Water pills: Balancing body fluid and so much more
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The bottom line
Diuretics, also known as water pills, help your body get rid of extra water. They are used to treat high blood pressure, heart failure, and kidney disease. A single overdose is usually not serious, but toxicity can occur with chronic use or misuse. Problems include dehydration and imbalances in blood salts (electrolytes), which can cause abnormal heart rhythms, muscle spasms, or muscle breakdown.
Prevention tips
Store diuretics up, away, and out of reach of children.
Take diuretics in the morning.
Take the prescribed dose.
Do not take a double dose.
Stand up slowly to prevent dizziness.
Stay hydrated.
Depending on which diuretic you are taking, you may need to increase potassium in food or avoid foods with potassium.
Limit alcohol, which can make fluid and electrolyte abnormalities worse.
This really happened
A 50-year-old woman had sudden, heavy hair shedding over 4 to 6 weeks. A scalp biopsy confirmed pattern hair loss (thinning on the top of the head and a widening part). She was started on spironolactone 100 mg daily. Four weeks later, her dose was increased to 200 mg daily. Six weeks later, she felt unwell and was itching all over. Blood tests showed liver problems. Her doctors suspected a reaction to spironolactone and stopped it. Over the next 3 months, she felt well, the itching stopped, and her liver tests returned to normal.
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What are diuretics (water pills)?
Diuretics are drugs that cause your kidneys to make more urine to get rid of excess water. They are used to treat high blood pressure (hypertension), heart failure, fluid buildup in the abdomen (ascites), and chronic kidney disease.
What are the different types of diuretics?
Thiazide diuretics (hydrochlorothiazide [Microzide], chlorthalidone, metolazone): Thiazide diuretics are used for hypertension and edema (swelling). They help the kidneys remove sodium and water.
Loop diuretics (furosemide [Lasix], bumetanide, torsemide): Loop diuretics are stronger than thiazide diuretics. They are used for heart failure, fluid overload, and kidney disease. They keep the kidneys from reabsorbing sodium and chloride.
Potassium-sparing diuretics (spironolactone [Aldactone], amiloride, triamterene): These diuretics are often used along with thiazide or loop diuretics to counteract loss of potassium. They help the kidneys remove water and sodium but block loss of potassium.
What to do if you take too much of a diuretic
If you accidentally take a double dose or more than your usual dose one time, you will probably be OK, although you may need to urinate more often or more urgently than usual. For some people, maintaining the right balance of fluids and electrolytes can be challenging. Contact your prescriber to find out whether you should drink extra fluids or take electrolyte supplements to help maintain this balance. Seek medical care if you take a very large dose, or if you take a diuretic long term and think you are having side effects.
Get expert help
If someone takes too much of a diuretic or you have questions about using diuretics safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
Why is spironolactone prescribed for acne and PCOS?
Spironolactone blocks the effects of testosterone and other male hormones (androgens) on the skin and scalp. In acne, this lowers production of oil in the skin so pores do not become blocked. Most women with polycystic ovary syndrome (PCOS) have high androgen levels. By blocking androgens, spironolactone helps treat acne, hair thinning, and unwanted facial and body hair, which can occur with PCOS. In rare cases, spironolactone can cause liver inflammation (hepatitis), which goes away when the drug is stopped.
What happens if you take too much of a diuretic?
If you take too much of a diuretic, you will experience dehydration, decrease in sodium, magnesium, and/or calcium as well as increase or decrease in potassium and chloride depending on the diuretic. Electrolyte abnormalities can lead to abnormal heart rhythms, tetany (involuntary muscle spasms or tremors), or rhabdomyolysis (muscle breakdown that can damage the kidneys).
If you take diuretics long term or misuse them for sports or dieting, toxicity can occur. Symptoms include nausea, vomiting, diarrhea, weakness, lethargy, and decreased reflexes. Decreased potassium can cause muscle weakness, cramps, and tetany as well as abnormal heart rhythms and muscle breakdown. Thiazides can lower sodium and magnesium and raise calcium, blood sugar, and urea in the blood. Loop diuretics can cause low calcium and low magnesium. Spironolactone and other potassium-sparing diuretics raise potassium. They can also make the blood too acidic.
A single overdose is usually not serious. Most problems come from long-term use or misuse.
Are water pills safe for children?
Yes, water pills are safe for children when prescribed by a physician or other health care provider. Children need to be monitored to prevent dehydration, electrolyte abnormalities, and kidney problems.