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Potassium-sparing diuretics or antikaliuretics [1] refer to drugs that cause diuresis without causing potassium loss in the urine. [2] They are typically used as an adjunct in management of hypertension , cirrhosis , and congestive heart failure . [ 3 ]
Due to its potassium-sparing capacities, hyperkalemia (elevated potassium concentration in the blood) can occur. The risk of developing hyperkalemia is increased in patients who are also taking ACE inhibitors , angiotensin II receptor antagonists , other potassium-sparing diuretics , or any potassium-containing supplements.
For potassium-sparing diuretics, its common side effects include hyponatremia, hyperkalemia, metabolic acidosis and sexual dysfunction specifically for spironolactone. [4] [5] The use of diuretics should be avoided in patients with severe dehydration, anuria (absence of urine production). [4]
[2] [3] Other serious side effects may include high blood potassium. [2] [3] Use in pregnancy and breastfeeding is not generally recommended. [2] [3] Use in those with significant kidney problems is not recommended. [2] [3] It decreases blood pressure mainly by hydrochlorothiazide while triamterene decreases the amount of potassium lost. [2] [3]
The thiazides and potassium-sparing diuretics are considered to be calcium-sparing diuretics. [6] The thiazides cause a net decrease in calcium lost in urine. [7] The potassium-sparing diuretics cause a net increase in calcium lost in urine, but the increase is much smaller than the increase associated with other diuretic classes. [7]
The thiazide diuretics also deplete circulating potassium unless combined with a potassium-sparing diuretic or supplemental potassium. Some authors have challenged thiazides as first line treatment. [55] [56] [57] However, as the Merck Manual of Geriatrics notes, "thiazide-type diuretics are especially safe and effective in the elderly." [58]
Thiazide diuretics (e.g. hydrochlorothiazide, chlorthalidone, chlorthiazide) – may be useful for mild CHF, but typically used in severe CHF in combination with loop diuretics, resulting in a synergistic effect. Potassium-sparing diuretics (e.g. amiloride) – used first-line use to correct hypokalaemia.
Triamterene directly blocks the epithelial sodium channel [4] (ENaC) on the lumen side of the kidney collecting tubule. [5]: 127 Other diuretics cause a decrease in the sodium concentration of the forming urine due to the entry of sodium into the cell via the ENaC, and the concomitant exit of potassium from the principal cell into the forming urine.