Diuretics Side Effects Are Dangerous and Common

A new study has discovered that thiazide diuretics side effects are far more common than previously thought and doctors aren’t monitoring patients properly.

diuretics side effects

Diuretics side effects are more common than previously thought.

Patients in the U.S. whose doctors follow national guidelines for treating high blood pressure are typically prescribed a diuretic such as hydrochlorothiazide as the primary therapy. According to the guidelines, these drugs, known as thiazide diuretics, should be the preferred initial medication for the treatment of hypertension in older adults.[1] However, a new study published in the Journal of the American Geriatric Society has found that diuretics side effects are more common than previously thought. The authors urge doctors to use greater caution when prescribing these so-called “safe” high-blood-pressure drugs.[2]

Why Diuretics for High Blood Pressure?

Diuretics such as hydrochlorothiazide (HCTZ) are some of the least expensive and most commonly prescribed drugs for high blood pressure. They work by increasing the excretion of sodium and fluid by the kidneys, reducing the total amount of fluid in the body, and lowering the concentration of sodium and calcium in the walls of the arteries, which causes them to relax.

High Rates of Thiazide Diuretic Side Effects Discovered

The new study looked at 35,865 veterans with hypertension.[2] The participants were predominantly men whose average age was 74. Of those prescribed a thiazide diuretic for hypertension, 98 percent of the initial prescriptions were for hydrochlorothiazide.

Thiazide users had a 14 percent risk of developing an adverse event, compared with 6 percent for those not prescribed a thiazide diuretic.

Likewise, thiazide users had a significantly greater risk for every single adverse event the researchers were tracking:

  • low sodium
  • low potassium
  • risk of kidney injury or failure
  • hospitalizations or ER visits with low sodium, low potassium, electrolyte imbalance, and acute kidney injury.

For every 12 patients prescribed a thiazide diuretic, one developed an adverse event that he or she would otherwise not have had.

Doctors Fail to Properly Monitor Patients on Thiazide Diuretics

The researchers also discovered that the patients were not getting the proper monitoring and follow-up care they should have been getting after being prescribed the diuretic. Proper monitoring requires blood testing within three months of starting a thiazide diuretic, plus regular testing after that at intervals determined by the initial laboratory results and the patient’s health status. Despite the fact that adverse events caused by the thiazide diuretics were common, fewer than half of participants had laboratory monitoring within three months of starting the drugs.

Why Diuretics Side Effects Are Alarming

These results highly alarmed the researchers. Even mildly low blood levels of sodium and potassium are linked to death, according the researchers.  Furthermore, mildly low sodium levels are associated with an increased risk of falls, unsteadiness while walking, and cognitive impairment. Meanwhile, mildly low potassium levels are associated with higher rates of cardiovascular events like heart attacks and strokes, said the researchers.

The results of this study may actually underestimate the actual rates of adverse effects of thiazide diuretics, explained the researchers, because they tracked only men and not women; based on results of other studies, women may be at even higher risk for thiazide diuretic complications.

Additional Facts About Thiazide Side Effects

  • Diuretics are among the top five classes of drugs causing adverse effects leading to hospitalization.[3]
  • Among all the first-line drugs used for hypertension, the side effects of thiazide diuretics have the low adherence rate, which include frequent urination, tiredness, dizziness, cramps, and weakness.[3]
  • Low potassium levels can lead to irregular heart rhythms and related sudden death, muscle weakness, and balance problems.[3]
  • Low sodium may contribute to confusion, delirium, and irreversible brain damage, adding to age-related dementia.[3]
  • Some diuretics, such as HCTZ, are strongly linked to an increased risk of developing diabetes.[4]
  • Thiazides also increase total cholesterol by 5 percent to 7 percent, accompanied by an increase in LDL cholesterol.[4]
  • Long-term use of diuretics is associated with an increased risk of kidney cancer (renal cell carcinoma).[4]

What to Do If You’re Using a Thiazide Diuretic for High Blood Pressure

If you currently take a diuretic like hydrochlorothiazide for lowering blood pressure, there is no need to panic, nor is there any reason to suddenly stop taking your medication, which could be dangerous. Instead, you can use this information to talk with your doctor about potential dangers of diuretics. You can also have a discussion about the pros and cons of alternative medications as well as non-drug therapies.

Furthermore, and most importantly, by implementing lifestyle changes and taking certain natural blood pressure-lowering supplements, you may be able to reduce your need for hypertension medication over time. These changes are best made in partnership with your healthcare provider and require frequent and vigilant blood pressure monitoring during the process.

