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    Old 02-07-2008, 11:28 PM   #1
    flowergirl2day
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    Diuretics and side effects

    Hi,

    I have been researching diuretics extensively because some of their side effects are consistent with the recent changes in my electrolyte & other levels. I thought I'd share some interesting facts.

    Diuretics help us get rid of fluid. They interfere with the production of antidiuretic hormone, which results in the kidneys secreting more water. (Antidiuretic hormone helps prevent excessive water loss.)
    The volume depletion is what helps with the blood pressure control. Besides having this therapeutic effect, diuretics can cause many electrolyte and endocrine disturbances.
    The most commonly used diuretic for a treatment of hypertension is Hctz. Hctz acts directly on the arteries, causing vasodilation. Some of the concerns with its use include a potassium loss into urine from the blood, a decrease in magnesium and sodium bicarbonate, an increase in calcium, lipids, and blood sugar levels, low plasma sodium level, high uric acid level and additional disturbances with higher doses. Postural hypotension is also common. This is why the lowest effective doses should always be used. Interestingly, diuretics have been shown to reduce the risk of stroke and heart failure when compared with ACE inhibitors, calcium channel blockers and beta blockers.

    Loop diuretics are more potent than thiazides. They act at the Loop of Henle, thus the name. Their side effects are similar to those of Hctz. There are many more side effects than mentioned in this post. One cannot question the diuretics' effectiveness. It is really good to know that if my diuretic(s) need to be changed, there's another option-the loop diuretics. They appear to be more suitable for me than the Hctz. It is scary to see how many potential side effects a simple drug can have. Unfortunately, most drugs do.
    I tried to determine which of the side effects I have experienced can be attributed to Hctz. It is impossible though due to my multidrug therapy. The symptoms often overlap, making the determination difficult. I am positive the diuretics are responsible for the abnormalities in the lab tests.

    What side effects have you experienced that can be attributed to the use of Hctz? I found out recently that it can cause bladder function mishaps.

    flowergirl

     
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    Old 02-08-2008, 06:08 AM   #2
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by flowergirl2day View Post
    ... tried to determine which of the side effects I have experienced can be attributed to Hctz. It is impossible though due to my multidrug therapy.
    Yes, given the secondary nature of your hypertension, it would be very difficult. That is why it is so important that others, who don't have secondary hypertension, get their bp under control with 1 medication before their condition changes. I was very fortunate to be treated with only one drug at a time...and at a relatively low dose (except for the hct) which makes it easier (looking back) to identify the side effects.

    Quote:
    The symptoms often overlap, making the determination difficult.
    How very true...I experienced horrendous fatigue through 4 medications so it didn't occur to me that it was the meds...I kept blaming it on my sleep disorder. I'm off meds, and surprise! No fatigue...but I still have the sleeping disorder.

    Quote:
    I am positive the diuretics are responsible for the abnormalities in the lab tests.
    Yes, except for low potassium (due to a poor diet and not hormonal/adrenal issues) I had perfect labs...until hct.

    Quote:
    I found out recently that it can cause bladder function mishaps.
    Mishaps? Mine were like dam breaks...I've posted this before but for the benefit of new readers: nausea and vominting, diarrhea, blurry vision, mental disorientation/mental confusion, poor/no concentration, extreme pain in lower back and left shoulder (why is it only one and not the other), periodic limb movements starting in the afternoon which continued throughout the night, hip pain waking me at different hours of the night--this I believe due to the severity of the periodic limb movements), nocturia, extreme fatigue (sleeping 16-20 hours per day at times), mood outbursts (I'm too embarrassed to go into certain stores anymore due to my behavior), a 100 point increase in cholesterol, and finally, I had to have a hemangioma surgically removed from my back. I have no idea if the hemangioma is related but I think it strange that I would have one (given almost flawless skin) when hemangiomas ususally occur in children under the age of 5.

    I had voming and diarrhea for 3 weeks of my upped dose (25 to 50 mg) and attributed it to the flu. I had a doctors visit within weeks of this happening but he did not connect my symptoms to the hct nor did he order lab tests at that time. I have since read that vomiting and diarrea are signs of overdose...and of course those symptoms alone would have contributed to an electrolyte imbalance.

    Bethsheba

    PS Forgot to mention those coughing fits that triggered the dam breaking...I would also like to say that I was on this med for I"m thinking about 1 1/2 years but the old doc never associated my symptoms with the hct....again, it is SO VERY IMPORTANT to know what the side effects are BEFORE you start taking a drug so you know what to look for and can act accordingly.

