2.2 Diuretics

General Guidance

For Dudley Hypertension Pathway click here 

Hypokalaemia

• Hypokalaemia may occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with the equipotent dose of a loop diuretic. Hypokalaemia can be dangerous in severe coronary artery disease and in those also being treated with cardiac glycosides. Often the use of potassium sparing diuretics avoids the need to take potassium supplements in such patients. The routine prescribing of potassium sparing diuretics should be avoided in other groups. Such patients should be commenced on a diuretic alone and the U&Es checked after one month.
• Combination products should be avoided routinely. However, if one is required due to poor compliance then use co-amilofruse.

Recommended drugs

Thiazides and related diuretics

Bendroflumethiazide: 2.5mg for hypertension  £

Indapamide 2.5mg  £ 

Metolazone £££  

 

Loop diuretics

Furosemide £

Bumetanide £

 

Potassium-sparring diuretics

Amiloride £

Spironolactone

 

Combination diuretics

Co-amilofruse £

 

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

 

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low