II. Indications: Potassium-Sparing Diuretics only (Aldosterone independent, Amiloride and Triamterene)
III. Indications: Aldosterone Antagonists (Spironolactone, Eplerenone)
-
Congestive Heart Failure
- Counter Aldosterone adverse effects on myocardial remodeling
IV. Mechanism
- Weak Diuretics (compared with Loop Diuretics or Thiazide Diuretics)
- Potassium-Sparing Diuretics only
- Primarily used to counter urinary Potassium loss with other Diuretics (e.g. Thiazide Diuretics)
- Act directly at the distal convoluted tubule (Aldosterone independent)
-
Aldosterone Antagonists (Spironolactone and Eplerenone)
- Commonly used as adjunctive in Congestive Heart Failure management
- Counter Aldosterone adverse effects on myocardial remodeling
V. Medications
- Potassium-Sparing Diuretics only (Aldosterone independent)
- Potassium-Sparing Diuretic and Aldosterone Antagonists
VI. Precautions
- Monitor Serum Potassium after starting a Potassium-Sparing Diuretic in those at Hyperkalemia risk
- Obtain Serum Potassium at 3 days, 7 days and then monthly for the first 3 months
VII. Adverse Effects: Potassium-Sparing Diuretics (Amiloride and Triamterene)
-
Hyperkalemia
- Risk factors
- Renal Insufficiency
- Concurrent use with agents that raise Potassium (e.g. ACE Inhibitors, Potassium supplements)
- Risk factors
- Blue Urine Color
- Specific to Triamterene
- Decreased renal perfusion (if Sodium and water depletion)
-
Glucose Intolerance
- Potassium-Sparing Diuretics
VIII. Drug Interactions
- Potassium supplements (risk of Hyperkalemia)
IX. References
- Olson (2020) Clinical Pharmacology, Medmaster, Miami, p. 62-3
- Hamilton (2010) Tarason Pocket Pharmacopeia, p. 100