A Comprehensive Review of the Pharmacologic Perspective on Loop Diuretic Drug Interactions with Therapeutically Used Drugs

Abstract

Background: Loop diuretics help to manage the patients with edema associated with congestive heart failure, liver cirrhosis, and renal disease and hypertension. The patients taking loop diuretics may receive other medications to treat comorbidities leading to drug interactions. Methodology: The literature was searched in databases such as Medline/PMC/PubMed, Google Scholar, Cochrane Library, Science Direct, EMBASE, Web of science, Ebsco, Directory of open access journals (DOAJ) and reference lists to spot relevant articles using the keywords Drug interactions, Pharmacodynamic interactions, Loop diuretics, Bumetanide, Ethacrynic acid, Furosemide, and Torsemide. Results: Loop diuretics are associated with hypokalemia, ototoxicity and other adverse effects. The drugs affected by hypokalemia, and having the potential of inducing ototoxicity could interact with loop diuretics pharmacodynamically. Loop diuretics can interact with drugs such as amphotericin B, digoxin, angiotensin-converting enzyme inhibitors (ACE inhibitors), antidiabetic drugs, antifungal agents, dobutamine, gossypoland sotalol due to diuretic associated hypokalemia. In addition, the risk of ototoxicity could be enhanced by the concomitant use of loop diuretics and cisplatin, aminoglycoside antibiotics or phosphodiesterase 5 (PDE 5) inhibitors. Loop diuretics may also interact pharmacodynamically with drugs like cephalosporins, ceritinib, levothyroxine, pixantrone, probenecid, lithium, non-steroidal anti-inflammatory drugs (NSAIDs), sulfonylureas and herbal drugs. Conclusion: Clinicians, pharmacists and other health care providers should take responsibility for the safe use of medications. In addition, they are required to be aware of the drugs interacting with loop diuretics, to prevent adverse drug interactions.

Loop Diuretics and Sarcopenia: A Potential Association

“…Moreover, they augment the urinary excretion of K + , Mg 2+ , H + and CI -. Meanwhile, LDs, of which furosemide is the most frequently administrated, are utilized to manage fluid overload in heart failure (HF), renal disease (RD), liver cirrhosis and hypertension in order to improve manifestations of breathlessness and edema [25,26]. Nevertheless, a diuretic-induced reduction in plasma volume might activate several neurohumoral systems, such as renin-aldosterone-angiotensin, leading to impaired renal perfusion and increased Na + and water resorption [25].…”

“…LDs are related to various adverse outcomes such as hypokalemia, ototoxicity, and others [26]. LDs can potentially interact with other medications.…”

“…LDs can potentially interact with other medications. It is already established that LDs might interact with several medications including digoxin, amphotericin B, angiotensin-converting enzyme inhibitors (ACE inhibitors), antifungal agents, antidiabetic drugs, dobutamine, and sotalol due to diuretic-associated hypokalemia [26]. Moreover, the hazard of ototoxicity could be augmented by the concomitant utilization of LDs, cisplatin, aminoglycoside antibiotics or phosphodiesterase 5 (PDE 5) inhibitors [26].…”

“…It is already established that LDs might interact with several medications including digoxin, amphotericin B, angiotensin-converting enzyme inhibitors (ACE inhibitors), antifungal agents, antidiabetic drugs, dobutamine, and sotalol due to diuretic-associated hypokalemia [26]. Moreover, the hazard of ototoxicity could be augmented by the concomitant utilization of LDs, cisplatin, aminoglycoside antibiotics or phosphodiesterase 5 (PDE 5) inhibitors [26]. Moreover, LDs might interact pharmacodynamically with medications such as levothyroxine, cephalosporins, pixantrone, ceritinib, lithium, probenecid, nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonylureas, and other herbal drugs [26].…”

“…Moreover, the hazard of ototoxicity could be augmented by the concomitant utilization of LDs, cisplatin, aminoglycoside antibiotics or phosphodiesterase 5 (PDE 5) inhibitors [26]. Moreover, LDs might interact pharmacodynamically with medications such as levothyroxine, cephalosporins, pixantrone, ceritinib, lithium, probenecid, nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonylureas, and other herbal drugs [26].…”