Data provided by Applied Health
side effects, nutrient depletions, herbal interactions and health notes:
• One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.1 Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Folic acid is also an important cause of elevated homocysteine levels. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.1
• Preliminary research in animals suggests that amiloride, a drug similar to spironolactone, may inhibit the urinary excretion of magnesium.2 It is unknown if this same effect would occur in humans or with spironolactone. Persons taking more than 300 mg of magnesium per day and spironolactone should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of spironolactone and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.2
• As a potassium-sparing diuretic, spironolactone reduces urinary loss of potassium, which can lead to elevated potassium levels.3 People taking spironolactone should avoid potassium supplements, potassium-containing salt substitutes (Morton Salt Substitute®, No Salt®, Lite Salt®, and others), and even high-potassium foods (primarily fruit). Doctors should monitor potassium blood levels in patients taking spironolactone to prevent problems associated with elevated potassium levels.3
• Diuretics, including spironolactone, cause increased loss of sodium in the urine. By removing sodium from the body, diuretics also cause water to leave the body. This reduction of body water is the purpose of taking diuretics. Therefore, there is usually no reason to replace lost sodium, although strict limitation of salt intake in combination with the actions of diuretics can sometimes cause excessive sodium depletion. On the other hand, people who restrict sodium intake and in the process reduce blood pressure may need to have their dose of diuretics lowered. People taking spironolactone should talk with their prescribing doctor before severely restricting salt.4
• Food can increase absorption of spironolactone.5 Spironolactone should be taken at the same time and always with food or always without food, every day for best results. People with questions about spironolactone and food should ask their prescribing doctor or pharmacist.5
• Diuretic herbs Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may increase the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.46
References1 . Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866–70.
2 2. Devane J, Ryan MP. The effects of amiloride and triamterene on urinary magnesium excretion in conscious saline-loaded rats. Br J Pharmacol 1981;72:285–9.
3 3. Ramsay LE, Hettiarachchi J, Fraser R, Morton JJ. Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients. Clin Pharmacol Ther 1980;27:533–43
4 5. Threlkeld DS, ed. Diuretics and Cardiovasculars, Potassium-Sparing Diuretics, Spironolactone. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jul 1993, 138h–8j.
5 4. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102–3.
6 4. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102–3.
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The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.