Thiazide diuretics mechanism of action and side effects

Drugs of this group inhibit the reverse absorption of sodium and chloride in the tubules of the kidneys, so they do not enter the bloodstream, but are excreted in the urine from the body. Together with them, the release of water, potassium and magnesium ions increases. The second point of application of thiazides is the inhibition of the activity of the enzyme carbonic anhydrase and increased excretion of bicarbonate ions.

Among all diuretics, potassium loss is most likely to occur and the sodium content in the vessel wall decreases.
The latter effect prevents the narrowing of the lumen of the arteries, so they reduce the blood pressure only with its initially high level. They enhance the effect of antihypertensive drugs and regulate the osmotic blood pressure in diabetes insipidus, which facilitates the feeling of thirst in patients.

Diuretics do not occupy the last place in the treatment of high blood pressure due to the removal of excess fluid from the blood and lowering the volume of the substance circulating in the vessels. This further reduces cardiac output.

When taking diuretics, a lasting effect of lowering blood pressure is achieved, since a decrease in peripheral resistance is observed in the vessels. Drugs of this type are prescribed for hypertension in small quantities (the exact dosage and type of drug are determined by the doctor based on the patient’s condition, thiazide and loop diuretics are often used).

Diuretics are not used in the treatment of hypertension in those who have diabetes, have any degree of obesity, or are too young. With increased blood pressure, thiazide diuretics are most often used, since these drugs do not cause the development of heart failure.

The method of influencing this type of diuretics on the body is similar to how thiazide diuretics work – in this case, the reverse absorption of sodium ions is disrupted with their loss in the water excreted by the kidneys.

The effectiveness of potassium-sparing diuretics can not be called high. Such drugs do not have a quick effect – the first therapeutic manifestations are observed only by 3-5 days from the start of administration. That is why drugs that preserve potassium in the body are most often used not as a primary means, but as an additional.

Such diuretics are used for heart failure, adrenal tumors and cirrhosis. Potassium-sparing diuretics are common as the main therapeutic agent for those who cannot tolerate stronger drugs that can remove potassium cations (during the treatment of heart diseases). They can be used as a prophylactic in the treatment of thiazide or loop diuretics by reducing the loss of K. ions.

Among potassium-sparing diuretics are especially popular:

  • Amiloride;
  • Spironolactone;
  • Triamteren (Triampur).

Members of this class of diuretics are benzothiadiazine derivatives. The term “thiazide” is also often used for drugs with a similar effect that do not have a thiazide chemical structure. For example, chlortalidone and metolazone. These agents are more correctly called thiazide-like diuretics.

The mechanism of action of thiazide diuretics in lowering blood pressure is not fully understood. With the introduction of thiazides, pressure decreases due to an increase in diuresis, a decrease in plasma volume and a decrease in cardiac output. An interesting fact is that with constant use
thiazide diuretics pressure reduction is also achieved by reducing peripheral resistance (i.e.

Unlike loop diuretics, thiazide diuretics increase calcium reabsorption.
in the distal tubules of the nephron. With a decrease in the concentration of sodium in the epithelial cells of the tubule, thiazides indirectly increase the activity of the Na-Ca antiporter.

This facilitates the transfer of Ca from epithelial cells to the renal interstitial tissue. By itself, the Ca movement decreases the concentration of intracellular Ca, which allows Ca to diffuse even more from the lumen of the tubules into epithelial cells through apical Ca selective channels (TRPV5). In other words, a decrease in the concentration of Ca in the cell increases the motive force for its reabsorption from the lumen of the tubule of the nephron.

Thiazide diuretics also increase Ca reabsorption using a mechanism in which reabsorption of Na and Ca in the proximal tubules is involved in response to a decrease in Na concentration. Part of this reaction occurs due to an increase in parathyroid hormone levels.

The diuretic effect of thiazide diuretics is much weaker than that of loop diuretics, it develops more slowly, but is longer.

Thiazides act on the renal tubules in which urine concentration occurs. Medicines do not allow the absorption of sodium, potassium, and chlorine ions into the body back into the blood. As a result, the volume of circulating blood decreases, edema disappears, blood pressure (BP) decreases.

What caused the long-term effect of the drugs is still completely incomprehensible. After canceling their intake, the blood volume quickly increases, a person gains weight, the level of renin drops. However, blood pressure rises very slowly. It has been suggested that a decrease in the concentration of sodium in the walls of blood vessels makes them less susceptible to brain signals, causing the arteries to contract. This explanation could be confirmed experimentally, but the mechanism of its operation is incomprehensible.

The main properties of thiazide, thiazide-like diuretics:

  • hypotensive – lower blood pressure (BP);
  • dehydration – contribute to the removal of water;
  • antianginal – inhibit the development of angina pectoris;
  • antiatherogenic – prevent the occurrence of atherosclerosis;
  • metabolic – affect the mineral metabolism, accelerating the excretion of sodium, chlorine, prevent the leaching of calcium.

The main direction of action of diuretics is the removal of excess fluid from the tissues of the human body. Thanks to this, the body is cleansed of the excessive content of mineral salts, water, as well as harmful substances.

Diuretics are prescribed in the event of the following pathologies in the body:

  • renal disease;
  • high blood pressure;
  • heart failure;
  • disruption of the liver;
  • swelling of the brain, also lungs of varying severity.

The mechanism of action of diuretic drugs is to reduce the absorption capacity of the renal tubules. At the same time, increased urine production occurs. As a result of these processes, excess water and mineral salts are removed from the body at a faster rate.

In turn, this has a beneficial effect on processes such as:

  • normalization of blood pressure;
  • normalization of intraocular pressure;
  • normalization of intracranial pressure;
  • improving heart function;
  • blood purification (in case of poisoning).

Disease and impaired proper functioning of the kidneys are almost always accompanied by the occurrence of edema of varying severity. They are one of the first signals of a problem.

In order to choose the right diuretic drug, you must go through a doctor’s consultation and pass the tests first. Issues of diseases of the excretory system and kidneys in particular are dealt with by a nephrologist or urologist.

