most people realize—7 calories per gram, in compar-
ison to 9 calories per gram for fat and 4 calories per
gram for protein. Some women, however, drink an
occasional glass of wine or beer for its diuretic effect,
to relieve the discomfort of fluid retention before the
onset of their menstrual period.
PAMABROM.Pamabrom is a mild diuretic related
chemically to theophylline, one of the breakdown
products of caffeine. It is compounded with acetami-
nophen in a number of over-the-counter (OTC) rem-
edies for premenstrual bloating and backache
associated with fluid retention, including New Tylenol
for Women, Backaid, and Diurex.
Precautions
Both prescription and nonprescription diuretics
should be used with care.
Prescription diuretics
Prescription diuretics should be used only under a
doctor’s supervision and monitored in long-term
users, as dosage requirements may change or the doc-
tor may recommenddietary supplementsto compen-
sate forelectrolytesand nutrients lost through the use
of some diuretics. In addition, patients should not stop
taking prescription diuretics or change the dosage
without consulting their doctor.
Loop diuretics. Patients taking loop diuretics may
require supplemental potassium, folic acid, and vita-
min B 1. In addition, they should learn to recognize
the symptoms of potassium depletion, as loss of
potassium is a common adverse effect of this type
of diuretic.
Thiazide diuretics. Nursing mothers should not use
thiazide diuretics during the first month of breast-
feeding, as they can pass into the milk and in some
cases decrease the flow of milk. Thiazide diuretics
should also be taken with food or milk to lower the
risk of upset stomach. They should be used very
cautiously in patients with diabetes, as they tend to
raise blood sugar levels.
Potassium-sparing diuretics. Patients should avoid
the use of salt substitutes containing potassium
while taking this type of diuretic, as it may lead to
overly high levels of potassium in the blood. In addi-
tion, patients should be advised to avoid driving or
operating dangerous machinery until they know how
these drugs affect them, because potassium-sparing
diuretics may cause dizziness and blurred vision.
Osmotic diuretics. Sodium levels in the patient’s
blood should be closely monitored, particularly if
the patient develops muscle cramps.
Carbonic anhydrase inhibitors. Acetazolamide
should not be given to patients with a history of
liver or kidney disorders, Addison’s disease, known
sensitivity to sulfonamide drugs, or angle-closure
glaucoma; and used cautiously in patients with dia-
betes or gout. The patient should be advised to take
this type of diuretic in the morning to prevent sleep
interruption.Nonprescription diuretics
Nonprescription diuretics can still cause adverse
effects even though they are weaker than prescription
diuretics:
Caffeine. A dose of caffeine higher than 400 milli-
grams (more than 3 or 4 cups of brewed coffee) will
produce a state of caffeine intoxication in most
adults. Over-the-counter caffeine tablets, however,
typically contain more caffeine than brewed coffee,
usually 100–200 mg per tablet. In very high doses
(around 5 g), caffeine will produce nausea, coma,
convulsions, and eventually death.
Herbal preparations. Herbal preparations should be
purchased only from reliable sources, as their
potency may vary from batch to batch. In addition,
herbal products made outside the United States may
be adulterated with filler products or contaminated
by industrial byproducts.
Alcohol. Alcohol should always be consumed in
moderation and never combined with driving or
operating heavy machinery.
Pamabrom. Pamabrom is a mild diuretic that causes
skin rashes in a few people who take it for backache
or menstrual cramps.Interactions
Prescription diuretics interact with some other
prescription drugs as well as with herbal products:
Loop diuretics. Loop diuretics are known to interact
with licorice, digitalis, and buckthorn or alder
buckthorn.
Thiazide diuretics. Thiazide diuretics interact with
insulin to inhibit its effects in lowering blood sugar;
they intensify the toxic side effects of lithium therapy;
and they increase the effects of corticosteroids in
causing loss of potassium.
Potassium-sparing diuretics. May increase the toxic-
ity of lithium.
Osmotic diuretics. None reported as of 2007.
Carbonic anhydrase inhibitors. Enhance the effects
of amphetamines and tricyclic antidepressants;
increase the excretion of lithium and phenobarbital;Diuretics and diets