Overuse of diuretics is common and risky for elderly

Seniors are commonly overprescribed diuretic medications, leading to risks of adverse drug reactions, cardiac arrhythmias, brain damage and even death, according to research published in this month’s issue of JAMDA.

Older people have higher occurrences of the top illnesses treated by diuretics—hypertension, heart failure and renal disease—and therefore are at high risk of being overprescribed. The ability of diuretics to treat a wide variety of medical conditions also contributes to its "epidemic overuse," the article notes.

High doses of or long-term use of diuretics can actually aggravate the symptoms they are meant to correct, the study found. Hyponatremia, or a low ratio of electrolytes to water in the body, can prevent the body’s cells from functioning correctly, especially in the brain. Hypokalemia, or abnormally low potassium levels, can trigger abnormal heart rhythms.

Non-diuretic drugs should be among the first choices for treating less severe cardiac conditions, including hypertension, the researchers suggest. “In heart failure treatment, overdosing of diuretics is common, as doses often reflect requirements for acute recompensation, which is two- to threefold the requirement of that in maintenance therapy,” notes Martin Wehling, MD, the article’s author. “Combining loop and thiazide diuretics may be indicated for severe cardiac or renal failure, but it is also excessively used in less severe stages, causing an even more severe threat to patients; thiazides are often added unintentionally if overlooked in combination pills.”

The study’s subject matter also reinforces the importance of hydration among the elderly and testing of electrolyte and potassium levels in those who are on long courses of diuretics and/or certain cancer drugs.

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