Often, for the treatment of renal pathologies, plant-based diuretics based on such herbs are prescribed:

Usually prescribed to take decoctions of one particular herb. In the case of cranberries, we are talking about the use of fruit drinks from berries.

Of the drugs of industrial production, the most effective in treating kidney diseases are:

Furosemide and Trifas are drugs that quickly and effectively relieve excessive swelling. Phytolysin, in addition to the diuretic effect, is a good anti-inflammatory and bactericidal agent.

A proven drug for the treatment of pyelonephritis and urolithiasis is Cyston.

Diuretics are often used in conjunction with other drugs. As a result, the effectiveness of these drugs varies, and unwanted effects may occur.

The combined use of thiazide diuretics and cardiac glycosides increases the toxicity of the latter due to hypokalemia. Their simultaneous use with quinidine increases the risk of its toxicity. The combination of thiazide drugs with antihypertensives has an increased hypotensive effect. With their simultaneous administration with glucocorticosteroids, the likelihood of hyperglycemia is high.

torasemid diuretik - Thiazide diuretics mechanism of action and side effects

Furosemide increases the ototoxicity of aminoglycosides, increases the risk of glycoside intoxication. With a combination of loop diuretics with non-steroidal anti-inflammatory drugs, the diuretic effect weakens.

Spironolactone helps increase the concentration of cardiac glycosides in the blood, enhances the hypotensive effect of antihypertensive drugs. With the simultaneous administration of this drug and non-steroidal anti-inflammatory drugs, the diuretic effect decreases. Uregitis causes an increase in the toxicity of aminoglycosides and zeporin.

The combination of thiazide and loop diuretics and ACE inhibitors leads to an increase in the diuretic effect.

Thiazide diuretics are a special class of diuretics, which is most often used to treat hypertension and edema (caused, for example, by heart, liver or kidney failure). This group of diuretics is homogeneous in pharmacological action, and substances differ from each other only in duration and strength of action.

This particular class of diuretics was developed back in 1950. Chlortiazide was the first known drug in this group. It should be noted that in most countries of the world, thiazide diuretics are the most readily available drugs for the treatment of hypertension.

Drug List

In pharmacies, you can now find a large number of urinary drugs of various types.

Before you go shopping, which absolutely should not be done without the recommendation of a doctor, is it worth figuring out what applies to thiazide diuretics?

pills 1 - Thiazide diuretics mechanism of action and side effects

The following drugs are common in Europe:

  • Lozol
    generic: indapamide
  • Thalitone
    generic: chlorthalidone
  • Zaroxolyn
    generic: metolazone
  • Aquatensen
    generic: methyclothiazide
  • Aquazide h
  • Diuril
    generic: chlorothiazide
  • Diuril sodium
    generic: chlorothiazide
  • Enduron
    generic: methyclothiazide
  • Esidrix
    generic: hydrochlorothiazide
  • Microzide
    generic: hydrochlorothiazide
  • Mykrox
    generic: metolazone
  • Naturetin
    generic: bendroflumethiazide
  • Saluron
    generic: hydroflumethiazide
  • Renese
    generic: polythiazide

According to some data abroad, the following drugs are also actively used:

  • metolazone
  • hydroflumthiaz >List of drugs with the active substance hydrochlorothiazide (Hydrochlorothiazidum)
  • Hydrochlorothiazide
  • Hydrochlorothiazide
  • Hydrochlorothiazide SAR
  • Hypothiazide

Due to the fact that these drugs are widely used to treat hypertension, this list is far from complete, but contains the main trade names for these compounds.

Thiazides include all derivatives of benzothiadiazine – hydrochlorothiazide, cyclopentiazide. A similar effect is possessed by substances completely different in chemical structure, which are called thiazide-like. These include chlortalidone, indapamide, xipamide, clopamide.

Conventionally, all diuretics are divided into two generations. The first includes hydrochlorothiazide, chlortalidone, the second – indapamide, xipamide, metolazone. More modern drugs differ from their predecessors in their ability to effectively remove sodium salts and water from the body, regardless of the state of the kidneys. The best of them is indapamide. Even the isolated use of this medication can normalize blood pressure in 70% of people.

The main effect, as the name implies, is the elimination of excess fluid. Otherwise, this type of medication is called a diuretic.

Thiazide diuretics are considered the safest and at the same time effective among this category of drugs. They are used in the treatment of arterial hypertension, heart failure and a number of other diseases.

However, like other diuretics, they are not suitable for independent use, they require accurate dosing and constant dynamic monitoring of the patient’s condition. Appointment is the prerogative of the doctor.

mochegonnye preparaty - Thiazide diuretics mechanism of action and side effects

The basis of the work of thiazide diuretics is the ability to influence the electrolytic balance in the body. In particular, drugs of this type reduce the rate of reverse absorption of sodium, chlorine and potassium ions.

For this reason, there is a decrease in the intensity of urine filtration and, as a result, a controlled violation of fluid reabsorption.

The result is the removal of water from the body. In addition, there is an increase in the transport of calcium ions, which is considered atypical for other types of diuretics.

Due to this effect, an even greater increase in urine production is observed.

The diuretic of the thiazide series is characterized by a combination of efficacy and relative safety. This is confirmed, including by numerous foreign studies.

The result from the use of a thiazide diuretic occurs after 30-60 minutes or faster. It depends on the individual characteristics of the body, body weight, the amount of food taken and other factors.

Drugs have a prolonged effect. They work for 10-12 hours, the peak falls on the first 180 minutes after application, then the effect becomes softer. This reduces the number of medications without compromising treatment.

At the same time, thiazide agents do not so actively remove electrolytes, when compared with loop diuretics, therefore, they can be used for the systematic treatment of hypertension.

Thiazide diuretics are considered moderate in potency, however, they excrete potassium, which makes them heavier and more dangerous in comparison with “soft” analogs like Veroshpiron, Spironolactone, and others like that.

Thus, the mechanism of action of thiazide diuretics is based on the ability to slow the penetration of potassium, sodium and chlorine ions into the kidney structures and accelerate the same process with respect to calcium. This gives a pronounced clinical effect without significant harm to the body.

