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Drugs and Medications For Edema

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There are several prescription drugs that are used to treat edema.

According to American Family Physician, edema is the result of an imbalance in the filtration system between the capillary and interstitial spaces. You must follow a systematic approach to determine the exact cause of edema.

Treatment options include sodium restriction, diuretic use, and appropriate management of the underlying disorder. Though there are several drugs available for edema, you must first consult a doctor before taking edema medications. 

Your healthcare provider will be able to identify the actual cause of the disease and prescribe drugs based on the severity of the condition. 

All the drugs used in the treatment of edema are diuretics. Diuretics simply cause the kidney to eliminate more water and sodium in the urine.

Diuretics can be classified either by the site along the kidney tubules on which they act or by the chemical structures.

Care should be taken when taking diuretics because getting rid of too much fluid too quickly can damage the kidney and can cause severe hypotension when the blood pressure falls sharply.

When Should You Take Drugs For Edema 

Mild edema usually goes away on its own, with a few home remedies such as keeping your legs elevated while relaxing or sleeping, wearing compression stockings, and monitoring your salt intake to reduce edema. 

Severe cases of edema may be treated with drugs that help your body expel excess fluid in the form of urine. Long-term management of the condition typically focuses on treating the underlying cause of edema

Drugs For Edema

There are basically three classes of diuretics for edema, namely potassium-sparing diuretics, loop diuretics, and thiazide diuretics. Here are some popular drugs for edema. 

Loop Diuretics

Loop diuretics are the diuretics that act on the ascending loop of Henle of the nephrons of the kidney. Apart from edema, they are also used to treat hypertension.

Unlike thiazide diuretics, loop diuretics are effective even in patients with impaired kidney functions.

Loop diuretics specifically act on a transporter complex in the thick ascending arm of the loop of Henle. This transporter complex is responsible for carrying sodium, potassium, and chloride ions in and out of the tubules of the kidney.

Diuretics in this class compete against chloride ions at binding sites in the transporter complex.  In this way, they interfere with the reabsorption of sodium and chloride ions from the kidney. Therefore, they prevent the concentration of the urine.

When the urine is not concentrated, the renal medulla remains hypotonic and so water does not have enough osmotic pressure to leave the kidney tubules. This leads to the removal of water from the body via increased urine flow.

As loop diuretics increase urine production, water pockets in the body are gradually depleted and the edema is relieved. The consequence of this action is that less water is returned to the blood. Therefore, blood volume and blood pressure are reduced.

Because of their mechanism of action, loop diuretics are especially effective for treating edema associated with renal impairment, heart failure, liver cirrhosis, and nephrotic syndrome.

Some drugs and underlying disease conditions may reduce the effectiveness of loop diuretics.

For example, people with renal insufficiency suffer from insufficient blood flow to the kidneys and, therefore, loop diuretics are not extensively transported to the kidneys, specifically, to the loop of Henle where they are needed. This effect is also observed with non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.

To improve the effectiveness of loop diuretics in reducing edema for patients experiencing renal insufficiency or also taking NSAIDs, a thiazide diuretic may be added.

Alternatively, the dose of the loop diuretic will be increased to make up for the poor distribution of the drug to its site of action.

Furosemide or Lasix is the most popular example of loop diuretics.

Lasix (Furosemide): Furosemide is a loop diuretic that prevents your body from absorbing excess salt. It also treats fluid retention (edema) in people with liver disease, congestive heart failure, or a kidney disorder. 

Before using this medication, you must tell your doctor if you have gout, lupus, kidney disease, liver disease, diabetes, or an allergy to sulfa drugs. 

Potassium-sparing Diuretics

Potassium-sparing diuretics are so named not because of the similarities in their chemical structures or their common site of action but because, unlike other diuretics, they promote the retention of potassium ions in the kidney tubule.

Reducing potassium loss is important because it does not contribute to edema or high blood pressure, and also because it is a victim of flushing out sodium ions.

Thiazide and loop diuretics sometimes lead to hypokalemia or potassium deficiency, and, for this reason, potassium supplements are recommended when taking them.

Potassium-sparing diuretics, on the other hand, spare potassium. There are two types of potassium-sparing diuretics. Diuretics in the two categories act mostly at the collecting duct and late distal tubules of the kidney.

The two groups of potassium-sparing diuretics are aldosterone antagonists such as spironolactone and epithelial sodium channel blockers such as amiloride.

Aldactone (Spironolactone): Spironolactone is a potassium-sparing diuretic that keeps your body from absorbing excess sodium and prevents your potassium levels from getting too low. 

It treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney disorder. Before taking this medication, you must tell your doctor if you use a steroid or another diuretic. 

