Diuretics. Use and misuse.

It is apparent that the large number of diuretics available today enables the clinician to mobilize edema fluid from patients with heart failure or other fluid retention states, to control blood pressure effectively in many patients with hypertension, and to manage many nonedematous states more successfully. The potency of some of these agents and their varied effects on renal tubular transport necessitate a cautious approach based on an understanding of their mechanisms of action. By selectively choosing different diuretics or diuretic combinations, the clinician can achieve the desired diuretic effect and prevent many of the electrolyte and acid-base derangements that accompany diuretic therapy. Selectivity of usage based on knowledge of the practical clinical pharmacology of these agents will also minimize the occurrence of side effects and avoid undesirable drug interactions.