The result is a drop in blood pressure (relatively slow if the funds are used correctly), normalization of the heart rate, and a decrease in the load on the cardiac structures.

Thiazide drugs are diverse, there are a large number of trade names.

There is no practical sense in the independent study of the assortment of the pharmacological market. Doctors need this information, because without knowledge it will not work to choose the “right” medication. But a common understanding does not hurt.

A relatively mild preparation with indapamide as the main active ingredient. Available in the form of tablets for oral administration.

According to specialized studies, it is used as part of the treatment of arterial hypertension. This is a key destination.

Efficiency in other cases is not known. The manufacturer himself points to the same thing in the description of the medication.

Arifon is available in several versions. There is a prolonged form (with the postfix “retard”), which is valid for more than 12 hours.

Despite the impressive number of listed side effects in the annotation, the likelihood of occurrence of those with proper administration and normal tolerance is minimal.

After the start of use, it is recommended to carefully monitor the condition and well-being. Any violation is the basis for consultation with a specialist and review of treatment.

A similar remedy. Contains the same active substance.

It is actively used for the treatment of arterial hypertension, regardless of the severity of the pathological condition.

As in the case with the previous medicine, this one does not have proven effectiveness in relation to other diseases and conditions.

Therefore, it should be used only as part of a systematic, comprehensive therapy for increasing blood pressure.

45613be65a56a678f266f23d445b5208 - Thiazide diuretics mechanism of action and side effects

Indapamide provokes side effects more often, because, as well as the concentration of the active component is higher than in Arifon: 2.5 mg versus 1.5.

The main problem that patients encounter is tachycardia. An increase in heart rate per minute.

At the same time, cases of an absent clinical effect are known. This is usually due to improper use, or the wrong combination of medications.

Indapamide is forbidden to take during pregnancy and lactation.

There is no fundamental difference between this name and the previous one. Full analogues. Only manufacturers are not identical.

Doctors recognize the possibility of some differences in efficacy and safety, because companies do not report on the raw materials used and the technology for creating drugs.

The intolerance of Indiur is likely with a normal reaction to other means of this series. In such a situation, a review of the therapeutic course is indicated.

In all cases, you need to carefully monitor your well-being, regularly evaluate blood and urine.

It is made in India. It is considered an affordable medication. As in the previous case, it is a complete analog of Indapamide with an identical dosage and exactly the same characteristics.

At the moment, finding the name is difficult, because the pharmacological agent is almost not supplied to the country.

The medication is formally considered an analog of Indapamide. But it is available in the form of capsules for oral administration.

This is not an obvious advantage of the drug. Because the medicine dissolves faster in the digestive tract. This means that the speed of occurrence of a useful result is achieved much faster. Otherwise, there are no fundamental differences.

All the medicines mentioned above have indapamide in different concentrations per tablet as their main active ingredient.

In all situations, there is a general recommendation: do not use the medication during pregnancy and breastfeeding. The tool increases the risks of congenital abnormalities in the development of the fetus, mental and physical, the likelihood of a child dying or fatal disorders in the mother’s body also increases.

tiazidniediuretikispisokpreparatovmexani F2E47C92 1 - Thiazide diuretics mechanism of action and side effects

Indapamide passes into breast milk and is passed on to the baby. This makes the preparations unsuitable for use during the period of gestation. If necessary, preference is given to other types of drugs.

In addition, medicines of this series are used only for the treatment of hypertension. This limits the use of funds. They are not suitable for edema and other conditions.

At the same time, the narrow focus of the action makes it possible to prescribe indapamide drugs with minimal risks of side effects.

The medication has a wider list of grounds for use.

The active substance of the same name has the ability to stop edema, reduce blood pressure.

It is also possible to prescribe a drug for the treatment of heart failure, glaucoma in the subcompensated phase, and diabetes mellitus of the renal type.

Such a wide list of indications, which is paradoxical, does not provoke an increase in the list of side effects. Moreover, hydrochlorothiazide and its analogues cause negative effects less frequently than indapamide names.

The question of the possibility of prescribing a medication during pregnancy remains open. Comprehensive studies have not been conducted.

However, there is evidence from experimental clinical trials. The use of the drug did not adversely affect the fetus, but information is still insufficient.

Therefore, experts are of the opinion that hydrochlorothiazide can be used for health reasons.

Thiazide diuretics are considered the safest and at the same time effective among this category of drugs. They are used in the treatment of arterial hypertension, heart failure and a number of other diseases.

Detonic – a unique medicine that helps fight hypertension at all stages of its development.

Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

Detonic not addictive and withdrawal syndrome, since all components of the product are natural.

Detailed information about Detonic is located on the manufacturer’s page

Mechanism of action

Thiazide diuretics are considered moderate in potency, however, they excrete potassium, which makes them heavier and more dangerous in comparison with “soft” analogs like Veroshpiron, Spironolactone, and others like that.


At the same time, cases of an absent clinical effect are known. This is usually due to improper use, or the wrong combination of medications.

Mechanism of action

Loop diuretics

Loop diuretics act in such a way that the active substance of the drug removes sodium ions and water through the kidneys. Often used as a quick aid, as the action usually occurs no later than 6 hours. If chronic heart failure is observed, loop diuretics are allowed only in short-term courses.

Prolonged or uncontrolled use of loop diuretics can cause abnormalities in the heart due to the loss of magnesium and potassium. Can be used if kidney function is impaired.

Among the contraindications, the following conditions can be noted:

  • myocardial infarction;
  • acute renal failure;
  • severe liver failure;
  • pancreatitis
  • stones in the kidneys;
  • gout;
  • urethral stenosis;
  • hypersensitivity;
  • aortic stenosis;
  • low blood pressure (loop diuretic can critically lower blood pressure).

Among the side effects can be noted: drowsiness, dizziness, photosensitivity, convulsive effects, arrhythmias, decreased pressure, acute urinary retention, decreased potency, vomiting, nausea, muscle weakness, impaired hearing and visual analyzers, tachycardia.

