Furosemide Vs Hydrochlorothiazide

Introduction

High blood pressure is characterized by excessive pressure against the artery walls that can damage body organs and blood vessels. It decreases the flow of blood and oxygen to the heart, leading to heart disease. In addition, the decreased blood flow to the heart can lead to chest pain, also known as angina.

Nearly half of all adults in the US have high blood pressure with a systolic blood pressure of over 130 mmHg. The most effective treatment for high blood pressure is diuretics such as Furosemide and Hydrochlorothiazide. These medicines work by helping the kidneys release more sodium into the urine.

The sodium helps remove water from the blood, thereby reducing the amount of fluid flowing through the arteries and veins. This, in turn, lowers blood pressure. Let’s take a closer look at how furosemide and hydrochlorothiazide work to help with hypertension.

About Furosemide and Hydrochlorothiazide

What is Furosemide?

Furosemide belongs to a group of medicines known as water pills (also called loop diuretics). The drug is highly effective at reducing high blood pressure, but it can result in dehydration and an electrolyte imbalance. Furosemide may also be used to help with urination when the kidneys are not working properly.

Furosemide can be used orally as a tablet or as a solution. It can be taken once or twice daily to treat high blood pressure and edema. It is worth noting that Furosemide does not cure high blood pressure and is merely used to mitigate the symptoms of the condition. Oral Furosemide is often prescribed alone for managing high blood pressure.

It may be combined with other antihypertensive medications for managing severe hypertension. In some cases, a patient may be prescribed intravenous Furosemide to achieve emergency diuresis.

What conditions is Furosemide approved to treat?

Furosemide is primarily used in the treatment of high blood pressure. It can also treat edema (characterized by excess fluid stored in the tissues) caused due to medical problems such as liver and kidney disease.

How does Furosemide work for High Blood Pressure?

Furosemide works by increasing the secretion of sodium and water by preventing their absorption from the distal and proximal tubes, as well as the loop of Henle in the renal tubule Jackson.

It is often referred to as a high ceiling diuretic because of its greater effectiveness compared to other diuretics. Furosemide can reduce the reabsorption of chloride, potassium, and sodium from the tubule. Another mechanism of action is through prostaglandin synthesis. Furosemide increases the production of intrarenal prostaglandin, which increases renal blood flow.

The terminal half-life of Furosemide is about 2 hours, with each dose working for about 6 hours before it is purged from the system.

What is Hydrochlorothiazide?

Hydrochlorothiazide is used to treat high blood pressure and excess fluid retention in the tissues. It is classified as a diuretic or water pill. Much like Furosemide, Hydrochlorothiazide works by causing the body to make more urine. Doing so helps the body purge the extra salt and water. This drug should be taken orally as directed by your doctor, usually once per day in the morning, with or without food.

Taking this medicine too close to bedtime is not advice because it will cause the patient to wake up for orientation. For best results, it is recommended to take Hydrochlorothiazide a few hours before bedtime. Make sure to take the medication at the same time each day, whether you take it at night or morning.

What conditions is Hydrochlorothiazide approved to treat?

Hydrochlorothiazide is used to treat high blood pressure in patients. If left untreated, high blood pressure can lead to heart problems and prevent the arteries from working properly.

How does Hydrochlorothiazide work for high blood pressure?

Hydrochlorothiazide inhibits the sodium chloride cotransporter system, which has a diuretic effect that reduces blood pressure. As a result, more sodium is excreted in the kidney. The effects of Hydrochlorothiazide can begin in just 2 hours after taking a dose and can last for as long as 12 hours, depending on how much the patient took. It is worth noting that Hydrochlorothiazide is not metabolized, and the majority if it is excreted in the urine without undergoing any changes.

Hydrochlorothiazide also causes a loss of nutrients such as potassium and bicarbonate. Acute administration of the drug can lower blood pressure and reduce plasma volume. However, the long-term usage of Hydrochlorothiazide is not advisable.

Effectiveness

How effective are Furosemide and Hydrochlorothiazide for treating High Blood Pressure?

Both Furosemide and Hydrochlorothiazide are very effective at treating high blood pressure. In fact, Furosemide is so efficient that it is referred to as a high ceiling diuretic because it has been shown to yield better results than other medications.

Furosemide can start to work in as little as 60 minutes after taking an oral dose. However, patients should allow for at least one week for the drug to take full effect.

By comparison, the pharmacological effects of Hydrochlorothiazide take about 2 hours to work after an initial dose, peaking in 4 hours and lasting for as long as 12 hours. The majority of Hydrochlorothiazide is secreted from the urine without undergoing any changes. This makes Furosemide more effective for immediate relief.

However, studies have shown that Hydrochlorothiazide can increase the fractional excretion of sodium more so than Furosemide in patients with severe renal failure. On the flip side, Furosemide seems to have a preferable side effect profile compared to Hydrochlorothiazide (with less hypokalemia, hyponatremia, and less glucose intolerance).

