Carbonic Anhydrase Inhibitors

Acetazolamide (Diamox®)

Methazolamide (Neptazane®)

Dichlorphenamide (Daranide®)

Brinzolamide (Azopt®)

Dorzolamide (Trusopt®)

Carbonic Anhydrase Inhibitors

Site of Action: Proximal Convoluted Tubule

MOA: Inhibits carbonic anhydrase thereby preventing exchange of H+ ions with sodium and water

SE: Metabolic acidosis, anorexia, hematuria, photosensitivity, drowsiness, paresthesia, urticaria, melena, may elevate blood glucose in diabetic patients

Less potent than loop or thiazides

Acetazolamide

Diamox®

Used for the management of edema in HF, glaucoma, motion sickness, and epilepsy

Not metabolized

Carbonic Anhydrase Inhibitor

Methazolamide

Neptazane®

More potent than Acetazolamide

Slow GI absorption, Half life= 14 hours

Seldom used as a diuretic, useful in glaucoma

Carbonic Anhydrase Inhibitor

Dichlorphenamide

Daranide®

Promotes chloride excretion therefore it causes less metabolic acidosis

Seldom used as a diuretic, used in glaucoma

Carbonic Anhydrase Inhibitor

Brinzolamide

Azopt®

Used for glaucoma

Carbonic Anhydrase Inhibitor

Dorzolamide

Trusopt®

Used for glaucoma

Carbonic Anhydrase Inhibitor

Loop Diuretics

Furosemide (Lasix®)

Bumetanide (Bumex®)

Torsemide (Demadex®)

Ethacrynic Acid (Edecrin®)

Loop Diuretics

Site of Action: Loop of Henle

MOA: Acts directly on the Loop of Henle to inhibit sodium and chloride reabsorption

Indications: Edema associated with HF, or hepatic or renal disease, hypertension, hypercalcemia

SE: Dizziness, headache, tinnitus, blurred vision, nausea, vomiting, diarrhea, agranulocytosis, neutropenia, thrombocytopenia, hypokalemia, hyperglycemia, hyperuricemia

Greater response than thiazides

Furosemide

Lasix®

Half life= 1 hour

Most commonly prescribed loop diuretic

Loop Diuretic

Bumetanide

Bumex®

More potent than Furosemide

Loop Diuretic

Torsemide

Demadex®

Loop Diuretic

Ethacrynic Acid

Edecrin®

Only loop diuretic that does not contain a sulfur group, may be an alternative for patients with a sulfur allergy

Loop Diuretic

Thiazides

Chlorothiazide (Diuril®)

Hyrochlorothiazide (Esidrix®, Hydro-DIURIL®)

Hydroflumethiazide (Saluron®)

Bendroflumethiazide (Naturetin®)

Trichlormethiazide (Diurese®, Naqua®)

Methylclothiazide (Aquatensen®, Enduron®)

Polythiazide (Renese®)

Thiazides

Site of Action: Distal Convoluted Tubule

MOA: Inhibite tubular reabsorption of sodium and chloride ions

Used for hypertension, edema, hypercalciuria, diabetes insipidus

SE: Dizziness, headache , blurred vision, paresthesias, decreased libido, anorexia, nausea, vomiting, diarrhea, impotence, urticaria, photosensitivity, hypokalemia, glucosuria, hyperglycemia

Chlorothiazide

Diuril®

Not extensively absorbed, higher dose=less absorption

Thiazide

Hydrochlorothiazide

Esidrix®, Hydro-DIURIL®

70% bioavailable, Rapid onset (1 hour), Half Life= 8-10 hours

Most commonly prescribed thiazide

Thaizide

Hydroflumethiazide

Saluron®

Thiazide

Bendroflumethiazide

Naturetin®

Thiazide

Trichlormethiazide

Diurese®, Naqua®

Thiazide

Methylclothiazide

Aquatensen®, Enduron®

Thiazide

Polythiazide

Renese®

Thiazide

Thiazide-Like Diuretics

Metolazone (Mykrox®, Zaroxolyn®)

Quinethazone (Hydromox®)

Indapamide (Lozol®)

Chlorthalidone (Hygroton®, Thalitone®)

Thiazide-Like Diuretics

Site of Action: Distal Convoluted Tubule

MOA: Inhibite tubular reabsorption of sodium and chloride ions

Used for hypertension, edema, hypercalciuria, diabetes insipidus

SE: Dizziness, headache , blurred vision, paresthesias, decreased libido, anorexia, nausea, vomiting, diarrhea, impotence, urticaria, photosensitivity, hypokalemia, glucosuria, hyperglycemia

Metolazone

Mykrox®, Zaroxolyn®

Thiazide-Like Diuretic

Quinethazone

Hydromox®

Thiazide-Like Diuretic

Indapamide

Lozol®

Thiazide-Like Diuretic

Chlorthalidone

Hygroton®, Thalitone®

Thiazide-Like Diuretic

Potassium-Sparing Diuretics

Spironolactone (Aldactone®)

Triamterene (Dyrenium®)

Amiloride (Midamor®)

Eplerenone (Inspra®

Potassium-Sparing Diuretics

Site of Action: Collecting ducts and distal convoluted tubules

MOA: Blocks the resorption of sodium and water usually induced by aldosterone

SE: Dizziness, headache, nausea, vomiting, diarrhea, cramps, urinary frequency, weakness, hyperkalemia

Often used in combination with other diuretics, weak diuretic activity

Spironolactone

Aldactone®

Used in the management of hyperaldosteronism, hypertension, potassium-loss caused by potassium depeleting drugs

Metabolized to an active metabolite, Canrenone

Additional SE: Gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding

Potassium-Sparing Diuretic

Triamterene

Dyrenium®

Used in the management of hyperaldosteronism, hypertension, potassium loss caused by potassium depeleting drugs

Unlike Aldactone, it does not require aldosterone to work 

Potassium-Sparing Diuretic

Amiloride

Midamor®

 Used in the treatment of hypertension

Does not require aldosterone

Potassium-Sparing Diuretic

Eplernone

Inspra®

Potassium-Sparing Diuretic

Osmotic Diuretics

Mannitol (Osmitrol®)

Glycerin (Osmoglyn®)

Urea (Ureaphil®)

Isosorbide (Ismotic®)

Osmotic Diuretics

Site of Action: Proximal tubule

MOA: Pulls water into the blood vessels and nephrons from the surrounding tissues

Used in the oliguric phase of acute renal failure, to promote the excretion of toxic substances, reduce intracranial pressure, for treatment of cerebral edema

SE:Convulsions, thrombophlebitis, pulmonary congestion, headache, chest pain, tachycardia, blurred vision, chills, fever

Mannitol

Osmitrol®

Water soluble

Osmotic Diuretic

Glycerin

Osmoglyn®

Osmotic Diuretic

Urea

Ureaphil®

Osmotic Diuretic

Isosorbide

Ismotic®

Osmotic Diuretic

Other Agents

Conivaptan (Vapisol®)

Demeclocycline (Declomycin®)

Conivaptan

Vaprisol®

Non-peptide inhibitor of anti-diuretic hormone

Other Diuretics

Demeclocycline

Declomycin®

Tetracycline Antibiotic

Other Diuretic