Diuretic
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Classification of common diuretics and their mechanisms of action | |
| agent | mechanism |
| Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) | inhibition within collecting ducts of Na+-K+ exchange: spironolactone inhibits aldosterone action; amiloride inhibits epithelial sodium channels (ENaC) |
| water | inhibits vasopressin secretion |
| ethanol | inhibits vasopressin secretion |
| V2 vasopressin receptor antagonists | inhibit vasopressin's action on nephron's collecting duct |
| Xanthines (e.g., caffeine, theophylline) | inhibit tubular reabsorption of Na+, increase glomular filtration rate |
| acidifying salts (e.g., CaCl2, NH4Cl) | |
| carbonic anhydrase inhibitors (e.g., acetazolamide, dorzolamide) | inhibit H+ secretion, resultant promotion of Na+ and K+ excretion |
| loop diuretics (e.g., furosemide, bumetanide, ethacrynic acid) | inhibit the cotransporter in the medullary thick ascending limb of the loop of Henle |
| Thiazides (e.g., hydrochlorothiazide, bendroflumethiazide) | inhibit Na+/Cl- reabsorption from the distal convoluted tubules of nephrons |
| Osmotic diuretics (e.g., mannitol, glucose) | promote osmotic diuresis |
A diuretic is any drug that elevates the rate of bodily urine excretion (diuresis). Diuretics also decrease the extracellular fluid (ECF) volume, and are primarily used to produce a negative extracellular fluid balance. Caffeine, cranberry juice and alcohol are all weak diuretics.
In medicine, diuretics are used to treat heart failure, liver cirrhosis, hypertension and certain kidney diseases. Diuretics alleviate the symptoms of these diseases by causing sodium and water loss through the urine. As urine is produced by the kidney, sodium and water – which cause edema related to the disease – move into the blood to replace the volume lost as urine, thereby reducing the pathological edema. Some diuretics, such as acetazolamide, help to make the urine more alkaline and are helpful in increasing excretion of substances such as aspirin in cases of overdose or poisoning.
The antihypertensive actions of some diuretics (thiazides and loop diuretics in particular) are independent of their diuretic effect. That is, the reduction in blood pressure is not due to decreased blood volume resulting from increased urine production, but occurs through other mechanisms and at lower doses than that required to produce diuresis. Indapamide was specifically designed with this is mind, and has a larger therapeutic window for hypertension (without pronounced diuresis) than most other diuretics.
Chemically, diuretics are a diverse group of compounds that either stimulate or inhibit various hormones that naturally occur in the body to regulate urine production by the kidneys.
Alcohol produces diuresis through modulation of the vasopressin system.de:Diuretikum fr:Diurétique nl:Diureticum ja:利尿薬 nn:Urindrivande lækjemiddel pl:Leki moczopędne pt:Diurético th:ยาขับปัสสาวะ zh:利尿劑