Share Your Experience on Diuretics Side Effects

Have you experienced any long-term diuretics side effects? Share your experiences on any potential dangers of hydrochlorothiazide in the comments section below.

[1] Hypertension. 2003;42:1206–1252.

[2] J Am Geriatr Soc. 2014;62(6):1039-1045.

[3] J Am Med Dir Assoc. 2013 Jun;14(6):437-42.

[4] Diabetes Care. 2011 May;34 Suppl 2:S313-9.

Originally published in 2015, this post has been updated.

As a service to our readers, University Health News offers a vast archive of free digital content. Please note the date published or last update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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  • Took thiziade for about 2months. Had severe pains in legs. I couldn’t sleep they hurt so bad.Dr. Said not side effect of this medicine. After 6nights of leg pain and being awake my legs became covered in red rash that burned. I called and refused to take med. Within 3days my legs was back to normal. They put me on Altace it works great .

  • I took hydrochlorothiazide (HCTZ) for 10 days and developed aggressive behavior and had memory loss. I stopped taking the drug. I am 70 years old and take Accupril daily for hypertension, Synthroid daily, Prolia every 6 months and Latanaprost daily.

  • I’m 37 and have been taking hydrochlorothiazide for the past 10 years. I haven’t had any problems with it, however, the issue may be age related. I’m just one guy, so that’s the vast research I’ve done 🙂

    I’m going to try hawthorn berry as a natural diuretic.

  • I’m 66 and have been taking 25 mg. HCTZ for just over one year. Recently noticed puffiness around bottom of both ankles (possible edema???) I’ve been reading other articles where diuretics can damage kidneys. Seeing my doctor to have blood test for kidney function. Going to switch to ACE inhibitor if HCTZ is culprit.

  • Ive been taking enalapril, atenelol and indamipide and ive been feeling awful, this week the doc gave me teneroc and torasimide and now im feeling overly dehydrated. My head feels heavy. Im trying to wean myself off these drugs…..anyone experienced this how do i get the heaviness of my head to stop. Plus everytime i drink plain water it come back up as saliva. So im spitting alot.

  • I was taking a combination pill of Valsartan/HCTZ for several months. After a few months, my mouth became extremely dry with a metal taste and I felt dehydrated from the HCTZ. I even upped my water intake, which didn’t help. I also felt tired and dizzy often. I had my physician drop the HCTZ and now I just take Valsartan by itself at a higher dose. I’m feeling much better after doing that.

  • I have had several episodes of life-threatening acute pancreatitis and now have a pancreas with significant permanent damage (chronic pancreatitis). My gastroenterologist is convinced that HCTZ is the cause.

  • I have been taking HCTZ for years and was recently diagnosed with type 2 diabetes. SIx months ago my doctor cut my HCTZ dose in half and I started seeing a drop in cholesterol and LDL. Last month he took me off HCTZ all together and I immediately saw a 20 point drop in my fasting glucose.

  • I had been on HCTZ for a few months. Before I started my potassium was 3.9 in Dec. In April it was 3.3. Taking potassium supplement and stopped HCTZ. Watching blood pressure. Wondering how long it will take for level to return to normal.

  • I took HCTZ for 2 years and just developed diabetes, high cholesterol, high liver enzymes and weight gain. I’m a vegan and avid runner!

  • I was taking 12.5 mg HCTZ combo with 50 mg Losartan for 10 days when out if nowhere my hand and wrist blew up – swollen and so painful I could not write or open the fridge door.

  • I’ve been taking it 12.5 for several months now. Am feeling weaker n weaker. Tired constantly n VERY poor memory that is worsening.

  • My husband was taking 25 mg of Hydrochlorothiazide and also 40 mg Benazepril Hydrochloride
    He was trim, healthy, ate mainly vegetables and chicken, low cholesterol and low carbohydrates, hiked and did weightlifting several times a week. He died suddenly on a hike on April 20th, with no heart symptoms experienced previously.

  • Sir I use a ayurvedic diuretic punanava himalayas tablet due to this I HAVE 15KG WEIGHT LOSS AND NOT ABLE TO RECOVER WEIGHT AFTER ONE YEAR OF USING THIS MEDICINE AND FEEL WEEK MY SELF PLS HELP ME SIR.weight loss due to excessive urination. I am from India delhi my mobile number 9891850081

  • I have been taking 12.5 hztz for 1 yr. I have memory loss, confusion, weight gain. I walk everyday & eat healthy. Tired & trouble sleeping sometimes.