    Last edited by bethsheba; 02-08-2008 at 09:18 AM. Reason: spelling check

     
    Old 02-08-2008, 08:50 AM   #3
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    Re: Diuretics and side effects

    Beth,

    Thank you for listing your many side effects while on this drug. What a long list...I have read a chapter on antihypertensives and each and every one had a subsection titled: toxicity....As you indicate, posting your experience will help others. People should be aware of the damaging potential of these drugs - as well as their therapeutical properties. That is why it is so important to do the research prior to starting the drug.

    On the positive side, diuretics are the one drug that can bring resistant hypertension under control. Failing to achieve adequate blood pressure control is often due to the volume expansion going unrecognized. When peripheral edema is absent in people with resistant hypertension, volume expansion is difficult to determine. It is often insidious so there may be no outward signs. Sometimes there is only weight gain without edema. Weight gain (and/or edema) results from a compensatory response to antihypertensive therapy via increased fluid volume.
    An aggressive therapy with diuretics gets results in most people. This is done by manipulating the diuretics - adding one if none is being used, increasing the dose, switching to one that's stronger or adding another diuretic. At the same time, the remaining medications are adjusted. Some people run into problems with excessive diuretic use after a time. Diuretics play a very important role in blood pressure control and in other conditions, in spite of their many side effects.
    For anyone on diuretics, regular monitoring of serum electrolytes, BUN, uric acid, and glucose is a must.
    Going to work now...wishing you a good day!
    flowergirl

    Last edited by flowergirl2day; 02-08-2008 at 08:51 AM.

     
    Old 02-08-2008, 09:50 AM   #4
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by flowergirl2day View Post
    ...On the positive side, diuretics are the one drug that can bring resistant hypertension under control.
    Yes, I would agree...and on another positive note, unlike other families of drugs, diuretics have been used a long time so although no drug has been extensively tested (tested in everyone), diuretics have had a long history and doctors should be quite familiar with this class of med.

    Despite the overwhelming side effectst that I experienced, if I were to go back on medication, it would be a diuretic...but I would do some things first...

    list every possible side effect noted in the literature, and on the package insert

    list symptoms that would be considered life threatening and get medical advice BEFOREHAND so I would know what to do and how and when to stop taking the diuretic if I experienced these symptoms

    make sure my electrolytes were in balance (in other words get lab work done beforehand)

    post my doctor's and my pharmacist's phone number and office hours in LARGE PRINT on the refrigerator for easy reference. Believe it or not, these meds can mess with your mind and your vision so much this may not be possible to do with a phone book...

    I would post another reminder on the refrigerator that "doctors do not know everything", and that unless it's under life threatening circumstances, a doctor tells me something, I need to find out if other health care professionals, other people in similar circumstances, and the literature support what the doctor is telling me!!

    Last but not least, I would demand to start on 1/2 of the lowest recommended dose!

    Bethsheba

    PS Really, really, really appreciate the info about peripheral edema and I can't thank you enough for it. Haven't read about this at all but can't help think that this may apply to me given my weight fluctuations!!!

    Last edited by bethsheba; 02-08-2008 at 10:13 AM.

     
    Old 02-08-2008, 02:48 PM   #5
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    Re: Diuretics and side effects

    After having adverse reactions to every other class of med, I saw a cardiologist who put me on 25mg of HCTZ, despite the fact that I told him I had a terrible reaction to Bactrim, a sulfa drug. He said all the diuretics are sulfa drugs, but he did not think that would apply to me. After the 2nd pill I could not breathe, was dizzy and felt I was going insane. The Dr on call said to stop taking it. I got another Dr who is using natural methods to control it, and this afternoon my BP was 118/71. However, my HBP was caused my Depo Provera injections, and I had the last one 18 1/2 weeks ago.

    I feel for anyone who has to take these meds and I pray I never have to again. I eat very well, am slim and was informed today by the Dr that I'm now in menopause at 52. (Digging the hot flashes which are giving me a sleep disorder.)

    Last edited by wamylove; 02-08-2008 at 02:49 PM.

     
    Old 02-08-2008, 03:53 PM   #6
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by wamylove View Post
    ... felt I was going insane. ...I feel for anyone who has to take these meds and I pray I never have to again. ... (Digging the hot flashes which are giving me a sleep disorder.)
    Wamylove,

    Why, may I ask, did you feel like you were going insane? Was it due to the physical symptoms or were you having mental problems as well?

    And just fyi, disrupted sleep and/or not enough sleep can elevate your pressures temporarily...so don't panic if you have a bad hot flash night and your pressures are up the next day. Also, my understanding is that women who go through menopause lose some natural protection in the blood pressure regulation department. I'm sure it can be avoided with diet and exercise, because women in non western cultures (and women who are vegetarians) don't seem to experience this.