This category of drugs is the most common. It includes such drugs as Ethacrine acid, Torasemide, Furosemide, Pyrethanide, Bumetanide. Despite the fact that they can vary significantly in chemical structure, these diuretics have the same mechanism of action.

These medications inhibit the reabsorption of substances such as sodium, chlorine and potassium. The name “loop diuretics” is associated with their mechanism of action. Resorption occurs in the ascending lobe of the Henle loop. It is carried out due to the blockade of sodium, chlorine, potassium ions in the apical membrane of the tubular epithelium of cells. Due to this, the operation of the rotary countercurrent system in the kidneys is suppressed. In addition, diuretics of this type are able to dilate the vessels of the cortical substance.

The strength of the effect of these medications is unusually high: they can increase diuresis by 25%. Unlike other drugs that lose their effect with normalization of bcc, loop-type diuretics continue to function under these conditions. It is due to the strong diuretic effect that they can provoke such side effects. The most rare and severe are a drop in blood pressure, hypovolemia, a decrease in the level of GFR and renal blood flow.

Due to the increased level of excretion of hydrogen, chlorine and potassium, metabolic alkalosis is not excluded. Sometimes loop diuretics provoke hyponatremia and hypokalemia. In rare cases, hyperglycemia, hyperuricemia. Other side effects are: lightheadedness, nausea, weakness. The medicine “Ethacrine acid” often provokes permanent or temporary deafness, as well as neutropenia. All medications of this type, which were listed above, are excreted by the kidneys, metabolized in the liver.

Especially powerful drugs with a diuretic effect. The components of drugs affect the Gengle loop – the tubule of the kidneys, which is directed to the center of the organ. This formation in the form of a loop absorbs back liquid with various kinds of substances. Medicines of this group contribute to the relaxation of the walls of blood vessels, activate renal blood flow, gradually reduce the volume of fluid between cells, accelerate glomerular filtration. Loop diuretics reduce the reverse absorption of potassium, sodium, chlorine and magnesium salts.

The advantages of these drugs:

  • fast efficiency (up to half an hour after application);
  • powerful influence;
  • suitable for emergency care;
  • work up to six hours.

The most effective formulations: Ethacrine acid, Pyrethanide, Furosemide tablets.

The latter is a loop diuretic that causes fast onset, strong and short-term diuresis. Reabsorption of sodium and chlorine ions is blocked both in the proximal and distal sections of the renal tubules, as well as in the thick segment of the ascending part of the Gentle loop. “Furosemide” in tablets has a pronounced diuretic, natriuretic and chloruretic action.

It is worth noting that such drugs are used only in critical situations. Taking diuretics often leads to serious complications: pulmonary and brain edema, hypertensive crisis, severe inflammation of the liver, excessive potassium, heart and kidney failure.

Loop diuretics are used in medicine mainly for the treatment of hypertension and edema of various origins, more often with congestive heart failure or renal failure.

Loop diuretics are used for:

  • edema of various origins (liver, cardiac and especially renal), for example, with edema associated with heart failure, cirrhosis, renal failure and nephrotic syndrome;
  • in acute renal failure – increase renal blood flow and stimulate the separation of urine in anuria (soak the patient);
  • hypercalcemia (intensively remove calcium from the body);
  • for forced diuresis in case of poisoning with various chemicals, including drugs;
  • loop diuretics are used for emergency care for pulmonary edema and cerebral edema;
  • with arterial hypertension – are prescribed only for severe heart failure, in other cases, due to prolonged action, thiazide diuretics are more preferable.

A systematic review by the Cochrane Hypertension group, evaluating the antihypertensive effects of loop diuretics, found only a moderate decrease in blood pressure compared with placebo. The review emphasizes the need for more randomized trial control.

Use for the treatment of hypertension

The mechanism of action of thiazide diuretics determines their main medical indications:

  1. edema of the body that occurs during the development of heart failure, cirrhosis of the liver and nephrotic syndrome;
  2. hypertension, during the treatment of which antihypertensive drugs are also used;
  3. renal stone disease.


When taking thiazide diuretics, it is worth remembering that there are diseases in which it is not advisable to use the drug, and in some cases it is even contraindicated.

The main disease in which the use of such medications is contraindicated:

  • Gout
    , which is a consequence of metabolic disturbances, which means if they accelerate the development of the disease will also accelerate;
  • Hyperuricemia
    – a disease in which the amount of uric acid exceeds the norm. With this disease, accelerating the withdrawal of fluid from the body will aggravate the concentration of uric acid.
  • Hypokalemia, hyponatremia
    – lack of potassium and sodium in the body. With an increase in fluid urine output, more and more potassium or sodium will be excreted.
  • Hypercalcemia
    – the calcium content in the body is higher than normal, drugs can lead to calcification of kidney stones, which will aggravate urolithiasis.
  • Kidney and liver failure
    in acute form, is a direct contraindication to taking diuretics. The kidneys simply can not cope with a large flow of fluid.
  • Addison’s disease
    – bilateral inflammation of the adrenal cortex, which interrupts the production of corticosteroids.

These medications are prescribed for all types of heart failure. And they are especially necessary for diseases such as heart failure of the refractory type and pulmonary edema. Medications are also effective for hyponatremia, hypoalbuminemia, hypokalemia, hypochloremia, and renal failure. Loop-type diuretics continue to work when other diuretic groups and their combinations are ineffective. This is their great value. Therefore, this type is so common – a loop diuretic. What is it, we have already figured out.

Diuretics for hypertension are well established. They help to remove fluid from the body, which reduces pressure. A proven fact is that diuretic drugs are more effective for the treatment of elderly patients compared to beta-blockers.

Urethic drugs are included in the list of first-line drugs that are used to normalize blood pressure. According to the recommendations of US physicians, this category should be used for the initial treatment of hypertension (uncomplicated). Due to the great importance of controlling blood pressure, as well as reducing cardiovascular risks during treatment, special attention is paid to the metabolic effects that are characteristic of antihypertensive medications. Their influence on the course of associated ailments and organ-protective characteristics is also important.

