increase the risk of aspirin toxicity for patients taking
aspirin or other salicylates.Nonprescription diuretics
Nonprescription diuretics, particularly alcohol,
may interact with a variety of substances:
Caffeine. Caffeine is known to intensify the effects of
cimetidine (a drug that lowers the secretion of stom-
ach acid) and theophylline.
Herbal preparations. Herbal preparations with diu-
retic effects should be strictly avoided by people tak-
ing prescription diuretics, as the herbs may intensify
the effects of the prescription drugs and lead to var-
ious cardiovascular side effects.
Alcohol. Alcohol is known to interact with a wide
number of prescription medications. It should never
be taken together with other drugs that depress the
central nervous system. These types of medications
include antidepressants, benzodiazepines (tranquil-
izers), barbiturates, other sleeping medications, nar-
cotic pain relievers (codeine and other derivatives of
opium), and antihistamines. Alcohol may interact
with antipsychotic medications to cause liver dam-
age, with aspirin to cause stomach bleeding, and with
some cardiovascular medications to cause dizziness
and fainting.
Pamabrom. No interactions between pamabrom and
other medications have been reported as of 2007.AftercareAftercare following abuse of diuretics varies
according to the substance and the consumption pat-
tern. Caffeine intoxication can usually be treated by
tapering intake of caffeinated beverages and/or dis-
continuing use of caffeine tablets. Alcohol hangovers
may require rehydration as well as administration of
vitamin B 6. Abuse of diuretics in patients with eating
disorders requires long-term medical nutrition therapy
supervised by a professional nutritionist. The position
statement of the American Dietetic Association
(ADA) is as follows: ‘‘It is the position of the Ameri-
can Dietetic Association (ADA) that nutrition educa-
tion and nutrition intervention by a registered dietitian
is an essential component of the team treatment of
patients withanorexia nervosa,bulimia nervosa, and
eating disorders not otherwise specified (EDNOS)
during assessment and treatment across the contin-
uum of care.’’ Similarly, adolescents who abuse diu-
retics as part of athletic training regimens require
supervision by a registered dietitian as well as by a
specialist in sports medicine.ComplicationsPrescription diuretics have a number of side
effects:
Loop diuretics. Loop diuretics may produce several
different types of adverse reactions. The first type are
related to diuresis and electrolyte balance. Loop diu-
retics may cause loss of potassium and magnesium
from the body; the loss of magnesium may lead to the
loss of additional potassium. Patients taking loop
diuretics should be taught to recognize the signs of
potassium deficiency (hypokalemia), which include
weakness, loss of appetite, irregular heartbeat, con-
stipation, muscle cramps, a weak or heavy feeling in
the legs, mental confusion, or unusual tiredness. The
second type of adverse reaction to loop diuretics is
ototoxicity, or damage to the nerves in the ears that
control hearing and the sense of balance. Symptoms
of ototoxicity include ringing in the ears (tinnitus)
and dizziness. The third type of adverse effect of loop
diuretics is uncommon but may occur in patients
who are also taking ACE inhibitors (medications to
control blood pressure) and nonsteroidal anti-
inflammatory drugs (NSAIDs). This so-called ‘‘tri-
ple whammy’’ may lead to kidney failure.
Thiazide diuretics. Thiazide diuretics may cause low
blood potassium levels, impotence in men, and
increased levels of blood cholesterol. They also
cause photosensitivity in some people, which means
that the person will be more sensitive to sunlight and
sunburn more readily. Last, thiazide diuretics can
raise the levels of glucose and uric acid in the blood,
which increases the patient’s risk of developing gout.
Potassium-sparing diuretics. Adverse effects may
include loss of interest in sex (in both men and
women), visual disturbances and dizziness, shortness
of breath, nausea and vomiting.
Osmotic diuretics. Use of mannitol causes high
blood pressure, blurred vision, chills, fever, nausea,
and vomiting in some patients.
Carbonic anhydrase inhibitors. May depress the
activity of bone marrow, leading to anemia; may
contribute to liver dysfunction; increases the
patient’s risk of developing gut; may lead to overly
low blood levels of sodium, potassium, magnesium,
and calcium.Nonprescription diuretics
Adverse effects from nonprescription diuretics
may include:
Caffeine. Adverse effects from high doses of caffeine
include nervousness, insomnia, restlessness, twitching,Diuretics and diets