    I really appreciate your insights on the sulfa allergy. It seems a number of bp meds have a warning about sulfa. Do you have problems with wine or other things that have sulfites in them? Or was your only reaction to the Bactrim?

    Wonder how many other people out there are having similar reactions to their diuretic without knowing why?

    Bethsheba

    PS A clarification is needed regarding my comments about sleep...while sleep deprivations can elevate bp temporarily, they may elevate pressures permanently if the sleep problems remain over a period of time.

    Last edited by bethsheba; 02-09-2008 at 04:25 AM.

     
    Old 02-08-2008, 04:46 PM   #7
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    Re: Diuretics and side effects

    I used to take furosemide(Lasix), a loop diuretic.

    When I took it at 20mg per day, it lowered my average blood pressure, but, after a few days, it caused increased heart rhythm/rate problems and increased breathing difficulties, possibly due to the depletion of body minerals.

    When I took it at 40mg, for just two days, it caused painful joints.
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    Old 02-08-2008, 08:39 PM   #8
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    Re: Diuretics and side effects

    Bethsheba,

    The crazyness came on very quickly and was a physical reaction. It went away within 24 hours of discoing the drug.

    I noticed the other night my BP went up after I was upset about the awakenings, but came down after I ate breakfast.

    Today I drove 4 hours after working out of town for 2 days and having similar problems last night and was shocked that my BP was normal after I got home.

    My DR called today and told me about my blood work results and I had been thinking this is what they say hot flashes feel like. I see him Monday and we are going to consider bioidentical hormone therapy. I obviously need to avoid Progestin (the natural progesterone does not raise my blood pressure) and in the past, I noticed that estrogen actually lowered it, which is opposite from most women. Just as with BP meds, we are all different.

    I never liked wine enough to find out if I react to it, except when I got sick after a chugging contest at age 16. (I could never drink it again.) I don't know about other foods with sulfites and may need to look into it. When I took Bactrim for 5 days last year for a urinary problem, I could not eat or sleep and had constant anxiety. It went away completely the day after I stopped and I found out that there are some people who have the exact same reaction to it, which also came on about 2 hours after taking it. I lost 5 pounds. With the HCTZ, it did not cause the anxiety reaction until after the 2nd dose.

    Last edited by wamylove; 02-08-2008 at 08:46 PM.

     
    Old 02-08-2008, 09:36 PM   #9
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    Re: Diuretics and side effects

    I experienced symptoms similar to those you describe. No shortness of breath -I hope I never have to deal with that again! I think these symptoms were a result of mineral imbalances caused by my diuretics. I am on two diuretics, Hctz and Spironolactone. Things have been good the last few days I am happy to say.
    I just read about Lasix. Definitely not a drug I'd want to take. It is the most powerful diuretic in existence. It is harmful, very dangerous and potentially life threatening. Thank you for describing your experience with this drug. I am glad you discontinued it as soon as you started experiencing its adverse effects on your body.
    Muscle contraction is based on the exchange of electrolytes. Electrolyte imbalance causes cramping - in the calf, leg, heart muscle... Diuretics are used extensively in bodybuilding for rapid weight loss, sometimes with tragic consequences. People can die suddenly. This is one of the reasons the bodybuilders are tested extensively for diuretics and narcotics use.

    flowergirl

     
    Old 02-08-2008, 10:53 PM   #10
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    Re: Diuretics and side effects

    wamylove,

    Just a quick comment. Since your doctor's appointment isn't until next week, please spend some time this weekend reading about hormonal therapies. Research the one you are considering thoroughly if you haven't already. Someone I know had a terrible time with hers. She even fainted once in front of a bunch of people. She also experienced embarassing emotional outbursts and seemed to have no control over them. Her problems turned out to be dosage related. Luckily, she quit taking the stuff not long after that.

    flowergirl

     
    Old 02-09-2008, 04:23 AM   #11
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    Re: Diuretics and side effects

    beerzoids,

    Do you have any idea why these meds cause painful joints? It is such a common problem, especially with diuretics.

    Isn't it strange how the side effects/pain can begin within 2 days of changing a dose? I'm sure it takes longer than 2 days for a med to become "effective".

    Bethsheba

     
    Old 02-09-2008, 04:41 AM   #12
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by wamylove View Post
    ...Today I drove 4 hours after working out of town for 2 days and having similar problems last night and was shocked that my BP was normal after I got home.
    Well, that's good news!

    Quote:
    I see him Monday and we are going to consider bioidentical hormone therapy.
    A friend of mine was experiencing severe (disabling) hot flashes and was (under the guidance of her physician) able to bring them under control with an over the counter supplement. Everyone is different, so this may not work for you (especially given your health hx), but I, too, would recommend that you do a lot of reading before your visit on Monday.

