Diuretics, often called water pills, help remove excess salt and water from the bloodstream through urine. There are different types of diuretics available and all act differently on the kidneys but the primary goal of this prescription drug is to draw sodium into the urine, reducing fluid levels in the body. This effect is commonly used as a first-line treatment for heart conditions such as high blood pressure (hypertension). Excess sodium in the body leads to fluid retention, making it harder for the vascular system to circulate blood, which increases pressure on the blood vessels. To resolve this problem, diruretics are prescribed.

What are diuretics?

Diuretics or water pills are medications that are made to remove excess fluid from the body by increasing urine production. These help your kidneys release more sodium into your urine."The sodium helps remove water from your blood, decreasing the amount of fluid that flows through your veins and arteries, which in turn reduces blood pressure. They make you pee more frequently, which is why you should take them in the morning if you can," explains Nephrologist Dr Shailesh Kakde. You may need to take these medicines once or twice a day at the same time each day. In most cases, these are taken orally, but in some serious cases, they are taken intravenously (through the veins).

Why are diuretics used?

The most common condition treated with diuretics is high blood pressure (hypertension) or those who have too much fluid in their bodies, as per research published in StatPearls. They can  other health conditions, such as:

• Cirrhosis: A liver disease where scar tissue replaces healthy liver tissue, leading to various complications.
• Liver failure: A severe condition where the liver is unable to perform its vital functions.
• Congestive heart failure: A condition where the heart struggles to pump blood effectively.
• Kidney disorders: Since the kidneys filter blood, kidney issues can lead to blood pressure problems.
• Edema: Characterised by excess fluid accumulation in the body, resulting in swelling.
• Glaucoma: A group of eye disorders that damage the optic nerve, potentially causing vision loss.

Diurtics are used to lower blood pressure. Image courtesy: Shutterstock

Overall, they help manage symptoms related to fluid retention.

How can diuretics help with high BP?

Diuretics are medications that help eliminate excess water and electrolytes from the body by increasing urine production. Dr Kakde explains, "The drugs reduce the amount of fluid buildup in your blood vessels, and this helps lower your blood pressure." They are commonly prescribed to manage hypertension, or high blood pressure, which may contribute to the development of heart disease and stroke by causing the blood to exert excessive pressure on blood vessel walls.

According to the Journal of Hypertension, prescribed diuretics can lower blood pressure and reduce the risk of serious health issues. Since high sodium levels in the bloodstream are a major factor in hypertension, diuretics aid in removing sodium and are beneficial in treating high blood pressure.

Types

They come in different types, including carbonic anhydrase inhibitors (CAIs), loop diuretics, osmotic diuretics, potassium-sparing diuretics, and thiazides, each with specific uses and potential side effects, as per a study published in the Archives of Pharmacology.

1. Thiazide diuretics

This includes hydrochlorothiazide, chlorthalidone, metolazone, and indapamide, which are the most common types of diuretics used to increase the release of salt in urine. They help decrease fluid levels and relax blood vessels. Its side effects include headache, loss of appetite, and hair fall.

2. Loop diuretics

These include furosemide, bumetanide, ethacrynic acid, and torsemide, which are often used to treat heart failure, nephrotic syndrome or cirrhosis, and high blood pressure. They cause the kidneys to pass out more fluid, which leads to increased urine production. This may also help reduce the symptoms of edema and any breathlessness that fluid congestion may have caused. Its side effects include dizziness, diarrhoea, and an upset stomach.

3. Potassium-sparing diuretics

Amiloride, eplerenone, triamterene, and spironolactone are some potassium-sparing diuretics that can help your kidneys clear salt and water out of your body, but do not let you lose too much potassium in the process. They are often used in combination with other diuretics to prevent hypokalemia (potassium deficiency). Its side effects include gas, nausea, and headache.

4. Carbonic anhydrase inhibitors (CAIs)

They include acetazolamide, methazolamide, and dorzolamide, which are used to inhibit the action of an enzyme called carbonic anhydrase. This enzyme is involved in various body processes and inhibiting it can have effects like reducing eye pressure or increasing urine production. CAIs are often used to treat glaucoma, sickness, and edema due to congestive heart failure.

There are different types of diuretics. Image courtesy: Pexels

5. Osmotic diuretics

Osmotic diuretics such as mannitol, remove extra water from your body without disrupting the balance of electrolytes. These are used primarily in acute situations, like reducing intracranial pressure or treating an acute kidney injury.

Each diuretic type has specific applications and potential side effects. All these above-mentioned details are mentioned in a study published by the Archives of Pharmacology.

Side effects you must know

• Lack of potassium in the blood
• Too much potassium in the blood
• Low sodium levels
• Headache
• Dizziness
• Thirst
• Increased blood sugar
• Muscle cramps
• Increased cholesterol
• Skin rash
• Gout
• Diarrhoea

“In some rare and serious cases, a person may experience more serious side effects, including allergic reactions, kidney failure, and an irregular heartbeat. If a person is experiencing side effects when taking diuretics, they should speak to a doctor. Also, a person should never start or stop taking their diuretics without consulting a doctor,” suggests Dr Kakde.

Risks of diuretics

Water pills are generally safe, but there are some risks if you have other medical conditions or take certain medications.

1. Diseases

Diuretics, while effective for managing conditions like hypertension and edema, come with several risks. For individuals with certain health issues, such as diabetes, gout, pancreatitis, kidney disease and menstrual problems, diuretics can worsen electrolyte imbalances, lead to dehydration, or impair kidney function. So, a person should inform their doctor if they have any pre-existing conditions before they take water pills.

2. Drug interactions

Some drugs, such as laxatives, oral antidiabetic agents, antihypertensive agents, antidepressants, digoxin, and other high BP, may interact with diuretics. Diuretics can alter the effectiveness of these medications and increase the risk of adverse effects.

Consult with your doctor before taking diuretics! Image courtesy: Adobe Stock

3. Herbal and plant diuretics

Herbal or plant-based diuretics, such as hawthorn, green and black tea, and parsley, might seem safer due to their natural origins, but they can also pose risks. These herbal remedies may interact with prescription medications or exacerbate existing health conditions. Therefore, it is crucial to avoid or take them after consulting a doctor.

Prescription diuretics can help treat serious conditions, such as heart failure, and less-pressing conditions, such as mild high blood pressure. However, if you experience any adverse effects, speak to your doctor. Your doctor may help you.

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