Thiazide Diuretic

Generic and Trade Names:

Chlorothiazide		Diuril
Chlorthalidone		Hygroton
Hydrochlorothiazide		Hydro-Diuril, [HCTZ],
			Esidrix, Oretic
Indapamide		Lozol
Methyclothiazide		Aquatensen
Metolazone		Zaroxolyn

Description:

Thiazide drugs are used to reduce blood pressure and edema in conditions like: hypertension, renal failure, congestive heart failure, and pulmonary edema. (See also under bloating, PMS, and water retention.)

Thiazide diuretics block sodium and chloride reabsorption in the kidney, thus increasing the amount of filtrate released by the kidney as urine.

Examples of thiazides are: chlorothiazide, hydrochlorothiazide, methyclothiazide, polythiazide and trichlormethiazide .

Hydrochlorothiazide may also be combined with other drugs e.g. amiloride HCL (Moduretic). (Facts and Comparisons 1999)

Nutritional Considerations:

Thiazide diuretics are potassium-depleting (Al Ghamdi, Dai, Dychner, Whang). Hence the use of potassium supplementation, or potassium preserving diuretics is recommended by many physicians.

While potassium is most widely recognized, magnesium, sodium and zinc are also lost and may require supplementation (Roe, Reyes, Cohanim, Mountokalakis,Shils, Whang).

Vitamin D used to treat hypoparathyroidism may interact to cause hypercalcemia with thiazide diuretics. (McKevoy 1998)

Limit alcohol.

Other vitamins requring supplementation may include: vitamin B1, vitamin B6 and riboflavin (B-2). (Pinto 1987)

Herbal Considerations:

Gingko may increase blood pressure if used with thiazide diuretics.(Shaw 1997)

Avoid natural licorice products (they tend to promote fluid retention) (Shintani, Wichtl).

Cascara sagrada, rhubarb plant and senna aggravate potassium loss caused by diuretics. (Blumenthal 1998)

Newall has also compiled an extensive list of herbs which possess diuretic action:

Agrimony, Artichoke, Boldo, Broom, Buchu, Burdock, Celery, Cornsilk, Couchgrass, Dandelion, Elder, Guaiacum, Juniper, Pokeroot, Shepherd's Purse, Squill, Uva Ursi and Yarrow.

The German Commission E has noted an interaction between thiazide diuretics and these herbs:

Aloe
Buckthorn bark/berry
Cascara sagrada bark
Licorice root
Senna pod and leaf

References

Al-Ghamdi SM, Cameron EC, Sutton RA: Magnesium deficiency - pathophysiologic and clinical overview, Am J Kidney Dis, 1994, 24(5):737-52

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Medical Publications, 1998.

Cohanim M, Yendt ER: The effects of thiazides on serum and urinary zinc in patients with renal calculi, Johns Hopkins Med J, 1975, 136(3):137-41.

Dai LJ, Friedman PA, Quamme GA: Cellular Mechanisms of chlorothiazide and cellular potassium depletion on Mg2+ uptake in mouse distal convoluted tubule cells, Kidney Int, 1997, 51(4):1008-17

Dychner T, Wester PO: Potassium/Magnesium depletion in patients with cardiovascular disease, Am J Med, 1987, 82(3A):11-7

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

Fries, E.D. The Cardiovascular risks of thiazide diuretics. Clin Pharmaco Ther 39 (1986): 239-244.

Gettes LS: Electrolyte abnormalities underlying lethal and ventricular arrhythmias, Circulation, 1992, 85(1 suppl):170-6

Hollifield JW: Potassium and magnesium abnormalities - diuretics and arrhythmias in hypertension, Am J Med, 1984, 77(5A):28-32

Kellick, KA: Diuretics. AACN Clin Issues Crit Care Nurs 1992 May; 3(2):472-82.

Lieberman, S. & Bruning, N.: The Real Vitamin & Mineral Book. Avery, NY.

Malini PL, Strocchi E, Valtancoli G, et al: Angiotensin-converting enzyme inhibitors, thiazide diuretics and magnesium balance - a preliminary study, Magnes Res, 1990, 3(3):193-6.

Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768-71.

McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

Mountokalakis T, Dourakis S, Karatzas N, et al: Zinc deficiency in mild hypertensive patients treated with diuretics, J Hypertens Suppl, 1984, 2(3):S571-2.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.

Nicholls MG: Interaction of diuretics and electrolytes in congestive heart failure, Am J Cardiol, 1990, 65(10):17E-21E

Osol, Arthur. 1980. Remington's Pharmaceutical Sciences. Mack Publishing Company, Pennsylvania.

Petri M, Cumber P, Grimes L, et al: The metabolic effects of thiazide therapy in the elderly - a population study, Age Ageing, 1986, 15(3):151-5.

Pinto, J.T. & Rivlin, R.S. : Drugs that promote renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5: 143-151.

Pronsky, Z Food Medication Interactions, 11th edition, 1999.

Reyes AJ, Leary WP, Lockett CJ, et al. Diuretics and zinc. S Afr Med J 1982;62:373-75.

Roe, DA: Handbook on Drug and Nutrient Interactions, 5th edition, 1994.

Shaw D, et al. "Traditional remedies and food supplements: a 5-year toxicological study." Drug Safety, 1997; 17:342-56

Shils M, Olson A, Shike M. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, PA: Lea and Febiger ; 1994

Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992;32:44-51.

Threlkeld DS, ed. Diuretics and Cardiovasculars, Thiazides and Related Diuretics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1993.

Whang R, Whang DD, Ryan MP. Refractory potassium repletion-a consequence of magnesium deficiency. Arch Intern Med 1992;152:40-45.

Wichtl M: Herbal Drugs and Phytopharmaceuticals, 1994