IV. Preparations: Related to Sulfa-base

  1. Hypersensitivity to Sulfonamide antibiotics does not confer other sulfa-based agent allergy
    1. May be safe to trial on sulfa-based agent despite prior sulfa antibiotic reaction
    2. Anaphylaxis to sulfa agent in past contraindicates repeat sulfa trial
    3. Strom (2003) N Engl J Med 349: 1628-35 [PubMed]
  2. Sulfa-based Diuretics
    1. Furosemide
    2. Torsemide
    3. Bumetanide
    4. All Thiazide Diuretics
  3. Non-sulfa based agents
    1. Potassium-Sparing Diuretics (e.g. Triamterene, Spironolactone, Amiloride)
    2. Ethacrynic Acid

V. Prevention: Hypokalemia in Diuretic Use

  1. See Potassium Replacement
  2. See Hypokalemia
  3. Monitoring
    1. Serum Potassium
      1. Obtain at baseline
      2. Repeat weekly when initiating high potency Diuretics (esp. Loop Diuretics, multiple Diuretics)
      3. Obtain periodically when stable on longterm Diuretics
        1. Every 3-4 months and as needed on high potency diurectics
        2. Every 6-12 months on Hydrochlorothiazide or Chlorthalidone
    2. Serum Magnesium
      1. Obtain at baseline and as needed for significant Hypokalemia
      2. Magnesium Replacement as needed
  4. Optimize concurrent medications that increase Serum Potassium
    1. ACE Inhibitors or Angiotensin Receptor Blockers
    2. Spironolactone
  5. Schedule Potassium Supplementation
    1. Adjust Potassium dose based on Diuretic dose and potency, Renal Function and baseline Serum Potassium
    2. Start Potassium chloride 20 meq orally daily when on Loop Diuretics
    3. Increase Potassium dosing as needed at times of increased Diuretic dosing
      1. When doubling the Diuretic dose, also double the Potassium chloride to 40 meq/day
      2. Monitor Potassium closely (weekly) after adjusting Diuretic and Potassium dosing
  6. References
    1. (2021) Presc Lett 28(8): 44
    2. Ferreira (2020) J Am Coll Cardiol 75(22):2836-50 +PMID: 32498812 [PubMed]

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Ontology: Diuretics (C0012798)

Definition (CHV) a drug that increases urinary elimination
Definition (CHV) a drug that increases urinary elimination
Definition (NCI) A class of agents that increases the production of urine by the kidney. Via various mechanism of actions, diuretics retain water in urine, thus provides a means of forced diuresis.
Definition (NCI_NCI-GLOSS) A drug that increases the production of urine.
Definition (CSP) agents that promote the excretion of urine through their effects on kidney function.
Definition (MSH) Agents that promote the excretion of urine through their effects on kidney function.
Definition (MSHCZE) Diuretika podporující vylučování chloridu sodného.
Concepts Pharmacologic Substance (T121)
MSH D004232
SnomedCT 30492008, 372695000
LNC LP18047-8, MTHU003217
English Diuretics, diuretics (medication), water pills, diuretics, [CV700] DIURETICS, DIURETICS, Diuretic, Diuretic (product), Diuretic (substance), diuretic, Diuretic, NOS
Swedish Urindrivande medel
Czech diuretika, saluretika
Finnish Diureetit
Russian SUL'FAMILOVYE DIURETIKI, DIURETIKI, PROIZVODNYE SUL'FAMOILANTRANILOVOI KISLOTY, DIURETIKI, MOCHEGONNYE SREDSTVA, MOCHEGONNYE SREDSTVA SUL'FAMILOVYE, DIURETICHESKIE SREDSTVA, DIURETIKI SUL'FAMILOVYE, ДИУРЕТИКИ, ДИУРЕТИЧЕСКИЕ СРЕДСТВА, МОЧЕГОННЫЕ СРЕДСТВА, ДИУРЕТИКИ, ПРОИЗВОДНЫЕ СУЛЬФАМОИЛАНТРАНИЛОВОЙ КИСЛОТЫ, ДИУРЕТИКИ СУЛЬФАМИЛОВЫЕ, МОЧЕГОННЫЕ СРЕДСТВА СУЛЬФАМИЛОВЫЕ, СУЛЬФАМИЛОВЫЕ ДИУРЕТИКИ
Croatian DIURETICI
Polish Leki moczopędne, Diuretica, Diuretyki
Norwegian Not Translated[Diuretics]
Spanish Efecto Diurético, diurético (producto), diurético (sustancia), diurético, Diuréticos
Portuguese Diurético, Efeito Diurético, Diuréticos
French Diurétiques
German Diuretika
Italian Diuretici