Mechanism of Action
- Most diuretics alter renal function, causing an increase in the excretion of fluid.
Treatment
- Hypertension
- Heart Failure
- Edema (swelling)
- Certain kidney disorders
Use / Abuse in Sports and Exercise
- Rapid weight loss (Caldwell 1987)
- Achieve a weight category
- Evading drug testing (Bahrke 2002)
- Diuretics increase urine volume and dilute drug metabolites
Effect at Rest
- Decrease of blood pressure
- Decreased blood volume (Peel 1995)
Effects during Exercise
- May decrease blood pressure
- May affect congestive heart failure patients
- May induce arrhythmias
- Healthy Individuals
- Decreased exercise tolerance in direct proportion to the degree of hypohydration induced (Caldwell 1987)
- Clinical setting with compromised cardiopulmonary function (Caldwell 1987)
- Increases exercise tolerance and decrease symptoms
Loop Diuretic
- Commonly used to treat edematous states
- Loop diuretics are inappropriate for the treatment of hypertension in competitive athletes and other physically active patients (Niedfeldt 2002)
Loop Diuretic Names
- Furosemide (Lasix)
- Bumetanide (Bumex or Burinex)
- Ethacrynic acid, Etacrynic acid (Edecrin)
- Torasemide, Torsemide (Demadex, Diuver, and Examide)
Potassium-sparing Diuretics
- Spironolactone (Aldactone)
- Amiloride (Midamor)
- Triamterene (Dyrenium)
- Used in combination with thiazide diuretics for the treatment of hypertension and edema
- Triamterene & Hydrochlorothiazid (Maxzide, Dyazide)
- Used in combination with thiazide diuretics for the treatment of hypertension and edema
Carbonic Anhydrase Inhibitor
- Acetazolamide
- The only Carbonic Anhydrase Inhibitor with significant diuretic effect (Kassamali 2011)
- Can correct significant metabolic alkalosis which occasionally occurs with loop diuretic therapy (Kassamali 2011)
- Prevents or improves symptoms of acute mountain sickness, thereby improving exercise performance at high altitude (Caldwell 1987)
Thiazide and Thiazide-like Diuretics
- Chlorothiazide (Diuril)
- Chlortalidone or Chlorthalidone
- Hydrochlorothiazide (Hydro-Diuril, Esidrix, Apo-hydro, Microzide)
- Triamterene & Hydrochlorothiazide (Maxzide, Dyazide)
Thiazide Diuretics Effect on Exercise
- No effect on heart rate (Niedfeldt 2002)
- Decrease in stroke volume (Niedfeldt 2002)
- Decrease in cardiac output (Niedfeldt 2002)
- Decrease in vascular resistance (Niedfeldt 2002)
- Decrease in plasma volume (Niedfeldt 2002)
- No effect on endurance (Niedfeldt 2002)
Potential Side Effects
- Orthostatic (postural) hypotension (Caldwell 1987, Niedfeldt 2002)
- Hypohydration (Caldwell 1987)
- Adverse effects on performance
- Impaired strength, power and endurance
- Urinary loss of potassium and magnesium (Niedfeldt 2002)
- Could lead to muscle cramps, arrhythmias, and rhabdomyolysis in patients exercising intensely or competing in warm weather
- Hypovolemia (decreased blood volume) (Niedfeldt 2002, Boron 2004)
- Diuretics
- Loop diuretics (Boron 2004)
- Thiazides (Boron 2004)
- Not an issue with diuretics interfering with the aldosterone mechanism in the distal nephron (Caldwell 1987)
- Symptoms (Boron 2004)
- Fatigue
- Thirst
- Muscle cramps
- Hypotension
- May affect (Caldwell 1987)
- Cardiac rhythm
- Muscle function and integrity
- Local blood flow
- Carbohydrate metabolism
- Blood lipid profile
- Precautions (Caldwell 1987)
- Diet may help to some degree
- Potassium chloride supplements or potassium-sparing diuretics or diuretic combinations may be necessary
- Diuretics
- Hypokalemia (low blood potassium) (Caldwell 1987, Boron 2004)
- Diuretics (Boron 2004)
- Acetazolamides
- Loop diuretics
- Thiazides
- Symptoms (Boron 2004)
- Muscle weakness
- Paralysis
- Arrythmia
- Diuretics (Boron 2004)
- Hyperkalemia (high blood potassium) (Boron 2004)
- Diuretics
- Potassium-sparing Diuretics
- Symptoms
- Arrhythmia
- Muscle cramps
- Paralysis
- Diuretics
- Hyponatremia (low blood sodium) (Boron 2004)
- Diuretics
- Furosemide (Lasix)
- Thiazides
- Symptoms
- Nausea and vomiting
- Headache
- Confusion
- Fatigue
- Restlessness and irritability
- Muscle weakness, spasms or cramps
- Seizures
- Coma
- Diuretics
- Metabolic Alkalosis (low hydrogen ion concentrations) (Boron 2004)
- Diuretics
- Loop diuretics
- Thiazides
- Symptoms
- Arrhythmia
- Hand tremor
- Lightheadedness
- Muscle twitching
- Nausea
- Vomiting
- Numbness or tingling in the face, hands, or feet.
- Tetany (prolonged muscle spasms)
- Confusion
- Stupor or coma
- Diuretics
- Metabolic Acidosis (high hydrogen ion concentrations) (Boron 2004)
- Diuretics
- Acetazolamides
- Amiloride (Midamor)
- Triamterene (Dyrenium)
- Symptoms
- Kussmaul respirations
- Muscle weakness
- Lethargy
- Seizures
- Stupor
- Coma
- Diuretics
- Hypercalcemia (high blood calcium) (Boron 2004)
- Diuretics
- Thiazides
- Symptoms
- Fatigue
- Depression
- Confusion
- Anorexia
- Nausea
- Vomiting
- Constipation
- Increased urination
- Pancreatitis
- Gout
- Tissue calcification
- Diuretics
- Hyperuricemia (high blood uric acid) (Boron 2004)
- Diuretics
- Thiazides
- Loop Diuretics
- Symptoms
- Gout
- Diuretics
Recommended Population
- Elderly (Niedfeldt 2002)
- Black (Niedfeldt 2002)
- Those with congestive heart failure (Niedfeldt 2002)
Populations Not Recommended
- Endurance athletes (Niedfeldt 2002)
- Collegiate athletes (Niedfeldt 2002)
Banned Status
- Banned by USOC and NCAA
References
Boron WF (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. 875.
Bahrke Ml (2002). Performance-Enhancing Substances in Sport and Exercise. Human Kinetics.
Caldwell JE (1987). Diuretic therapy and exercise performance. Sports Med. 4(4):290-304.
Kassamali R, Sica DA (2011). Acetazolamide: a forgotten diuretic agent. Cardiol Rev. 19(6):276-8.
Niedfeldt MW (2002). Managing Hypertension in Athletes and Physically Active Patients. Am Fam Physician. 1;66(3):445-453.
Peel C, Mossberg KA (1995). Effects of exercise medications on exercise responses. Phys Ther;75(5):387-96.