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Diuretics - thiazide diuretics

Thiazide diuretics include:

  • Chlorothiazide (Diuril)
  • Hydrochlorothiazide (Aquazide, Esidrix, Ezide, Hydrocot, HydroDIURIL, Microzide, Oretic)
  • Indapamide (Lozol)
  • Methyclothiazide (Aquatensen, Enduron)
  • Metolazone (Mykrox, Zaroxolyn)
  • Chlorthalidone (Thalitone)
  • Bendroflumethiazide (Naturetin)

Thiazide diuretics and potassium-sparing diuretics may sometimes be used together. Diuretic combinations include:

  • Hydrochlorothiazide/triamterene (Maxzide, Dyazide)
  • Hydrochlorothiazide/ spironolactone (Aldactazide)
  • Amiloride/ hydrochlorothiazide (Moduretic)

Depletions from thiazide diuretics are discussed in this article. If you are taking any of these combinations, you may also want to consult the potassium-sparing diuretics depletion article.

 

Depletions

Taking thiazide diuretics may deplete sodium, magnesium and potassium.

Sodium

Sodium deficiency is rare because it is widely available in dietary sources. When it does occur, low levels have been associated with:

  • Weakness
  • Nausea and vomiting
  • Headache
  • Confusion
  • Memory impairment
  • Reduced attention
  • Muscle cramps
  • Strong, rapid or irregular heartbeat
  • Lack of energy
  • Restlessness

Severe cases can cause seizures, loss of consciousness, and possibly coma. The development of symptoms depends on how fast you lose sodium.

Magnesium

Magnesium deficiency affects calcium and vitamin D levels in the body. This may cause:

  • Muscle cramps
  • Muscle weakness
  • Irregular heartbeat
  • Numbness and tingling in feet and toes
  • Seizures
  • Insomnia
  • High blood pressure

Potassium

Symptoms of potassium deficiency include:

  • Nausea and vomiting
  • Tiredness
  • Drowsiness
  • Feeling of apprehension
  • Weakness
  • Muscle pain and weakness (mostly in the legs)
  • Muscle cramps
  • Strong, rapid or irregular heartbeat

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

  • Your medical history
  • Diet
  • Lifestyle
  • How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Dineen R, Hannon MJ, Thompson CJ. Hyponatremia and hypernatremia. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 112.

First Consult: Hypomagnesemia. February 20, 2013. www.clinicalkey.com/#!/content/medical_topic/21-s2.0-2001655. Accessed July 7, 2016.

Gold Standard Drug Database. Drug Monograph: Amiloride; Hydrochlorothiazide, HCTZ, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-863. Accessed July 19, 2016.

Gold Standard Drug Database. Drug Monograph: Bendroflumethiazide, 2015. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1205. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Chlorthalidone, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-122. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Chlorothiazide, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1249. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide, HCTZ, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-296. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide, HCTZ; Spironolactone. 2016, www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1085. Accessed July 19, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide, HCTZ; Triamterene, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1087. Accessed July 19, 2016.

Gold Standard Drug Database. Drug Monograph: Indapamide, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-312. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Methyclothiazide, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1449. Accessed July 11, 2016.

Gold Standard Drug Database. Drug Monograph: Metolazone, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-396. Accessed July 11, 2016.

Leone KA. Calcium, magnesium, and phosphorus. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 166.

Osborn MB. Potassium. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 165.

Pfennig CL, Slovis CM. Electrolyte disorders. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 125.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31.

Yu ASL. Disorders of magnesium and phosphorus. In: Lee G, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier; 2016:chap 119.

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          Review Date: 9/19/2016  

          Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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