Diuretics, Thiazide Diuretics

Table of Contents > Depletions > Diuretics, Thiazide Diuretics

Diuretics

Thiazide Diuretics

Chlorothiazide

(Diuril®)

Hydrochlorothiazide

(Aquazide®; Esidrix®; Ezide®; Hydrocot®; HydroDIURIL®; Microzide™; Oretic®)

Indapamide

(Lozol®)

Methyclothiazide

(Aquatensen®; Enduron®)

Metolazone

(Mykrox®; Zaroxolyn®)

Depletions

Chloride; Sodium

Because of the wide availability of sodium in dietary sources, deficiency is very uncommon. In the rare instances where it does occur, depleted levels have been associated with gas, nausea and vomiting, headache, memory impairment, diminished attention, muscle weakness, heart palpitations, lethargy, and confusion. Extreme cases can cause stupor, seizures, and possibly coma. The development of symptoms depends in large part on the rate of the loss of sodium.

Coenzyme Q10

A deficiency of the antioxidant coenzyme Q10 may be associated with long-term conditions including heart disease and high blood pressure. Symptoms of deficiency include gingivitis, and weakened immune function.

Magnesium

Magnesium deficiency affects calcium and vitamin D levels in the body and may be associated with muscle cramps, heart irregularities, high blood pressure, diabetes, and osteoporosis (bone loss).

Potassium

Symptoms of deficiency include loss of appetite, nausea, drowsiness, feelings of apprehension, excessive thirst, irrational behavior, fatigue, muscle pain and weakness (usually of the lower limbs); severe cases may lead to irregular heartbeat.

Zinc

Signs and symptoms of zinc deficiency include loss of appetite or sense of taste, growth retardation, skin changes, and increased susceptibility to infection.

Editorial Note

The selected depletions information presented here identifies some of the nutrients that may be depleted by certain medications. The signs and symptoms associated with nutrient deficiency may also indicate conditions other than nutrient deficiency. If you are experiencing any of the signs or symptoms mentioned, it does not necessarily mean that you are nutrient deficient. Nutrient depletion depends upon a number of factors, including your medical history, diet, and lifestyle as well as the length of time you have been taking the medication. Please consult your healthcare provider; he or she can best assess and address your individual healthcare needs, and determine if you are at risk for nutrient depletions from these medications as well as others not listed here.

Supporting Research

Abraham AS, Brooks BA, Grafstein Y, et al. Effects of hydrochlorothiazide, diltiazem and enalapril on mononuclear cell sodium and magnesium levels in systemic hypertension. Am J Cardiol. 1991;68:1357-1361.

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Cashman K, Flynn A. Optimal nutrition: calcium, magnesium and phosphorus. Proc Nutr Soc. 1999;58:477-487.

Chan A, Reichmann H, Kogel A, et al. Metabolic changes in patients with mitochondrial myopathies and effects of coenzyme Q10 therapy. J Neurol. 1998;245(10):681-685.

Covington T, ed. Nonprescription Drug Therapy Guiding Patient Self-Care. St Louis, MO: Facts and Comparisons; 1999:467-545.

Dai LJ, Friedman PA, Quamme GA. Cellular mechanisms of chlorothiazide and cellular potassium depletion on Mg2+ uptake in mouse distal convoluted tubule cells. Kidney Int. 1997;51(4):1008-1017.

Dyckner T, Wester PO. Potassium/magnesium depletion in patients with cardiovascular disease. Am J Med. 1987;82(3A):11-17.

Falchuk KH. Disturbances in Trace Elements. In: Fauci A, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14^th ed. New York, NY: McGraw-Hill Companies Health Professional Division; 1998:490-491.

Folkers K, Morita M, McRee J Jr. The activities of coenzyme Q10 and vitamin B6 for immune responses. Biochem Biophys Res Commun. 1993; 28(19391):88-92.

Folkers K. Basic chemical research on coenzyme Q-10 and integrated clinical research on therapy of diseases, in Coenzyme Q, G. Lenaz, ed. John Wiley & Sons, 1985.

Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr. 1998;17(1):75-78.

Hambidge M. Human zinc deficiency. J Nutr. 2000;130(5S Suppl):1344S-1349S.

Hines Burnham T, et al, eds. Drug Facts and Comparisons. St. Louis, MO:Facts and Comparisons; 2000:617.

Kamikawa T, Kobayashi A, Yamashita T, et al. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol. 1985;56(4):247-251.

Kaplan NM. The dietary guideline for sodium: should we shake it up? NAm J Clin Nutr. 2000;71:1020-1026.

Kishi H, Kishi T, Folkers K. Bioenergetics in clinical medicine. III. Inhibition of coenzyme Q10-enzymes by clinically used anti-hypertensive drugs. Res Commun Chem Pathol Pharmacol. 1975;12(3):533-540.

Mountokalakis T, Dourakis S, Karatzas N, et al. Zinc deficiency in mild hypertensive patients treated with diuretics. J Hypertens Suppl. 1984;2(3):S571-S572.

Munkholm H, Hansen HH, Rasmussen K. Coenzyme Q10 treatment in serious heart failure. Biofactors. 1999;9(2-4):285-289.

Nakamura R, Littarru GP, Folkers R, et al. Study of CoQ10-enzymes in gingiva from patients with periodontal disease and evidence for a deficiency of coenzyme Q10. Proc Natl Acad SciUSA. 1974;71(4):1456-1460.

National Research Council. Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press; 1989.

Peczkowska M. [Influence of angiotensin I converting enzyme inhibitors on selected parameters of zinc metabolism]. Pol Arch Med Wewn. 1996;96(1):32-38.

Reyes AJ, Leary WP, Lockett CJ, et al. Diuretics and zinc. S Afr Med J. 1982;62(11):373-375.

Reyes AJ, Olhaberry JV, Leary WP, et al. Urinary zinc excretion, diuretics, zinc deficiency and some side effects of diuretics. S Afr Med J. 1983;64(24):936-941.

Singer GG, Brenner BM. Fluid and electrolyte disturbances. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill Companies Health Professional Division; 1998:269.

Singh RB, Niaz MA, Rastogi SS, et al. Effect of hydrosoluble coenzyme Q10 on blood pressure and insulin resistance in hypertensive patients with coronary heart disease. J Hum Hypertens. 1999;13(3):203-208.

Singh RB, Wander GS, Rastogi A, et al. Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction. Cardiovasc Drugs Ther. 1998;12(4):347-353.

Wester PO. Urinary zinc excretion during treatment with different diuretics. Acta Med Scand. 1980;208:209-212.

Review Date: October 2000

Reviewed By: All depletions monographs have been reviewed by a team of experts including Derrick M. DeSilva, Jr., MD, Raritan Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor, A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD, Woodbine, IA; Ruth Marlin, MD, Medical Director and Director of Medical Education, Preventive Medicine Research Institute, Sausalito, CA; Brian T Sanderoff, PD, BS in Pharmacy, Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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