Thiazide diuretics have been used continuously in the treatment of hypertension since they appeared on the market. This particular class of diuretics is the cornerstone in the treatment of hypertension. Very few drugs used to treat any disease can boast such a long period of use, and this indicates both the effectiveness and safety of these chemical compounds.

Many clinical guidelines for the treatment of hypertension consider the use of thiazide diuretics. They are used as first-line drugs in the USA (JNC VII) and are recommended for use in Europe (ESC/ESH). Nevertheless, in 2011, the National Institutes of Health in the United Kingdom (NICE) recommended calcium channel blockers (BCCs) as first-line drugs in their guidelines for the treatment of essential hypertension.

However, they also note that thiazide diuretics can be used as first-line drugs in cases where CCL is contraindicated, if the patient has edema or a high risk of heart failure. Thiazide diuretics have been replaced in Australia by angiotensin-converting enzyme inhibitors (ACE inhibitors) because of their tendency to increase the risk of type 2 diabetes.

Thiazide diuretics are actively used to treat the following types of edema:

  • Edema of cardiac origin;

However, it should be borne in mind that in severe chronic heart failure (CHF), loop diuretics are significantly more effective.

  • Edema of hepatic origin (with cirrhosis);
  • Edema of renal origin;

However, they are ineffective in severe renal failure – with a decrease in glomerular filtration of less than 30-40 milliliters per minute. The exceptions are metolazone
and indapamide
due to the additional site of action in the proximal tubules.

  • Edema with prolonged administration of glucocorticoids.

Thiazide diuretics are absolutely contraindicated in the following diseases:

  • Hypotension;
  • An allergic reaction to the drug;
  • Gout;
  • Renal failure;
  • Lithium therapy;
  • Hypokalemia;
  • May worsen diabetes.

Thiazide diuretics reduce uric acid clearance, as they compete with it for the same transporter, therefore they increase the level of uric acid in the blood
. Therefore, they should be used with caution in patients with gout or hyperuricemia.

Continuous use of thiazide diuretics can lead to hyperklycemia.
. Thiazide diuretics can cause the body to lose potassium
while maintaining the content of CA.

Thiazide diuretics can reduce placental perfusion and adversely affect the fetus, so you should avoid taking them during pregnancy

Thiazide diuretics can be considered from two sides: on the one hand it is a special type of molecule with a certain structure, on the other hand it is a medicine with a certain mechanism of action.

And confusion can occur because some molecules are thought to be thiazide diuretics, although they are not from a chemical point of view.

In this context, “thiazide” is taken to mean a drug that acts on the thiazide receptor, which scientists believe is located on the Na-Cl symporter.


In addition, medicines of this series are used only for the treatment of hypertension. This limits the use of funds. They are not suitable for edema and other conditions.


The tool is identical to the previous one. It is based on the same active substance. But the concentration of the component is four times higher (25 mg versus 100).

Because hypothiazide is considered more powerful, it is used carefully in severe cases. Strictly prescribed by a doctor and under his supervision.

The list of thiazide diuretics is incomplete. In fact, there are many more, but these are key funds that are actively prescribed by cardiology specialists.

All drugs of this type are characterized by a lack of dose dependence. That is, the clinical effect does not depend on the amount of funds taken, the result does not get better. Rather, the opposite.

The risks of overdose and the opposite effect are growing, in such a situation irreversible damage to the kidneys, heart, and vessels is possible. Also fatal.


The grounds for using the medicine depend on the specific name of the drug.

If we talk about drugs of the indapamide series, they are used in the treatment of arterial hypertension, regardless of its severity.

If we talk about the average list of indications, thiazide diuretics are used in such cases:

  • Heart failure in the decompensated phase.
  • Renal dysfunction.
  • Also, edema of nephro- or cardiogenic origin. For prolonged use, drugs are not suitable. Used situationally or at the discretion of the doctor.
  • Glaucoma. Increased intraocular pressure. Not in all cases, only in the subcompensated phase.
  • Renal diabetes insipidus. Violation of the reaction of the structures of the excretory system to vasopressin, which is responsible for adequate reverse absorption of fluid. Used with great care.
  • Nephropathies of various origins are also included in the list of indications. In any case, the question of the appropriateness of use is decided by the doctor. Also, specific names are selected by a specialist.

Thiazide diuretics for hypertension, however, are prescribed most often, because an increase in pressure is considered a key reason.


  • Severe forms of renal or hepatic unworthiness. In the decompensated phase. To a partial normalization of the condition.
  • Individual intolerance to the main active ingredient or excipients.
  • Polyvalent allergic reaction to drugs. It is relatively rare, accompanied by the inability to use certain medications.
  • Diabetes. Uncontrollable. Before the correction of the condition and its compensation.
  • Severe gout. With frequent relapses. Otherwise – a form of arthritis, inflammation of the joints. It is caused by metabolic disorders in the body.
  • Also, contraindications include the period of pregnancy, breastfeeding. The use of drugs in children is not recommended, not including some items. The issue is resolved individually.

Side effects

Adverse events often develop with the use of indapamide drugs.

Hydrochlorothiazide provokes disorders less frequently. The average list is represented by a group of deviations:

  • Headache, inability to navigate normally in space.
  • Nausea, less often vomiting.
  • A sharp drop in blood pressure with the development of the same neurological signs.
  • Visual impairment. Infrequently.
  • Tachycardia. An increase in the number of contractions of the heart per minute. It occurs mainly against the background of the use of Indapamide and its analogues.
  • Diarrhea.
  • Weakness, drowsiness, increased fatigue, decreased performance.
  • Allergic reactions. Basically – dermatitis, skin rash.

List of thiazide diuretics, mechanism of action, indications, contraindications and side effects

Do not use these diuretics for hypokalemia and ventricular arrhythmias. This threatens the patient with cardiac arrest, so saluretics are contraindicated in such situations.

If during the intake a decrease in the level of potassium in the blood is observed, then diuretics are immediately canceled.

When saluretics are used, an accumulation of uric acid salts is observed, so they are not used for gout and nephropathy.

