with acute kidney injury (AKI) especially in the early phase, especially with high doses and longer duration of therapy. In critically ill patients, especially those with septic shock, the use of furosemide can increase the risk of AKI by three to fivefold. Furosemide can also cause hypokalemia and electrolyte abnormalities which may be life threatening. The publications reviewed reflected increasing use of aldosterone receptor antagonists and related electrolyte imbalance, especially hyperkalemia and other renal insufficiency side effects. Thiazide diuretics can cause hypokalemia, hyponatraemia and also glucose intolerance and disturbed glucose homoeostasis influenced by KCNJ1 gene variation within a few weeks of use. Nondiuretic use-related side effects of mannitol are mentioned.