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Loop diuretics usually have a ceiling effect whereby doses greater than a certain maximum amount will not increase the clinical effect of the drug. Also, there is a threshold minimum concentration of loop diuretics that needs to be achieved at the thick ascending limb to enable the onset of abrupt diuresis. [10]
Metolazone and a loop diuretic will synergistically enhance diuresis over the use of either agent alone. Using this combination, diuretic effects will occur at two different segments of the nephron; namely, the loop diuretic will act at the loop of Henle, and metolazone will act at the distal convoluted tubule. Metolazone is frequently ...
Potentially serious side effects include electrolyte abnormalities, low blood pressure, and hearing loss. [4] It is recommended that serum electrolytes (especially potassium), serum CO 2, creatinine, BUN levels, and liver and kidney functioning be monitored in patients taking furosemide.
Thiazide diuretics (e.g. hydrochlorothiazide, chlorthalidone, chlorthiazide) – may be useful for mild CHF, but typically used in severe CHF in combination with loop diuretics, resulting in a synergistic effect. Potassium-sparing diuretics (e.g. amiloride) – used first-line use to correct hypokalaemia.
The potassium-sparing effects of amiloride offset the low blood potassium (hypokalemia) that is often induced by thiazides or loop diuretics, which is of particular importance in people for whom maintaining a normal level of potassium is critically important. [6]
Common side effects include headache, increased urination, diarrhea, cough, and dizziness. [1] Other side effects may include hearing loss and low blood potassium. [1] Torasemide is a sulfonamide and loop diuretic. [1] Use is not recommended in pregnancy or breastfeeding. [2] It works by decreasing the reabsorption of sodium by the kidneys. [1]
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Physicians must be careful to monitor potassium levels in both males and females who are taking spironolactone as a diuretic, especially during the first twelve months of use and whenever the dosage is increased. Doctors may also recommend that some patients may be advised to limit dietary consumption of potassium-rich foods.