Diuretics increase the excretion of sodium and water by the kidneys. They are incredibly important medications and are prescribed to tens of millions of Americans for the treatment of conditions such as hypertension, heart failure, and kidney disease.

I am going to discuss 3 very interesting and helpful ways to use diuretics that are rarely if ever discussed in the guidelines or suggested by physicians yet are extremely helpful in optimizing the use of diuretics. 

Please share this information with others. 

Vary the dose

Most diuretics are prescribed at a given dose, usually to be taken once daily. Often it is started at a low dose and then increased, or a second type of diuretic is added, if needed, to achieve treatment goals.

I often recommend to patients a strategy that very few physicians ever consider: vary the dose sometimes, rather than taking the same dose every single day.

Why? Because your sodium intake is much lower when you cook and eat at home than when you eat the very salty food prepared at restaurants. After a few evenings of eating out, your blood pressure might increase, or you might retain a few pounds of fluid. 

It is logical then to vary the dose accordingly. I suggest a dosage range to patients; a lower dose to take when eating at home, and a higher dose to take after a few meals of salty restaurant food. I trust the patient to get it right, and they do. And even if they don’t get it exactly right, they are better off than sticking rigidly to too low or too high a dose. I can’t remember the last time a patient got it wrong.

Other clues can also be used. In patients with congestive heart failure, the dose can be varied using markers such as changes in body weight or swelling in the legs. If a patient gains 5 pounds in a few days, it is not build-up of fat; it is build-up of fluid; I suggest guidelines to patients for varying the dose according to their weight. This helps prevent patients from gaining 10-20 pounds while taking a fixed dose and getting into trouble with their congestive heart failure.

Use a diuretic strategically to reduce interruption of sleep due to frequent nighttime urination

With age, many have to get up 2 or 3 times a night, or more, to relieve their bladder. It interrupts sleep.

Where appropriate, I suggest reducing excessive water intake, unless there is a reason to maintain a high fluid intake, such as a history of kidney stones or recurrent urinary infections. I also suggest minimizing late evening fluid intake, But even after that, some still have to arise from bed 2, 3 or more times. This is particularly true in patients with edema, i.e.,fluid retention, in their legs.  

If you are in this situation, and are taking a diuretic, there is a strategy that is unmentioned in the medical literature that can greatly reduce your frequency of nocturnal urination. 

I recommend a “loop” diuretic, such as torsemide (Demadex) or furosemide (Lasix) that considerably increases your urine output, but only for about 4 hours! I often recommend taking it in the late afternoon, resulting in increased urination in the evening before sleep, and then decreased urination overnight. It almost always works.

You will literally be taking a diuretic to reduce your overnight trips to the bathroom. If you are on the usual long-acting thiazide diuretic, such as hydrochlorothiazide, ask your physician if he could make the switch to a loop diuretic.

My favorite loop diuretic? Torsemide.

Strategize the time of day that you take a loop diuretic

Nearly all patients take a given medication at the same time every day. The problem with loop diuretics is that the sharp increase in urine volume and frequency that lasts a few hours can interfere with activities during that time. Some patients choose to take their daily diuretic in the morning; others prefer the late afternoon/early evening, to suit their convenience. 

But there is a third solution that is rarely mentioned: vary the time of day to suit your convenience. Don’t take the loop diuretic in the morning if you are about to get into your car for a 2-hour trip. Take it afterward. Don’t take it in the late afternoon if you expect to be going out that evening. Take it in the morning.

It is unlikely that your physician will suggest this, but it will make your life easier. Skipping a diuretic might affect your blood pressure and heart failure. Varying the time to suit your convenience, won’t.