Chlorothiazide: Chlorothiazide is a thiazide diuretic that helps prevent your body from absorbing too much sodium. It treats fluid retention in people with congestive heart failure, cirrhosis of the liver, or kidney disorders. 

Thiazide Diuretics

Thiazide diuretics have similar chemical structures and are derived from benzothiadiazine. They act at the distal convoluted tubules of the kidney by blocking the sodium ion-chloride ion symporter (a transporter complex).

Just like loop diuretics, thiazide diuretics also promote the loss of potassium alongside sodium. However, unlike loop diuretics, they promote the reabsorption of calcium ions.

By reducing the osmotic pressure of water in the kidney tubules, they prevent its reabsorption while encouraging its loss as urine. In this way, thiazide diuretics reduce edema.

Thiazide diuretics should be avoided during pregnancy. Since they encourage the deposition of uric acid, patients with gout should consider alternative diuretics. Long-term use of thiazide diuretics may cause hyperglycemia.

Thalitone (Chlorthalidone): Chlorthalidone is a thiazide diuretic that treats edema and prevents fluid retention. It can reduce edema in people with congestive heart failure, cirrhosis of the liver, or kidney disorders. 

Both potassium-sparing diuretics and thiazide diuretics are also sometimes referred to as calcium-sparing diuretics because, unlike loop diuretics, they do not promote calcium loss in the kidney.

Some of the effective prescription drugs for edema are Triamterene, Spironolactone, Osmitrol, Midamor, Metolazone, Methyclothiazide, Indapamide, Hydrochlorothiazide Triamterene, and Zaroxolyn. 

Avoid These Medications That Cause Edema

Certain medications could be causing your edema as a side effect of the medication. Here are some to look out for:

How Does Pramipexole Cause Edema?

A study published in the journal Archives of Neurology in 2000 found a link between pramipexole and edema. 17 of 300 patients tested had edema. When the patients reduced their dose of pramipexole or stopped taking it, their edema receded.

Even though the connection was extensively studied, the study authors could not determine why the medication caused edema.

Offering diuretics in addition to the medication only reduced the edema somewhat. The only way the patients saw complete relief was by stopping the medication. If you are taking pramipexole and have edema, consult with your doctor to see if you can use another medication instead that won't cause edema.

How Do Calcium Channel Blockers Cause Edema?

Calcium channel blockers are some of the most common medications associated with edema.

CCB medication affects the rate at which fluid moves through the bloodstream. Changes in resistance and pressure mean that a greater amount of fluid leaks out of the veins and into the surrounding tissues. CCB-related edema is more common in women than men, and it is also more common in the elderly. Typically, CCB dose is reduced or other medications are added to combat edema.

How Do Corticosteroids Cause Edema?

Corticosteroids can also lead to the development of edema. These steroid medications are often given to patients to reduce inflammation caused by autoimmune diseases. They boost cortisol levels in the body, which changes how the body's immune system functions. Another strange side effect is often edema, even though the steroid medication is designed to reduce swelling.

In some cases, individuals who take corticosteroids long-term (particularly prednisone) are more likely to develop swelling in the face. It is not clear how this happens, except that altering the body's natural immune system function can have far-reaching consequences. Stopping the medication usually reduces edema symptoms.

How Do NSAIDs Cause Edema?

NSAID medication works by blocking the production of prostaglandins. Prostaglandins are produced when the body is in pain and are a trigger of the immune system. Prostaglandins are also used in the kidneys to filter water. Suppressing the action of prostaglandins can lead to a buildup of fluid in the body. NSAIDs are more likely to cause edema when used long-term.

How Does Pioglitazone and Rosiglitazone Cause Edema?

Pioglitazone and rosiglitazone cause increase fluid reabsorption in the distal nephron and increase the permeability of adipose tissues. This means that fluid moves more rapidly and travels into tissues where it normally cannot go, leading to edema. The best treatment for edema caused by these medications is to stop taking them or to increase the intake of vitamins and herbs that strengthen tissue walls and the blood vessels.

Are Edema Drugs Safe For Me? 

The drugs for edema may not be suitable for all individuals. You must consult with your healthcare practitioner before taking diuretics to treat edema. You must also talk to your doctor before changing the dose or stopping any medication. 

Patients may experience varying side effects such as numbness or tingly feeling, fast or uneven heartbeat, dizziness, muscle pain or weakness, frequent urination, chest pain, mild skin rash, nausea, or vomiting. 

If the above-mentioned side effects persist or worsen, stop the medication, and call your doctor immediately. 

The drugs may also interact with other medications such as blood pressure medications, lithium, steroids, insulin or diabetes medications, etc. 

You must talk to your doctor clearly and inform him/ her about any medications you have been taking before using drugs for edema. 

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