Presented By: Ms. Kalaivani Sathish M.

Pharm
Assistant Professor,
PIMS -
Panipat
Diuretics is an agent which increase
urine and solute.it may be classified
as follows:
1. HIGH EFFICACY DIURETICS
Furosemide,azosemide,
bumetanide,piretanide,torsemide.
2.MODERATE EFFICACY DIURETICS
THIAZIDES
Benzothiadiazines
–
chlorothiazide,hydrochlorothiazide,
polythiazide
THIAZIDE RELATED AGENT
Chlorthalidone,clopamide,
indapamide,metolazone,xipamide.
3.LOW EFFICACY DIURETICS
POTASSIUM SPARING DIURETICS
Triamterene,amiloride,spironolactone.
CARBONIC ANHYDRASE INHIBITOR
Acetazolamide,methazolamide,
dorzolamide
OSMOTIC DIURETICS
Mannitol,urea,glycerol
METHYLXANTHINE
Theophylline
4.NEWER AGENT
Vasopressin antagonist –
conivaptan,tolvaptan,lixirvapta
n.
 Loop diuretics act on the
ascending limb of the loop
henle.frusemide is the of most
commonly useddiuretics.it is a
sulphonamide derivative.it is
a powerful diuretics.
 Frusemide acts by inhibiting NaCL
reabsorption in the thick ascending limb
of the Henles loop.it blocks the Na K
2CL symporter in the loop.it greatly
increase the excretion of Na and CL in
the urine.as large amount of NaCL is
absorbed in this segment. Diuretic
response increases with dose and over
treatment may cause dehydration.
 In Loop of Henle

Frusemide inhibits Na Cl reabsorption

Increase thethe
Increase excretion of Na
excretion & Cl
of Na in urine
& Cl in
urine

Leads to increased urinary output

Leads to increased urinary output
Frusemide is also a weak
carbonic enhydrase inhibitor hence it
the
increase excretion of HCO
and phosphate.
PHARMACOKINETICS
Frusemide is rapidly absorbed orally,
highly bound to
plasma
proteins,metabolized in the liver and
excreted by kidneys.IV it acts in 2-5
minutes,oral it takes
 20-40minutes.
BUMETANIDE
Is a sulfonamide like Frusemide but
it is 40 times more potent than
Frusemide.
TORSEMIDE
Is longer acting and can be given
once a day.
ETHACRYNIC ACID
Is more likely to cause adverse effect
ototoxicity and is not commonly used.
Hyperkalemi and metabolic
a alkalosis
dehydration,
hypotension
Hyperuricemi
a,hypocalcemi
a,
Hypomagnese
mia,ototoxicit
y,

Edema
Acute renal failure
Acute pulmanary edema
Cerebral edema
Forced diuresis:in poisoning
due to drug like barbiturates
and salicylates, Frusemide is
used with IV fluids.
Hypertension with
renal impairment
 Chlorthiazide was the first thiazide to be
synthesized.
 Mechanism of action
 Thiazide act on the early distal tubule.it
have a moderate efficacy 90% of the filtered
sodium is already reabsorbed before
reaching the distal tubule.they also inhibit
carbonic anhydrase activity and increase
bicarbonate loss.it also enhance excretion of
Mg and K .But they inhibit urinary
excretion of Ca and uric acid resulting in
hypercalcemia and hyperuricemia.
 In early distal tubule

inhibit
inhibit carbonic
carbonic anhydrase
anhydrase activity
activity and
and increase
increase bicarbonate
bicarbonate
loss
loss

Enhance
Enhance excretion
excretion of
of Mg
Mg and
and K
K and
and Inhibit
Inhibit urinary
urinary excretion
of Ca andof
excretion uric
Caacid
and uric acid

Leads
Leads to
to increased
increased urinary
urinary output
output
Thiazides are well absorbed
orally and are rapid
acting.they are excreted by
kidney.
Hyperkalemia,hyperuricemi

a,
hypotension,hyperglycemia,
GIT disturbance,allergic

reaction.
Hypertension
Congestive heart failure

Edema

Renal stones

Diabetes insipidus
Example of potassium sparing
diuretics is Spironolactone it is an
aldosterone antagonist,
It may act two ways .they may be
aldosterone antagonist or directly
inhibition of channels in distal tubes
and collecting duct.

Major amount of Na is reabsorbed

is proximal parts. It also reduces K
loss
 Potassium sparing diuretics

Inhibition of channels
Ald0sterone in Distal Tubules &
Antagonist Collecting Duct

Na is already Reabsorbed in proximal parts.

Na is already Reabsorbed
Reduces K Loss.
in proximal parts.
Reduces K Loss.
E
n
E
h
n
a
h
n
a
Increases the Urinary Excretion
c
n
e
c
s
e
 Mannitol is an osmotic diuretics.
 Given in IV (Orally Not Absorbed), it gets
filtered by the glomerulus but not
reabsorbed.
 Itcauses water to be retained in proximal
tubule and descending loop of Henle, by
osmotic effect resulting in water diuresis.
 There is also some loss of sodium.
 Increased Osmotic Pressure in Proximal
Tubule

 Decreased Water reabsorption

 Increased Urine Excretion

To maintain urine volume and prevent
oliguria (Decreased Urine Output)
To reduce ICP and IOP following
head injury and Glaucoma
respectively.