Diuretics exert their effect directly on the

kidneys. Most of them lead to electrolyte

excretion and
Hydrochlorothiazide Amiloride
consequently to Chlorthalidone Triamterene
Indapamide Spironolactone
osmotic excretion
Diuretic Drugs of water, which
increases the 24-hr
Prof.Dr.M.Aydın Barlas urine volume.
Mannitol
Acetazolamide
**Main mechanism Furosemide
Furosemide
Torsemide
of action of diuretics Torsemide

is inhibition of the
tubular reabsorption

1. Salidiuretics
(thiazides and their analogues)
They increase equivalently Na+ and Cl-
excretion (1:1) in distal renal tubules and
this increases diuresis. They lead to
excretion of 5 to 10% from filtrated Na+ ions
and have moderate diuretic action. They
can be classified as sulfonamides with free
–NH2 group, without antimicrobial activity.
 Salidiuretics (saluretics)

Thiazides Thiazide analogues

•Hydrochlorothiazide •Clopamide
•Cyclopenthiazide •Chlorthalidone

Vasodilators with antihypertensive effect

•Indapamide (stimulates synthesis of renal PGs
with vasodilating action)

Indapamide SR
(does not have Hydrochlorothiazide
metabolic effects) Chlorthalidone
•cardioprotector Indapamide
•nephroprotector (Fludex)
5–10%
 Thiazides have also a weak antihypertensive
effect because they reduce arterial wall sensitivity
to NA (noradrenaline) and AT-II (Angiotensin-II).
They potentiate significantly the effect of
other antihypertensive drugs.(popular combination)
Thiazides increase plasma renin levels.
Reduction of plasma sodium &osmolarity leads
to “paradoxal” antidiuretic effect in
diabetes insipitus
2. Loop Diuretics
Adverse reactions (ARs) of saluretics:
Hypokalemia & enhancing therapeutic & toxic eff.
of Cardiac Glucosides, hypochloremic alkalosis,
GI disorders, skin rashes and photosensibility,
muscle weakness and fatigue, hyponatremia,
hypoglycemia, increased plasma level of uric
acids, hypercholesterolemia, impotence…….
Thiazides decrease GF (glomerul filtration).
They reduce plasma volume in pregnant
women and decrease fetal oxygenation (PRC: D).
Furosemide(Lasix) has p.o. Bioavailability is
65 % & t1/2 30–60 min. It acts on the ascending
limb of Henley's loop by increasing
urine excretion of Na+, Cl, Mg2+ , K and
Ca2+. Its diuretic effect is achieved in
20–30 min after p.o. administration
and lasts 4–6 h. Its effect after i.v.
administration begins in 3–5 min. and
lasts 2 hrs. In low doses (5 to 10 mg p.o.)
furosemide has antihypertensive effect.
It does not disrupt Glomerular Filtration

Furosemide(Lasix) – indications:
Oedemas of different origin, acute ischemic
renal failure (together with mannitol), anuria &
eclampsia, forced diuresis in acute intoxications,
hypertension, resistant cardiac failure…….
Furosemide enhances the action of
antihypertensive drugs and
non-depolarazing neuromuscular blockers.
Furosemide – ARs: 3. Carbonic anhydrase inhibitors

Hypokalemia, skin rashes, hyperglycemia,

increased plasma levels of uric acid.
In fast i.v. administration – transient
hearing disturbances with temporary
deafness and orthostatic collapse. Acetazolamide inhibits carbonic
Ototoxic risk is increased in co-medicaton anhydrase (CA) mainly in proximal tubules.
with aminoglycosides, cephalosporines,
CA
polymyxins, sulfonamides or quinolones. H2O + CO2 H2CO3 HCO3– + H+

Acetazolamide(Diazomid) has weak diuretic action. 4. Potassium- Amiloride

Triamterene
It significantly enhances urinary K+ excretion.
The loss of HCO3– anions decreases blood alkaline reserve sparing diuretics Spironolactone
(for 48–72 h) and causes metabolic acidosis. In this state the 3%
drug becomes ineffective.(Tolerance rapidly develops to its
effect)
Acetazolamide blocks not only renal Carb.Anhyd. but also
CA in the ciliary body in the eye, reducing production of eye
liquid, indicated for glaucoma & in the brain(facilitates GABA
synthesis).Other uses include epilepsy, acute mountain
(altitude) sickness, cystinuria, benign intracranial HT, dural Often they are used
They have weak
ectazia……. diuretic action
in combination with
Diuretics which cause
and save K+.
hypokalemia.
 Potassium-sparing diuretics

Competitive Blockers of the

aldosterone amiloride-sensitive
antagonists: Na+ channels:
•Spironolactone •Amiloride
•Triamterene

Spironolactone(Aldacton) is a steroid compound

which is a competitive aldosterone antagonist (also blocks
mineralocorticoid effects of other steroids)
It increases Na+ excretion and decreases K+ and urea excretion
Its diuretic action is weak and is achieved slowly.
Spironolactone is effective in oedemas caused by
increased production of aldosterone, ascites in liver cirrhosis
and oedemas in congestive heart failure.

Spironolactone in low doses (25 mg/24 h)
potentiates the effect of ACE inhibitors. It
saves K+ and Mg2+ ions & has antiarrhythmic
effect. It also prevents the development of
myocardial fibrosis, caused by aldosterone
and in this way contributes to enhancing
myocardial contractility.
5. Osmotic diuretics
60–80%
Aldactazide(spironolactone/hydrochlorothiazide)
İs used in oedemas ,CHF, ascites, nephrotic synd.
and for certain types of HT(unknown origine)
Diuretidin® (not available in T.)
(triamterene/hydrochlorothiazide)is indicated in oedemas
of cardiac, renal, liver or other origin and for the
treatment of hypertension with other antihypertensive
drugs.
Moduretic® (not available in T.)
(amiloride/hydrochlorothiazide)has the same indications
After oral administration Mannitol is not
absorbed and has laxative effect. After i.v.
administration it is not metabolized, it
filtrates in the glomerulus and not reabsorbed
in renal tubules, causing increased osmotic
pressure and excretion of isoosmotic equivalent
of water. It increases blood flow in 30%.
Мannitol does not influence renin synthesis. 6. Phytodiuretics

It does not cross tissue barriers (BBB neither),

does not penetrate to the eye and brain and
in osmotic way reduces intraocular and intra-
cranial pressure.
Rhizoma Graminis
It is included in the treatment of brain oedema,
(Couch-grass:ayrık otu) Fructus Petroselini
initial stages of acute renal failure, chronic Stipites Cerasorum
renal failure, glaucoma, intoxications with (Parsley: maydanoz)
(Cherry: kiraz) Stigmata Maydis
drugs. Excreted in the urine. Fructus Faseoli sine semine (Maize, corn: mısır)
(Haricot: fasulye)

Tavşancıl otu
 Ayı üzümü
Biberiye
Adi ardıç

At kuyruğu

Kızılkök
Rubia tinctorum L. (madder). Radix Rubiae
contains 2–3% di- or trioxyanthraquinones
glycosides, flavonoids and other bioactive
substances with diuretic, urolitholytic and
spasmolytic effects.

Infusions (1:10) made from madder facilitate dilution

of calculi, containing calcium and magnesium sulfate
in the renal pelvis and bladder.

It is an important ingredient of many phytoproducts

(Cystenal©, Rowatinex©), indicated in urolithiasis.