Hydrochlorothiazide decreases the excretion of calcium from sodium, while Furosemide has the opposite effect.

Dosage information

How is Furosemide administered for High Blood Pressure?

The standard dose for Furosemide is 20 to 80 mg once a day as a single dose or divided and administered twice per day.

Side Effects

What are the most-common side effects of Furosemide?

Here are the most common side effects of Furosemide:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Stomach ache
• Vertigo (as if the room is spinning)
• Headache
• Blurry vision
• Rash or itching
• Excessive urination

These side effects often go away after a few days or weeks of taking the drug. If they persist or get severe with time, you should talk to your doctor.

Are there any potential serious side effects of Furosemide?

* If you experience any of these serious side effects, seek medical help immediately

• Dry mouth
• Feeling thirsty
• Fatigue
• Feeling restlessness
• Muscle pain or muscle cramps
• Less frequent urination
• Drowsiness
• Abnormal heartbeat
• Severe vomiting and nausea
• Pain when you eat or drink
• Fever
• Yellowing of the skin
• Yellowing of the whites of the eyes
• Ringing in the ear
• Hearing loss
• Blistering or peeling skin
• Allergic reaction
• Orthostatic hypotension

What are the most-common side effects of Hydrochlorothiazide?

Here are the most common side effects of Hydrochlorothiazide:

• Dizziness
• Fatigue
• Weakness
• Headache
• Muscle cramps
• High blood sugar levels
• Low blood pressure
• Electrolyte imbalance

Sexual side effects such as difficulty with erection and low libido

Increased skin sensitivity upon exposure to sunlight

Are there any potential serious side effects of Hydrochlorothiazide?

* If you experience any of these serious side effects, seek medical help immediately

• Dry mouth
• Pancreatitis
• Excessive fatigue
• Excessive vomiting
• Lower frequency of urination
• Seizures
• Excessive thirst
• Dizziness
• Not being alert
• Blurred visions
• Difficulty reading
• Eye pain

Contraindications and interactions

Warnings and general precautions for Furosemide and Hydrochlorothiazide

There is a Black Box Warning for Furosemide because the drug is associated with adverse reactions such as spasms of the bladder, loss of appetite, hyperuricemia, hypomagnesemia, and others. It is also possible to overdose on Furosemide, with common symptoms being hypotension, electrolyte imbalance, dehydration, and excessive reduction in blood volume.

Furosemide is extremely effective as a diuretic and may lead to an excessive loss of water, which can result in severe electrolyte depletion.

Hydrochlorothiazide also has Black Box Warnings, and it is recommended to discontinue the drug in pregnant patients as soon as pregnancy is detected. Thi is because the drug can cause injury and death to a developing fetus. Moreover, it is recommended for individuals with severe kidney disease and anuria to avoid taking the drug.

Here are a few precautions when taking Furosemide:

• Wear protective clothing when going out to protect yourself from the sun
• Use sunscreen and a hat when outdoors
• Avoid tanning and sunlamps
• Report immediately to your doctor if you develop an allergic reaction to Furosemide

Here are important precautions when taking Hydrochlorothiazide:

• Hydrochlorothiazide can cause you to feel dizzy and even faint; this is why you should not participate in any activities that require cognitive control, such as driving and operating heavy machinery.
• Do not take narcotics with Hydrochlorothiazide
• Avoid taking diabetes drugs with Hydrochlorothiazide to prevent a possible interaction
• Monitor your electrolyte stays regularly

Contraindications and important interactions for Furosemide and Hydrochlorothiazide

Contraindications

Furosemide

• Patients with a documented case of allergy to Furosemide
• Patients predisposed to excessive loss of electrolytes and water
• Ototoxicity
• Hypoalbuminemia, comorbid illnesses
• Patients with severe renal impairment
• High-risk patients for radiocontrast-induced nephropathy
• Patient with a history of urinary retention
• Taking high doses of Furosemide

Hydrochlorothiazide

Hydrochlorothiazide is contraindicated in patients with anuria, those who have demonstrated hypersensitivity to the drug, severe renal, hepatic failure, hypercalcemia, and Addison’s disease.

