Understanding Your Fluid Pills (Diuretics) by K. Melissa Hayes, DNP, ANP-BC, CHFN
Diuretics are a long-standing mainstay in the treatment of heart failure symptoms. Diuretics are medications that increase urination and pull extra fluid out of the body. In heart failure one of the main issues is fluid retention because there is a limited ability to effectively perfuse the kidneys to eliminate extra circulating fluids. Therefore, one of the most effective ways to help the kidneys work better and eliminate more fluid is to take diuretics or “fluid pills”. Eliminating the fluid helps you feel better if you are “congested”. Congested symptoms are the symptoms of being short of breath and having swelling in your legs and or abdomen.
One of the most common diuretics is called Furosemide or Lasix. Furosemide (Lasix), Torsemide (Demadex), and Bumetanide (Bumex) are all called “Loop” diuretics and are notorious for depleting potassium stores. Chances are if you take one of these “Loop” diuretics you will also need a potassium supplement. These loop diuretics have various doses and can be taken by mouth or can be given IV in the hospital. You only need to take one type of these loop diuretics. Check your med list to make sure you are not taking more than one type. The picture below shows the minimum and maximum doses and how long the medication will last in your system. If you have been on diuretics for a longer time or have a more severe case of heart failure you may be on the higher doses of the loop diuretics. Your diuretics are often adjusted up and down according to your “volume status” or how congested you may be. Your cardiac provider should always help you adjust diuretics.
Another type of diuretic is called a “thiazide” diuretic. Many people take thiazide diuretics for the treatment of high blood pressure. A common thiazide diuretic for high blood pressure is called hydrochlorothiazide. Often in heart failure, thiazide diuretics are not strong enough to pull large amounts of fluid from the body therefore Loop diuretics are used more often for heart failure symptoms. Do note that sometimes thiazide diuretics and loop diuretics are used together for an added diuretic effect. Your doctor, nurse practitioner, or physician assistant provider will instruct you if this is something you need to do at home. Do not combine thiazide and loop diuretics on your own accord because it can easily lead to severe potassium depletion and even kidney failure if not done under close supervision and instruction.
Just like it is problematic to have too much fluid circulating it can be problematic to lose too much fluid and become dehydrated from the diuretics. Weighing every day at the same time every day is a great way to help monitor if your “fluid” pills are doing a good job or if you have lost too much fluid. The general rule is -------weight gains or loss in 24 hours that are up or down more than 2-3 pounds overnight or up or down 5 pounds in one week--- should be discussed with your doctor's office for possible need of adjustments in diuretic doses.
Share with us what diuretics you take and any tips and tricks you have for monitoring your symptoms of congestion.
Heidenreich P, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2022 May, 79 (17) e263–e421.https://doi.org/10.1016/j.jacc.2021.12.012
