Diuretics (Water Pills)
Common brand names: Hydrochlorothiazide, Furosemide (Lasix), Chlorthalidone
Four nutrients listed against this medication. The most severe is marked critical.
At a glance
Three of the four are marked well documented. The other one carries its own evidence level.
At a glance
- MagnesiumCritical · Well documented
- PotassiumCritical · Moderate evidence
- ZincModerate · Well documented
- B Vitamins (B1, B6)Moderate · Well documented
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Loop and thiazide diuretics increase urinary excretion of magnesium. Magnesium depletion is one of the most consistent findings with long-term diuretic use.
Common signs, Cardiac arrhythmia, muscle cramps, hypertension (paradoxically worsens), fatigue
Kieboom et al. (Pharmacoepidemiol Drug Saf, 2018; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 30095199): thiazide (not loop) diuretic use was associated with lower serum magnesium; the risk was absent when combined with a potassium-sparing agent.
Magnesium bisglycinate was used at 300–400 mg daily. Serum magnesium is commonly monitored every 6 months, since low magnesium impairs potassium repletion.
Mechanism, Loop and thiazide diuretics directly increase renal potassium excretion. Hypokalemia is the most well-recognized and dangerous diuretic side effect.
Common signs, Muscle weakness, cardiac arrhythmia, fatigue, hypertension
Siscovick et al. (N Engl J Med, 1994; PMID 8196728): thiazide-induced potassium loss: higher thiazide dose raised primary cardiac-arrest risk, an effect reduced by adding a potassium-sparing agent.
Dietary potassium (bananas, leafy greens, avocado) is emphasized first. Potassium supplementation is done only under physician guidance, since dosing requires monitoring.
Mechanism, Thiazide diuretics increase urinary zinc excretion, documented in multiple studies of long-term use.
Common signs, Immune suppression, taste changes, wound healing impairment
Khedun et al. (Cent Afr J Med, 1995; PMID 8556776): hydrochlorothiazide significantly lowered serum zinc in hypertensive men.
Zinc 15 mg daily with food is a figure in common use, not from a trial cited on this row. The cited paper concerns zinc and hydrochlorothiazide and tested no repletion dose or form.
Mechanism, Loop diuretics (furosemide) increase urinary B1 (thiamine) excretion significantly. Thiamine deficiency in heart failure patients on furosemide is a documented clinical problem.
Common signs, Fatigue, nerve damage, heart dysfunction, cognitive impairment
Seligmann et al. (Am J Med, 1991; PMID 1867241): thiamine (B1) deficiency was common in heart-failure patients on furosemide.
Thiamine 50–100 mg daily is a range in common use with long-term loop diuretic therapy, not from a trial cited on this row. The cited pilot study measured thiamine deficiency in heart-failure patients on long-term furosemide.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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