Drug
Interactions of Loop Diuretics:
©
Loop diuretics are useful to treat hypertension and
edema associated with congestive heart failure or renal insufficiency. In
patients with impaired kidney function, loop diuretics are more effective than
thiazide diuretics.
© Loop
diuretics include Furosemide
(Frusemide), Bumetanide, Torsemide and
Ethacrynic acid.
©
Loop diuretics compete for the Cl−
binding site of Na+-K+-2Cl− symporter
(cotransporter) of thick ascending limb of the loop of Henle and inhibit the
reabsorption of sodium (Na+), chloride (Cl−)and potassium
(K+). Loop diuretics prevent
the generation of a hypertonic renal medulla by disrupting the reabsorption of
these ions leading to increased urine production. Loop diuretics induce
vasodilation and increased blood supply to the kidney by increasing the
production of prostaglandins.
©
Loop Diuretics can interact majorly with drugs such as Digoxin,
Digitoxin, Sotalol, Dofetilide, Droperidol, Metolazone, Foscarnet, Arsenic
Trioxide, Ketanserin, Bepridil, Cisplatin, Aminoglycoside Antibiotics and some
Antivirals.
© Moderate interaction of Loop Diuretics includes ACE
Inhibitors, NSAIDs, Antidiabetics and Ginseng.
© Frequent monitoring of potassium and magnesium is
recommended when Loop Diuretics and Digitalis glycosides (Digoxin, Digitoxin)
are used together.
© Concomitant use of Loop diuretics and Sotalol,
Dofetilide, Droperidol, Arsenic Trioxide, Ketanserin or Bepridil warrants
the monitoring of the patients for the signs of Cardiotoxicity (Prolonged QTc
interval, faintness, dizziness, and tachycardia).
© Monitor
for additive ototoxicity or nephrotoxicity, if concurrent therapy of Loop
Diuretics and Aminoglycoside Antibiotics (Tobramycin, Streptomycin,
Gentamicin, Kanamycin, Amikacin, Neomycin, Netilmicin) or Cisplatin
is required.
© The status of fluids and electrolytes should be
closely monitored, when Loop diuretics and Metolazone are administered
together.
© Foscarnet
elimination is impaired by Loop diuretics and to avoid the Foscarnet toxicity,
a Thiazide diuretic is indicated.
© Antivirals like Ritonavir, Ombitasvir and
Dasabuvir may increase the risk of adverse events of Frusemide.
© Monitor for hypotension, fluid status, and body
weight regularly for up to two weeks after the initiation of ACE Inhibitors (Captopril,
Lisinopril, Perindopril, etc) in patients taking Loop diuretics.
© The patients taking both Loop diuretics and
NSAIDs (Ibuprofe, Diclofenac, Naproxen, etc) should be monitored for
diuretic efficacy and for signs of renal failure.
© Concomitant
use of a diuretic and an Antidiabetic agent warrants the monitoring of
glucose levels more frequently.
© Patients should be advised to discontinue use of
Ginseng while taking loop diuretics, to avoid diuretic resistance.
© The patients with hypertension should bring a
list of all of the drugs they are taking including prescription drugs,
over-the-counter drugs, and any supplements, herbal or otherwise, during their
visit to the doctor or pharmacist.
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