Diuretic data

Synonyms 6-Chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide-1,1-dioxide Chlorosulthiadil Chlorzide Dihydrochlorothiazide Empirical C7H8CIN3O4S2 Properties Wh. or pract. wh. cryst. powd., odorless sol. in sodium hydroxide sol n., dimethylformamide, dil. ammonia, NaOH insol. in water, chloroform, ether, dil. min. acids m.w. 297.75 m.p. 273-275 C Toxicology LD50 (oral, mouse) 2830 mg/kg poison by IP and IV routes mod. toxic by ing. and subcutaneous routes mutagenic data diuretic TSCA listed... 

In a study with 3427 male and female patients having DBP of 95—109 mm Hg (12—15 Pa), and no clinical evidence of cardiovascular diseases, half of the patients were placebo-treated and half were SC antihypertensive dmg-treated, ie, step 1, chlorothiazide step 2, methyldopa, propranolol [525-66-6], or pindolol [13523-86-9], and step 3, hydralazine, or clonidine [4205-90-7] (86). Overall, when the DBP was reduced below 100 mm Hg (13 Pa), there were more deaths in the dmg-treated group than in the placebo group. The data suggest reduction of blood pressure by antihypertensive dmg treatment that includes a diuretic is accompanied by increased cardiovascular risks. 

Combined loop diuretic and albumin ° Data supporting efficacy is limited... 

Diuretics Not first-line agents probably safe available data suggest that throughout gestation a diuretic is not associated with an increased risk of major fetal anomalies or adverse fetal-neonatal events. 

Diuretics have been the mainstay for HF symptom management for many years. 0 Diuretics are used for relief of acute symptoms of congestion and maintenance of euvolemia. These agents interfere with sodium retention by increasing urinary sodium and free water excretion. No prospective data exist on I the effects of diuretics on patient outcomes.14 Therefore, the... 

Prolonged administration of loop diuretics can lead to a second type of diuretic resistance. Enhanced delivery of sodium to the distal tubule can result in hypertrophy of distal convoluted cells.17 Subsequently, increased sodium chloride absorption occurs in the distal tubule which diminishes the effect of the loop diuretic on sodium excretion. Addition of a distal convoluted tubule diuretic, such as metolazone or hydrochlorothiazide, to a loop diuretic can result in a synergistic increase in urine output. There are no data to support the efficacy of one distal convoluted tubule diuretic over another. The common practice of administering the distal convoluted tubule diuretic 30 to 60 minutes prior to the loop diuretic has not been studied, although this practice may first inhibit sodium reabsorption at the distal convoluted tubule before it is inundated with sodium from the loop of Henle. 

Diuretics, ACE inhibitors, ARBs, and CCBs are primary agents acceptable as first-line options based on outcome data demonstrating CV risk reduction benefits (Table 10-2). /TBIockers may be used either to treat a specific compelling indication or as combination therapy with a primary antihypertensive agent for patients without a compelling indication. 

ACE inhibitor with diuretic therapy is recommended as the first-line regimen of choice. ACE inhibitors have numerous outcome data showing reduced CV morbidity and mortality. Diuretics provide symptomatic relief of edema by inducing diuresis. Loop diuretics are often needed, especially in patients with more advanced disease. 

Offers potential advantages over other loop diuretics, including a longer duration of action and fewer adverse electrolyte and metabolic effects available data not extensive or convincing enough at present to recommend replacement of standard loop diuretic (furosemide) considered alternative in refractory patients... 

As noted earlier, lithium is contraindicated in patients with unstable congestive heart failure or the sick sinus node syndrome ( 307, 328). In older patients or those with prior cardiac histories, a pretreatment ECG should be obtained. Except for the potential adverse interactions with diuretics, the concomitant use of other cardiac drugs is generally safe. Because verapamil may lower serum levels of lithium, however, more careful monitoring may be required to assure continued therapeutic effects (329). Some data also indicate that verapamil may predispose to lithium neurotoxicity. Conversely, increased lithium levels leading to toxicity has occurred with methyidopa and enalapril. When antihypertensive therapy is necessary, b-blockers are a reasonable choice when lithium is coadministered. 

Children with heart disease often require high-dose diuretic therapy, which can lead to hypochloremic metabolic alkalosis. There are limited data on the safety of acetazolamide in the treatment of hypochloremic metabolic alkalosis in children. In 28 patients, median age 2 (range 0.3-20) months who took acetazolamide 5 mg/kg for 3 days, there were no adverse events (36). There was no significant difference in any electrolyte concentration, except for serum HC03, which fell from 36 to 31 mmol/1, and serum chloride, which rose from 91 to 95 mmol/1. There was no change in urine output. Acetazolamide appears to be safe in very young patients when given for 3 consecutive days. 

The U.S. Centers for Disease Control (CDC) and the National Center for Health Statistics (NCHS) report that cardiovascular-renal drugs (including diuretics, beta blockers, and calcium channel blockers) were the most frequently prescribed medications in the United States in 1999 (the most recent year for which data was available). In fact, the loop diuretic Lasix was the second most frequently prescribed medication overall, with more than 12.9 million prescriptions written. It was second only to the allergy drug Claritin. 

Practical use of ACE inhibitors Based on the data from published trials, the 2005 American College of Cardiology/ American Heart Association (ACC/AHA) guidelines (II) recommend ACE inhibitors as first-line therapy for symptomatic HF with reduced systolic function and for asymptomatic LV dysfunction. In stage C HF they should be used in conjunction with a diuretic to maintain the sodium balance and prevent the development of fluid overload. The ACC/AHA recommendations specify that ACE inhibitors should be initiated at very low dose and gradually uptitrated. Patients with HF should not generally be maintained on very low doses of an ACE inhibitor unless these are the only doses... 

Diuretics and/or (3-blockers are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality. Recent data suggest that diuretics are superior to (3-blockers in older adults. 

These data show the presence in subesophageal and thoracic ganglia of Locusta of an antiparallel dimeric peptide (F2), which was called the AVP-like insect diuretic hormone (AVP-like DH) (H). The sequence homology between the AVP-like DH and the vertebrate neurohypophyseal peptides is strong Cys-(2)-(3)-(4)-Asn-Cys-Pro-(8)-Gly-NH2. The AVP-like DH and AVP differ only at positions 2, 3, and 4, whereas the homology to the ancestral molecule arginine vasotocin is even stronger, with differences restricted to positions 2 and... 

---