It is forbidden to prescribe these drugs during pregnancy and in the presence of allergic reactions to drug components.

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Drugs from the group of thiazide and thiazide-like diuretics can cause various side effects in patients taking them. Most often diagnosed:

  1. allergies - Thiazide diuretics mechanism of action and side effectsHypersensitivity reactions of varying severity. In such situations, the drug should be stopped immediately.
  2. Decreased blood sodium and potassium. This threatens with serious complications in the work of the heart, therefore, the reception of saluretics is stopped, it is necessary to adjust the electrolyte balance of the body. After that, the attending physician selects the optimal treatment regimen.
  3. In some cases, the metabolism of uric acid is impaired, manifested by the deposition of its salts in the tissues of the joints and kidneys.
  4. Sometimes an increase in cholesterol in a biochemical blood test is diagnosed. This can cause the appearance of atherogenic plaques in the walls of blood vessels. In such situations, you need to take statins that normalize cholesterol.
  5. Drugs can disrupt carbohydrate metabolism.

The doctor should always be careful when prescribing thiazides, start treatment with small dosages, carefully monitor the patient’s condition (this will help to correct the therapy in time).

Thiazide diuretics can reduce blood pressure, normalize the amount of fluid in the body, remove excess. For prolonged use, the products are not suitable.

Also, you can not pick up medications yourself. Only as directed by a doctor.

Unlike other diuretics, these are optimal means for combining safety and effectiveness. Cost makes them one of the most affordable.

Arterial hypertension is a pathology that is characterized by high blood pressure and many people suffer from it. Diuretics for hypertension very well reduce pressure to normal levels. These medicines are effective and with minor side effects. Thanks to the diuretic effect, the load on the heart is significantly reduced, and the person’s well-being improves.

Diuretics are indicated for the long-term treatment of hypertension, but in small doses. Large dosages provoke diabetes, increase blood cholesterol. Diuretics are used not only for hypertension and heart failure, but also for other diseases:

  • kidney failure;
  • cirrhosis of the liver;
  • acute glomerulonephritis;
  • glaucoma;
  • pulmonary edema;
  • nephrotic syndrome.
  • hypersensitivity;
  • anuria (lack of urine formation);
  • gout;
  • severe hepatic or renal failure;
  • diabetes mellitus, which is difficult to treat;
  • Addison’s disease;
  • to children.

Caution thiazide diuretics are used for:

  • any damage to the liver, kidneys;
  • reduced potassium, sodium, increased calcium;
  • hyperparathyroidism;
  • ascites;
  • ischemic heart disease;
  • treatment with erythromycin, quinidine, disopyramide, amiodarone, astemizole, cardiac glycosides;
  • To old people.

Pregnant, lactating mothers are prescribed the drug in exceptional cases, if possible, doctors recommend refraining from taking thiazides.

Side effects

  1. Hypokalemia and its arrhythmogenic effect up to asystole. It requires drug withdrawal and correction of serum potassium content.
  2. Hyponatremia.
  3. Atherogenic changes in plasma with a tendency to thrombosis. Corrected by taking statins.
  4. Hyperuricemia with the development of gouty attacks of arthritis or with kidney damage by urate. Drug withdrawal causes a regression of this process.
  5. Impaired carbohydrate metabolism, especially when used together with beta-blockers.

From side effects of drugs, a list of contraindications is logically formed:

  • gouty arthritis, nephropathy;
  • hypokalemia;
  • reduced sodium
  • pregnancy (the use of Indapamide, as the least studied drug with an effect on the fetus, is especially undesirable); while taking Hypothiazide as part of a combination drug (without ACE inhibitors) is allowed;
  • allergic reaction.


Common combinations

Diuretics are rarely prescribed as monotherapy. To achieve a lasting effect with a minimum number of adverse reactions, they are combined with others. It can be two separate tablets or a complex medicine containing 2 active substances. Co-administration with, are the most preferred combinations (1). It is also advisable to prescribe thiazide diuretics and beta-blockers.

Common Combined Medicines

Active ingredientsTradename
valsartan hydrochlorothiazide
  • Valsacor
  • Duopress;
  • Valz N;
  • Co-Diovan.
irbesartan hydrochlorothiazide
  • Ibertan Plus;
  • Coaprovel;
  • Firmast N
losartan hydrochlorothiazide
captopril hydrochlorothiazide
lisinopril hydrochlorothiazide
  • Iruside;
  • Co-diroton;
  • Lysinotone H;
  • Scopril plus.
ramipril hydrochlorothiazide
  • Wazolong H;
  • Ramazide H;
  • Tritace plus.
enalapril hydrochlorothiazide
  • Burlipril plus;
  • Co-Renitec;
  • Enam H;
  • Enap N.
lisinopril indapamide
amplodipine valsartan hydrochlorothiazide
  • Co-Vamloset;
  • Co-Exforge;
  • Tritensin.
amplodipine indapamide

Diuretics are rarely prescribed as monotherapy. To achieve a lasting effect with a minimum of adverse reactions, they are combined with other antihypertensive drugs. It can be two separate tablets or a complex medicine containing 2 active substances. Combined use with ACE inhibitors, calcium antagonists, sartans is the most preferred combination (1). It is also advisable to prescribe thiazide diuretics and beta-blockers.

Active Ingredients Trade Name
valsartan hydrochlorothiazide
  • Valsacor
  • Duopress;
  • Valz N;
  • Co-Diovan.
irbesartan hydrochlorothiazide
  • Ibertan Plus;
  • Coaprovel;
  • Firmast N
losartan hydrochlorothiazide
captopril hydrochlorothiazide
lisinopril hydrochlorothiazide
  • Iruside;
  • Co-diroton;
  • Lysinotone H;
  • Scopril plus.
ramipril hydrochlorothiazide
  • Wazolong H;
  • Ramazide H;
  • Tritace plus.
enalapril hydrochlorothiazide
  • Burlipril plus;
  • Co-Renitec;
  • Enam H;
  • Enap N.
lisinopril indapamide
amplodipine valsartan hydrochlorothiazide
  • Co-Vamloset;
  • Co-Exforge;
  • Tritensin.
amplodipine indapamide


This group of drugs increases the release of water. Such drugs counteract the antidiuretic hormone. They are used for congestive heart failure, cirrhosis, psychogenic polydipsia. The main representative is Demeclocycline. Among the side effects are photosensitivity, nail changes, fever, eosinophilia.

