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A diuretic (colloquially called a water pill) is any drug or herb that elevates the rate of bodily urine excretion (diuresis). Diuretics also decrease the extracellular fluid (ECF) volume, and are primarily used to produce a negative extracellular fluid balance. Caffeine, cranberry juice and alcohol are all weak diuretics.

[edit] Uses

In medicine, diuretics are used to treat heart failure, liver cirrhosis, hypertension and certain kidney diseases. Diuretics alleviate the symptoms of these diseases by causing sodium and water loss through the urine. As urine is produced by the kidney, sodium and water – which cause edema related to the disease – move into the blood to replace the volume lost as urine, thereby reducing the pathological edema. Some diuretics, such as acetazolamide, help to make the urine more alkaline and are helpful in increasing excretion of substances such as aspirin in cases of overdose or poisoning. Diuretics are often abused by sufferers of eating disorders, especially bulimics as a weight loss attempt.

The antihypertensive actions of some diuretics (thiazides and loop diuretics in particular) are independent of their diuretic effect. That is, the reduction in blood pressure is not due to decreased blood volume resulting from increased urine production, but occurs through other mechanisms and at lower doses than that required to produce diuresis. Indapamide was specifically designed with this is mind, and has a larger therapeutic window for hypertension (without pronounced diuresis) than most other diuretics.

[edit] Mechanism of action

Classification of common diuretics and their mechanisms of action
Agent Group	Examples	Mechanism	Location
-	Ethanol, Water	inhibits vasopressin secretion
Acidifying salts	CaCl2, NH4Cl
Arginine vasopressin receptor 2 antagonists	amphotericin B, lithium citrate	inhibit vasopressin's action	collecting duct
Carbonic anhydrase inhibitors	acetazolamide, dorzolamide	inhibit H+ secretion, resultant promotion of Na+ and K+ excretion	proximal tubule
Loop diuretics	bumetanide, ethacrynic acid, furosemide, torsemide	inhibit the Na-K-2Cl symporter	medullary thick ascending limb
Osmotic diuretics	glucose, mannitol	promote osmotic diuresis
Potassium-sparing diuretics	amiloride, spironolactone, triamterene	inhibition of Na+/K+ exchange: Spironolactone inhibits aldosterone action, Amiloride inhibits epithelial sodium channels	cortical collecting ducts
Thiazides	bendroflumethiazide, hydrochlorothiazide	inhibit Na+/Cl- reabsorption	distal convoluted tubules
Xanthines	caffeine, theophylline	inhibit reabsorption of Na+, increase glomerular filtration rate	tubules

Chemically, diuretics are a diverse group of compounds that either stimulate or inhibit various hormones that naturally occur in the body to regulate urine production by the kidneys.

Alcohol produces diuresis through modulation of the vasopressin system.

Antihypertensives (C02) and diuretics (C03) edit
Antiadrenergic agents (including alpha):	Clonidine, Doxazosin, Guanethidine, Guanfacine, Lofexidine, Mecamylamine, Methyldopa, Moxonidine, Prazosin, Rescinnamine, Reserpine
Vasodilators:	Diazoxide, Hydralazine, Minoxidil, Nitroprusside, Phentolamine
Other antihypertensives:	Bosentan, Ketanserin
Low ceiling diuretics:	Bendroflumethiazide, Chlorothiazide, Chlortalidone, Hydrochlorothiazide, Indapamide, Quinethazone, Mersalyl, Metolazone, Theobromine
High ceiling diuretics:	Bumetanide, Furosemide, Torasemide
Potassium-sparing diuretics:	Amiloride, Eplerenone, Spironolactone, Triamterene

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