    Quote:
    I noticed that estrogen actually lowered it, which is opposite from most women. Just as with BP meds, we are all different.
    I thought it was the estrogen that keeps the bp lower, but, then again, I'm not current with female issues...

    Quote:
    when I got sick after a chugging contest at age 16. (I could never drink it again.)
    Perhaps, a mixed blessing.

    Quote:
    I don't know about other foods with sulfites and may need to look into it. When I took Bactrim for 5 days last year for a urinary problem, I could not eat or sleep and had constant anxiety. It went away completely the day after I stopped and I found out that there are some people who have the exact same reaction to it, which also came on about 2 hours after taking it. I lost 5 pounds. With the HCTZ, it did not cause the anxiety reaction until after the 2nd dose.
    If you ever look into it, do let us know. I think many people will benefit from your unfortunate experience. Isn't it amazing how fast those drug reactions can kick in? And then there are the other ones that take years to develop,

    I think it is VERY interesting that you experienced the same anxiety reaction with both meds...I would really like to know why this happens...does it create a chemical imbalance in the brain? and if so how? So many questions. I wonder if anyone knows, .

    Wamylove, thank you so very much for getting back to us. Good luck with your appt on Monday!

    Bethsheba

    Last edited by bethsheba; 02-09-2008 at 04:43 AM.

     
    Old 02-09-2008, 04:49 AM   #13
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by flowergirl2day View Post
    ...Muscle contraction is based on the exchange of electrolytes. Electrolyte imbalance causes cramping - in the calf, leg, heart muscle...
    Never occurred to me that it would cramp the heart muscle...scary.

    I might add that diuretics are sometimes used and abused by models and anorexics. I once knew someone who abused lasix (for weight loss) ...her problems as a result were horrific.

    Bethsheba

     
    Old 02-09-2008, 07:38 AM   #14
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    Re: Diuretics and side effects

    Hello All!!

    Is there a way (through supplementation, etc.) - to counteract the side mineral/electrolyte imbalance side effects if you have to take a diruetic?

    Flower,

    You said something about a diruetic being used even if evidence of pulmonary edema is not there. I was wondering about that - normally I have no swelling, etc. so I assumed a diruetic would not work for me. That is the next drug my Dr. wants me to try -- once I get off of the Toprol and try diet/exercise to see if that helps lower my B/P.

    I am of course hesitant to take yet another new drug -- I drink A LOT of water 12-14 cups per day. Wonder if that will affect the Diruetic?

    Any advice/help would be greatly appreciated!

    Nessa

     
    Old 02-09-2008, 08:27 AM   #15
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    Re: Diuretics and side effects

    Quote:
    Originally Posted by bethsheba View Post
    beerzoids,

    Do you have any idea why these meds cause painful joints? It is such a common problem, especially with diuretics.
    I have no idea. I had been experimenting with furosemide, and had just increased the dosage from 20mg to 40mg. Any bending of my elbows and wrists caused pain, so I stopped taking furosemide. The pain went away.

    I have atrial fibrillation and heart failure, causing an increased risk of stroke. So.... I don't take any diuretics, and will never take one again, because I think that diuretics also increase the risk of stroke.

    Quote:
    Isn't it strange how the side effects/pain can begin within 2 days of changing a dose? I'm sure it takes longer than 2 days for a med to become "effective".

    Bethsheba
    There are many different factors influencing how quickly a medication becomes effective. In my case, Verapamil was very effective within three hours of taking the very first pill. My ace inhibitor takes two-three days to kick in. Furosemide also took more than one day to noticeably lower my blood pressure.

    I may not be the typical patient. I've been off and on ALL of my medications, without telling my cardiologist, over the past nine years, and have taken almost 24,000 blood pressure readings. I track the effectiveness, or the lack of effectiveness of medications, VERY closely. It has not been easy. It is extremely difficult to evaluate changes to medication, diet, environment and lifestyle, especially when taking multiple medications, or making more than one change at a time. Many times during my twenty years of struggling with heart disease, I thought that I had something figured out, only to be wrong about my assumptions.

    Currently I am testing how best to take medications which are normally prescribed multiple times per day. I want to know how well they work when taken only once per day, or even every other day instead of every day.

    Let's say that a medication is 100% effective if taken, one pill, three times per day, every day. Let's say that I stop taking one pill, three times a day, and only take it once per day. If it is 90% effective taken, one pill, once per day, and gives less nasty side effects, then, to me, it is better to take, one pill, once per day. Then, if it is 80% effective if taken, one pill, every other day then...........???

    Oh well..... the battle continues..........!

    Regards, Bethsheba and have a great weekend.
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    Last edited by Machaon; 02-09-2008 at 12:12 PM.

     
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