Diuretics

The document from January 1, 2018, presents various studies and case reports on the adverse effects and safety concerns of diuretics, particularly acetazolamide, loop diuretics like furosemide, and thiazide diuretics. It includes a randomized controlled trial with 62 patients showing topical dorzolamide plus timolol as a safe alternative to oral acetazolamide for intraocular pressure reduction, and a retrospective cohort study with 99,766 elderly individuals indicating increased respiratory-related morbidity and mortality with loop diuretics. A prospective cohort study with 55,780 women and a retrospective case-control study with 4,523 elderly patients found an increased risk of fractures with diuretic use. A study in 30 patients showed furosemide increased renal oxidative stress, and a review of 61 pediatric patients suggested tolerance development to furosemide. Case reports included diuretic-induced acute pancreatitis, severe hypokalemia, leucopenia, secondary hyperparathyroidism, and hyperkalemia-induced cardiac arrest. Thiazide diuretics were linked to hyperuricemia, hyponatremia, and an increased risk of osteoporosis and fractures, with genetic associations identified. High cumulative doses of hydrochlorothiazide were associated with an increased risk of squamous cell carcinoma due to photosensitivity. The document underscores the importance of cautious diuretic use and the need for further research to balance benefits and risks.