What else is on the list of diuretic drugs?

What are thiazide diuretics?

Active ingredient Trade names
  • Acripamide;
  • Arifon;
  • Indap;
  • Ionic
  • Ravel SR;
  • Retapres.

Doctors prescribe drugs of this group based on the patient’s testimony. This affects the choice of the desired action of the drug:

  • with the detection of kidney stone disease;
  • with arterial hypertension in combination with antihypertensive drugs;
  • with severe swelling, against the background of cirrhosis of the liver, heart failure, or nephrotic syndrome.

Many drugs in combination with other medicines and tablets can distort the pharmacological properties of these same tablets. Thiazide diuretics are no exception. For example, coupled with loop diuretics, they enhance the effect of the latter. Sometimes such combinations are unacceptable, and sometimes necessary, for example, when you need a quick and breakdown diuretic effect. Also, benzothiadiazine-based substances enhance the effects of vitamin D, anesthetics, glycosides and lithium-based drugs.

But thiazide-like diuretics can also weaken the effect of certain drugs on the body.

These medicines include:

  • insulin;
  • anticoagulants;
  • some types of cure for gout.

The most unfavorable combination of thiazides and quinidine, since in the case of an excess of potassium as a side effect, ventricular arrhythmia may occur, which poses a great threat to life. In connection with such phenomena, consultation with a specialist before taking diuretics is mandatory.

What is diuretics is now clear, but you should understand what varieties of diuretics exist. Conventionally, they are classified according to several criteria: by efficiency, duration of action, and also by the speed of the onset of the effect. Depending on the condition of the patient and the complexity of the disease, the doctor selects the most suitable drug.

  • strong (“Lasix”, “Furosemide”);
  • medium ones (Gygroton, Hypothiazide, Oxodolin);
  • weak (“Diacarb”, “Veroshpiron”, “Triamteren”);

By speed of action:

  • fast (the action begins after 30 minutes) – “Furosemide”, “Triamteren”, “Torasemide”;
  • medium (after 2 hours) – “Amilorid”, “Diacarb”;
  • slow (after 2 days) – “Veroshpiron”, “Eplerenone”.

By duration of action:

  • long (about 4 days) – Veroshpiron, Eplerenone, Chlortalidone;
  • medium-term (no more than 14 hours) – “Hypothiazide”, “Diacarb”, “Indapamide”, “Clopamide”;
  • short action (less than 8 hours) – “Furosemide”, “Lasix”, “Mannit”, “Ethacrine acid”.

Depending on the pharmacological effect of the drug, there is a separate classification.

Thiazide diuretics

This type of diuretic pill is considered one of the most common. They are prescribed most often, since the therapeutic effect is achieved after a few hours. The average duration of their action is 12 hours, which allows you to set a single daily intake. These drugs are quickly absorbed in the intestines and are well tolerated by patients. One of the advantages of such diuretics is that they maintain the acid-base balance of the blood.

The action of thiazide diuretics is as follows:

  • the reverse absorption of sodium and chlorine is suppressed;
  • significantly increases the excretion of magnesium and potassium;
  • uric acid production decreases.

Thiazide diuretics – a list of effective drugs:

They are prescribed for various diseases of the liver and kidneys, essential hypertension, glaucoma and other pathologies associated with excessive levels of fluid in the body.

This type of diuretic is considered more sparing, as it contributes to the retention of potassium in the body. They are often prescribed in conjunction with other drugs to enhance the effect of the latter. This type of diuretics effectively reduces systolic pressure, so they are used for the treatment of hypertension in combination with other drugs. Their use is also indicated for the appearance of edema of various etiologies, heart failure.

Potassium-sparing drugs include: “Aldactone”, “Amiloride”. Take such diuretics with caution, since due to their hormonal effects, side effects occur. In male patients, impotence may develop, in women – a menstrual cycle failure, pain in the mammary glands, bleeding. With a long course of high doses, hyperkalemia may occur – large amounts of potassium can enter the bloodstream. This condition can cause cardiac arrest or lead to paralysis.

Loop diuretics

Loopback ones are considered the most powerful diuretics. They act on the Gangle loop – the renal tubule, directed towards the center of the kidney and performing the function of the reverse absorption of fluids and minerals. These diuretics act as follows:

  • reduce the reverse absorption of magnesium, potassium, chlorine, sodium;
  • increase blood flow in the kidneys;
  • increase glomerular filtration;
  • gradually reduce the volume of extracellular fluid;
  • relax the vascular muscle.

The action of loop diuretics occurs quickly enough, in just half an hour and lasts up to 6-7 hours. This type of drug is rarely prescribed, only in especially critical cases, since they have many side effects.

Loop diuretics, a list of the most popular:

The action of diuretics of this kind is to reduce the pressure in the blood plasma, which leads to a decrease in swelling and the removal of excess fluid. At the same time, the movement of blood in the renal glomeruli becomes higher, which increases the filtration. The following are the names of diuretic tablets that work on this principle:

“Mannitol” has a long-lasting effect, which cannot be said about the rest of the drugs in this group. Medicines of this series are used exclusively in acute cases. They are prescribed if the patient develops the following pathological conditions:

  • glaucoma attack;
  • lack of urine formation;
  • pulmonary or brain edema;
  • sepsis;
  • peritonitis;
  • shock;
  • acute poisoning.

Osmotic diuretics are potent drugs. That is why they are prescribed once, and not as a course therapy.

One of the drugs in this group is Diacarb. Under normal conditions, carbonic anhydrase helps the formation of carbonic acid in the kidneys from carbon dioxide and water. Diacarb blocks the production of this enzyme, contributing to the leaching of sodium, which in turn draws water. At the same time, potassium loss occurs.

