-
Diuretics are for symptomatic relief and should never be used alone
-
The goal of therapy is euvolemia with the minimum effective dose
-
Regular fluid assessment is key
-
Encourage daily weights to monitor shifts in fluid balance
-
If titration of dose is limited by hypotension:
-
- Reassess diuretic use
-
- Consider staggering dosing with other antihypertensives or dosing at bedtime
-
Other adverse effects:
-
- Electrolyte disturbances: K+ (except K+ sparing), Mg+, Na+, Ca++ (except thiazides)
-
- Diuretics can increase uric acid levels and predispose patients to gout and gout attacks
-
- Be mindful of combination antihypertensive products that may include diuretic agents
-
If non-responsive, consider:
-
- Adherence
-
- Increase sodium intake
-
- NSAID/COX-2 inhibitor use
-
- renal dysfunction (may require higher doses)