Beside the above, the drug is contraindicated in patients with

• Severe hyponatremia,
• Azotemia
• Hepatic coma

Drug/Medication Interactions

Furosemide

• Aliskiren
• Carbamazepine
• Cephaloridine
• Clofibrate
• Colestipol
• Cyclosporine
• Dibekacin
• Fludrocortisone
• Germanium
• Ginseng
• Cholestyramine
• Aceclofenac
• Acemetacin
• Albuterol
• Amikacin
• Amikacin Liposome
• Amtolmetin Guacil
• Arsenic Trioxide
• Aspirin
• Azilsartan
• Azilsartan Medoxomil
• Balsalazide
• Benazepril
• Bepridil
• Bismuth Subsalicylate
• Bromfenac
• Bufexamac
• Candesartan
• Capreomycin
• Captopril
• Cefepime
• Ceftazidime
• Celecoxib
• Chloral Hydrate
• Choline Salicylate
• Cisplatin
• Clonixin
• Dasabuvir
• Dexibuprofen
• Dexketoprofen
• Dichlorphenamide
• Diclofenac
• Diflunisal
• Digitoxin
• Dipyrone
• Dofetilide
• Droperidol
• Droxicam
• Enalapril
• Enalaprilat
• Eprosartan
• Ethacrynic Acid
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Fexinidazole
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Foscarnet
• Fosinopril
• Gentamicin
• Ibuprofen
• Indomethacin
• Irbesartan
• Kanamycin
• Ketanserin
• Ketoprofen
• Ketorolac
• Leflunomide
• Levomethadyl
• Levothyroxine
• Liothyronine
• Lisinopril
• Lithium
• Lornoxicam
• Losartan
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Mesalamine
• Methotrexate
• Metolazone
• Moexipril
• Morniflumate
• Nabumetone
• Naproxen
• Neomycin
• Nepafenac
• Netilmicin
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Nitisinone
• Norepinephrine
• Olmesartan
• Olsalazine
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Paromomycin
• Perindopril
• Phenylbutazone
• Piketoprofen
• Piroxicam
• Plazomicin
• Proglumetacin
• Propyphenazone
• Proquazone
• Quinapril
• Ramipril
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sotalol
• Spectinomycin
• Streptomycin
• Sulfasalazine
• Sulindac
• Telmisartan
• Tenoxicam
• Teriflunomide
• Tiaprofenic Acid
• Tobramycin
• Tolfenamic Acid
• Tolmetin
• Trandolapril
• Trolamine Salicylate
• Valdecoxib
• Valsartan
• Gossypol
• Licorice
• Pancuronium
• Tubocurarine
• Vecuronium

Hydrochlorothiazide

• Aminolevulinic Acid
• Bepridil
• Cholestyramine
• Ginkgo
• Gossypol
• Licorice
• Topiramate
• Carbamazepine
• Aceclofenac
• Acemetacin
• Acetyldigoxin
• Albuterol
• Amphetamine
• Amtolmetin Guacil
• Arsenic Trioxide
• Aspirin
• Benzphetamine
• Bromfenac
• Bufexamac
• Celecoxib
• Choline Salicylate
• Clonixin
• Deslanoside
• Desmopressin
• Dexibuprofen
• Dexketoprofen
• Ketanserin
• Ketoprofen
• Ketorolac
• Levomethadyl
• Lisdexamfetamine
• Lithium
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Methamphetamine
• Methotrexate
• Metildigoxin
• Morniflumate
• Nabumetone
• Naproxen
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Ouabain
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Phenylbutazone
• Piketoprofen
• Piroxicam
• Porfimer
• Proglumetacin
• Propyphenazone
• Proquazone
• Proscillaridin
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sotalol
• Sulindac
• Tenoxicam
• Tiaprofenic Acid
• Tolfenamic Acid
• Tolmetin
• Valdecoxib
• Dextroamphetamine
• Diclofenac
• Diflunisal
• Digitalis
• Digitoxin
• Digoxin
• Dipyrone
• Droperidol
• Droxicam
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Flecainide
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Ibuprofen
• Indomethacin

Food/Beverage/Supplement Interactions

Furosemide

Foods to avoid:

• Do not add extra salt when cooking a meal
• Do not eat processed foods that or ready-meals because of their high salt content

Drinks to avoid:

• Alcohol

Supplements to avoid:

• Sucralfate
• Cholestyramine
• Colestipol

Hydrochlorothiazide

Do not eat grapefruit because it can alter this medication.

Drinks to avoid:

• Do not drink grapefruit juice because it can alter the medication
• Avoid alcohol

Consult with your doctor if you are taking supplements with hydrochlorothiazide

Cost Comparison

How much do Furosemide and Hydrochlorothiazide cost?

Both Furosemide and Hydrochlorothiazide are moderately priced, making them accessible to the general public. The price of 25 mg Hydrochlorothiazide is about $14 for a supply of 30 tablets. Similarly, the price of Furosemide at 20 mg for a supply of 30 tablets is $13. This makes Furosemide marginally more affordable than Hydrochlorothiazide.

Generic forms of both Furosemide and Hydrochlorothiazide are covered by most Medicare and insurance plans.

Popularity of Furosemide and Hydrochlorothiazide

Both Furosemide and Hydrochlorothiazide are commonly prescribed in the US for patients with high blood pressure. In 2020 alone, Furosemide was prescribed over 26.7 million times. By contrast, Hydrochlorothiazide was prescribed about 41.5 million times in 2020, making it almost twice as popular.

Conclusion

Takeaway

So there you have it, an in-depth comparison of Furosemide and Hydrochlorothiazide. Both medications have been proven to have a relatively safe side effect profile and are successful in treating cases of high blood pressure in patients.

As always, you should consult with your doctor before changing your dosage of either medication and always report any side effects that you may encounter.