Diuretics, or simply diuretics, are substances that help to remove urine and reduce the amount of fluid contained in the serous cavities and tissues of the body. Most often, diuretics are used as an adjunct in the treatment of diseases of the heart, kidneys, and liver, which are accompanied by edema. Diuretics are intended only to reduce or eliminate stagnation, and the main treatment should eliminate the pathological process that provokes the accumulation of excess fluid in the body.
The very first diuretic preparations of high efficiency appeared about a hundred years ago, when the diuretic effect of mercury, or rather its compounds used in the treatment of syphilis, was completely accidentally revealed. Currently, due to its high toxicity, mercury diuretics are no longer used, however, the study of these drugs has played a large role in shaping the modern understanding of the extrarenal and diuretic mechanisms of the action of diuretics.
In addition to the previously obsolete xanthine-derived mercury diuretics that have been used, many other more effective drugs have been synthesized and used: dichlothiazide, furosemide cyclomethiazide (benzothiadiazine derivatives), diacarb (a carbonic anhydrase inhibitor), pterofen-triamterene, and amyl pyridine ( and etc.
In addition to medications, natural diuretics (herbal), such as lingonberry and bearberry leaves, various kidney teas, birch buds, diuretic fees No. 1 and No. 2, and horsetail grass are widely used to combat the accumulation of excess fluid in the body.
The main effect of diuretics is to increase the renal excretion of sodium ions and water. Due to its ability to influence the water and electrolyte balance, vascular tone and blood volume, diuretics are very often used as antihypertensive agents. Due to the acceleration of renal excretion, diuretics that have a strong diuretic effect are used in the course of treatment of poisoning with various water-soluble substances.
A single, taking into account all aspects of the action of diuretics, classification does not exist today. All diuretics, having different chemical structures, differ from each other in their localization, mechanism, force of action, speed of onset of effect, its duration and side effect. For a long time, the classification of diuretics was based on their chemical structure, there have also been attempts to classify them according to the nature of the effect on the kidneys, but for many diuretics, an extrarenal effect is also characteristic. Therefore, all diuretics are more rationally classified according to their mechanism of action.
Based on the pharmacodynamics of drugs, all modern diuretics are divided into three groups:
- potassium-sparing diuretics that increase sodium excretion and slightly affect potassium excretion. These include amiloride, triamteren, spironolactone and eplerenone.
- saluretics - thiazide derivatives, thiazide-like, loop diuretics, carbonic anhydrase inhibitors.
- osmotic diuretics that increase the pressure in the tubules and prevent water reabsorption - mannitol, urea.
In addition to the classification according to pharmacodynamics, diuretics are classified by the rate of onset and the duration of this effect.
By the strength of action they distinguish: weak, medium and strong diuretic. According to the speed of the onset of the diuretic effect, drugs of emergency (fast) action are distinguished - 30-40 minutes, medium effect - 2-4 hours, slow action - 2-4 days. By the duration of the diuretic effect: short-acting - 5-8 hours, medium-long - 8-15 hours, long-lasting - several days.
The main area of diuretic use is cardiovascular disease, especially circulatory failure with swelling syndrome and arterial hypertension.