Loop diuretics include- Furosemide, Bumetamide, Ethacrynic acid, Torsemide Refer Furosemide 

Anticoagulants- Anticoagulant activity may be enhanced.

Propranolol- Plasma levels of propranolol may be increased. Digitalis glycosides- Diuretic induced electrolyte disturbances may predispose to digitalis-induced arrhythmias.

Lithium- Increased plasma lithium levels and toxicity are possible. Sulfonylureas- May decrease glucose tolerance, resulting in hyperglycaemia in patients previously controlled by sulfonylurea.

Theophylline - Action of theophylline may be altered, enhanced or inhibited. Lab test abnormalities: Changes in LDH,total serum bilirubin, serum proteins, AST,ALT, alkaline phosphatase.

Loop diuretics include- Furosemide, Bumetamide, Ethacrynic acid, Torsemide Refer Furosemide 

Diuretic

Bumetanide-

CNS- asterixis, encephalopathy with preesisting liver disease,impaired hearing, esr discomfort, vertigo, headache, dizziness.

GI- upset stomach, dry mouth, nasusea, vomiting, diarrhea, pain

GU- premature ejaculation, difficulty inmaintaing erection, renal failure Musculoskeletal- weakness, arthiritic pain, pain, muscle cramps, fatigue

Cardiovascular- hypotension, ECG changes, chest pain

Miscellaneous- hives, pruritus, itching, dehydration, sweating, hyperventilation, nipple tenderness, rash, thrombocytopenia

Lab test abnormalities- Diuresis rarely accompanied by changes in LDH , total serum bilirubin, serum proteins, AST, ALT, alkaline phosphatase,cholesterol and creatinine clearance, deviations in hemoglobin, prothrombin time, hematocrit, WBC, platelet counts,and differential counts, increase in urinary glucose, and protein, hyperuricemia, hypoochloremia, hypokalemia, azotemia, hyponatremia, increased serum creatinine, hyperglycemia, variations in phosphorus, CO2 content,bicarbonate and calcium.

Anuria,hypersensitivity,patients with hepatic coma or in states of severe electrolyte depletion until condition is improved or corrected.

Special precautions:

Observe patients for blood dyscrasias, liver or kidney damage or idiosyncratic reactions.

Perform frequent serum electrolyte, calcium,glucose, uric acid, CO2, creatinine detrmn during the first few months of therapy and priodically thereafter.

Too vigourous a diuresis,as evidenced by rapid and excessive weight loss, may induce hypotensive episode.In elderly patients avoid rapid contration of plasma volume

Indications: Diuretic

Dosage:

0.5 to 2mg/day given as a single dose.

If response not adequate, give a second or third dose at 4 to 5 hour intervals, upto a maximum of daily dose of 10mg..

Loop diuretics

1. May cause GI upset, take with food or milk

2. Drug will increase urination, take early in the day

3. Notify physician if muscle weakness , cramps, nausea, or dizziness occur

4. Orthostatic hypotension may occur, get up slowly

5. Diabetes mellitus patients- may increase blood glucose levels, affecting urine glucose tests.

6. Photosentivity may occur in some patients. Cution patients to take protective measures (ie Sunscreens, protective clothing) against exposure to ultraviolet light or sunlight

7. Hypersensitivity patients should avoid medications that may increase blood pressure, including OTC products for appetite suppression and cold symptoms

May be taken with meals to reduce GI discomfort