Diacarb gives a weak effect, which develops relatively quickly. The duration of its action can be about 10 hours. Use this drug if the patient has:

  • intracranial hypertension;
  • increased eye pressure;
  • gout;
  • poisoning with barbiturates or salicylates.

This type of drug helps to block aldosterone receptors, as a result of which the hormone ceases to act on the kidneys. As a result, the reabsorption of water and sodium is disrupted, which leads to a diuretic effect. A frequently used agent of this kind is considered to be Spironolactone (Veroshpiron, Veroshpilakton). It is used in combination with loop or thiazide diuretics.

Thanks to recent studies, a new direction in the use of this drug has been discovered. Blocking the aldosterone receptors located in the myocardium helps stop cardiac remodeling (replacing the muscle tissue of the connective tissue). The use of spironolactone as part of complex therapy reduces mortality after myocardial infarction by 30%.

Another interesting feature of the drug is its ability to block testosterone receptors, which can lead to the development of gynecomastia in men and even impotence. In the female part of patients, this property of drugs is used in the treatment of diseases provoked by high levels of testosterone.

Along with medicines, plant diuretics are often used. Their effect on the body is milder, and side effects are practically absent. Plant-based diuretics not only help eliminate excess fluid, but also help saturate the body with mineral salts, vitamins, and have a mild laxative effect.

However, despite the fact that plant-based diuretic agents are significantly inferior in effectiveness to medications, it is also necessary to consult a doctor before using them to find out the cause of the pathology. Depending on the etiology of edema, the doctor will choose the most suitable option.

Treatment with decoctions and infusions of herbs is often necessary for renal edema. In addition to the diuretic, these drugs have anti-inflammatory and antibacterial effects. This is especially important in the presence of diseases of the urinary system. Among other things, herbal remedies are approved for use in pregnant women and children.

Drink herbal teas in short courses. Long-term use can cause addiction, and the effectiveness of therapy will gradually decrease. Also, with a long intake, it is possible to remove important trace elements of potassium and sodium from the body. Therefore, plant diuretics should also be used under the control of blood counts.

Thiazide diuretics pass into breast milk and may decrease its production. Therefore, they must be used with caution in nursing mothers.

  • Swelling, which was formed due to kidney disease, characterized by a violation of the water-salt balance. However, the effectiveness of thiazide diuretics for the treatment of this disease is low, so they are prescribed with other diuretics (loop diuretics are well suited).
  • Edema caused by cirrhosis. Often used in conjunction with other diuretics.
  • High blood pressure.
  • Acute and chronic heart failure.

Mechanism of action

  • 1 How do diuretics affect pressure?
  • 2 Types of antihypertensive drugs and diuretics
    • 2.1 Thiazide diuretics
    • 2.2 Loop diuretics
    • 2.3 Potassium-sparing diuretics
  • 3 List of drugs
  • thiazide (hypothiazide, cyclomethiazide);
  • non-thiazide;
  • loopback (Torasemide, Lasix, Furosemide, Bumetanide);
  • combined;
  • osmotic (Urea, Mannitol);
  • potassium-sparing (Spironolactone, Veroshpiron, Amilorid).


In this group, the mechanism of action is to reduce the pressure in the blood plasma, the active passage of fluid through the glomeruli of the kidneys, and to improve the degree of filtration. As a result, puffiness is eliminated, and an excessive amount of water is also excreted. Osmotic diuretics are weak agents that last up to 6-8 hours.

What drugs are also included in the list of diuretic drugs?

Advantages and disadvantages of drugs

The use of drugs for the treatment of hypertension has been known for more than 70 years, during this time their mechanism of action and features of the appointment are fairly well understood. The benefits of thiazide diuretics include:

  • average activity
  • fast onset of results (30 – 60 minutes),
  • long action profile (up to 11 hours),
  • do not cause alkalization or acidification of the blood,
  • prevent cerebral blood flow disorders in hypertension.

The diuretic Indapamide, the indications for the use of which are quite extensive, is drunk once a day. The properties of the drug help to remove excess fluid. For long-term use, the retard form is selected. Before you start taking it is better to know the contraindications.

  • Indications for potassium-sparing diuretics are heart disease, ascites, and even polycystic ovaries. The mechanism of action with ACE inhibitors is enhanced, so you can combine it under the supervision of a doctor. The latest generation of drugs – Veroshpiron, Spironolactone.
  • Prescribe drugs for heart failure to alleviate the condition, prevent progression. Admission is necessary in both acute and chronic form. You need to take medicines to support the heart, from shortness of breath, including diuretics, especially for the elderly.
  • If swelling of the legs has begun with heart failure, treatment should be started immediately. Well-known medicines and alternative methods will help with this.
  • The drug with the diuretic effect of chlortalidol, the use of which is indicated in the presence of edema due to pathologies, is almost impossible to find on sale. However, there are drugs based on a substance, or analogues.
  • The substance triamteren, the use of which is often found in combination with other diuretics, belongs to potassium-sparing diuretics. There are side effects, so in some cases it is better to choose analogues with a similar mechanism of action.

    Since ancient times, the question of the effectiveness of diuretics has been a topic of debate for many scientists. Some negatively related to this group of drugs because of their side effects on the kidneys. Others tried to invent targeted drugs that would act only on a particular nephron division, however, this theory was also shattered. Any drugs are active throughout the nephron.

    After, when the development of medicine began to take a big pace, a group of researchers concluded that the most effective would be to classify drugs according to their mechanism of action. That is how the group of thiazide diuretics appeared.

    Compared with other diuretics, other antihypertensive drugs, thiazides have several advantages:

    • speed of action;
    • a significant duration of the diuretic effect;
    • do not change the acid-base balance;
    • reduce the risk of stroke, especially relieve relapse;
    • suitable for older people;
    • do not contribute to the development of osteoporosis;
    • good result with an isolated increase in the “upper” pressure;
    • cheap.

    The lack of action of thiazide diuretics:

    • remove potassium, magnesium from the body;
    • contribute to uric acid retention;
    • increase plasma sugar concentration.

  • General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.