  • I have been taking Hydrochlorthiazide for over 30 years. I have experienced weakness, ever increasing balancing problems causing falls and finally suffering with actinic keratosis with
    both basal cancers and squamous cell cancers which I had to have excised. The last one on my back was unsuccessfully excised leaving cells remaining, which I am anxiously expecting to return
    I recently read a Medical journal in which it has been discovered that Hydrochlorthiazide can make one more susceptible to skin cancers.
    My doctors over the years have told me that my condition was sun damage. Although one cant avoid going out in the sun, I have never been one to sunbathe or go out uncovered and some of these lesions appear in areas that have never been explosed to the sun. I have always felt that this condition is coming from inside my body and not from some outside source
    I recently asked
    my GP to take me off Hydrochlothiazide for some safer diuretic, but I fear that after taking this drug for so long, there is no chance of a reversal of my condition

  • When I take this medication I experience extreme fatigue, heart palpitations, lethargy, so weak it is difficult to complete simple tasks. I have contemplated E.R. visits many times on this medication and am no longer taking it.

  • Hydrochlorothiazide has caused me to develop hyperhidrosis (severe sweating). Just walking a few minutes I break out into a sweat – I have had my heart tested for problems and none were found.

  • I was on hydrochlorithiazide for quite a few years and developed Type 2 diabetes because of it. I am so angry that doctors don’t warn you of this. I would of taken another approach to my high blood pressure. I am on antidepressants because of dealing with diabetes. How can one medication cause you to get another disease. There needs to be accountability of these doctors not telling you the risks of this horrible medication.

  • I want to warn people that have Diabetes do not take hydrochlorithiazide because it can raise your glucose(sugars) talk to your doctor for another treatment. I have been told this by my doctor. My blood pressure is fine now for 6 years since I dropped weight because of the diabetes, that the hydrochlorithiazide caused. This is a damn shame that I got diabetes from a medication it has caused a lot of stress.

  • I’m a 37 year old man and have been taking HCTZ 25mg daily for 10 years. I have had lethargy, swollen legs, weight gain, memory loss, hyperhidrosis, hypothyroid, and severe gout which is likely hyperuricemia. I recently stopped the HCTZ on my own and no more gout, I restarted the HCTZ and the gout came back within days. I also suspect that it is causing hyperkalemia which is no doubt exacerbating my underlying cause of hypertension and is the cause of my hypothyroidism. Which in turn is causing weight gain even though all I eat is salad and chicken and drink water and play squash 3 times a week and do construction for a living. DON’T LET THEM DO IT TO YOU. Get suggestions from your doctor and do your own research, they don’t take responsibility and don’t take the time to treat patients properly.

  • I’ve been taking Hctz for 2 years. 2 months after starting, was in hospital ER overnight for confusion and disoriented. After all tests & a $75,000 bill, only got doctors to say it could be due to TIA or dehydration (had just thrown a big party 2 days before). Now 2 years later, was busy with a big project all week, very dry weather, and same thing happened while driving. I pulled over into parking lot. Don’t remember ambulance ride or hospital experience until morning. Only thing found after MRI, ekg, EEG, ultrasounds, etc. was a bit low on potassium. I’m healthy at 60, but now have some days that are a total loss. In finding this page I now believe it is this Hctz drug.

  • I have been taking hydrochlorothiizide for many years and am now having problems with low potassium, Irregular heart beat and sore leg muscles,, Been to the er twice,, extra potassium pills make my stomach sick so i take Tums,,Haven’t heard from the cardiologist yet, I hope i can get off that water pill.

  • I am 72 years old have been taking HCTZ for mild hypertension for many years. Last week I suddenly became dizzy, very weak, light-headed & nauseated. It seemed like I could be having a heart attack so I went to the ER. They found that my electrolytes were low & I was having atrial fibrillation. I was taken off the HCTZ and will now be on (expensive) anticoagulants for the rest of my life. This experience will cost me over $2,000 in co-pays & drug costs, and since stopping the HCTZ my blood pressure is pretty much the same. Our medical industry really is a disaster

  • Since I started taking this medication at the beginning of November, I have now been diagnosed with PVC’s. The weekend it started really scared me as my heart has been done that before. My Dr. has yet to check any levels to see if I’m low on potassium, or if my A1C is raised since I am diabetic, or if my cholesterol is raised. We have to be our own advocates as the medical doctors are too busy meeting their quota of patients for the day to be an effective medical provider. I am looking at switching doctors and/or natural remedies such as Hisbiscus Teah, Cardamon and Hawthorn. I’m hoping those have less side effects as it’s detrimental to one’s health to take a pill which leads to another pill, which leads to another one.

  • Long term use of hydrochlorothiazide. From doses of 50 mg down to current use of 12.5 mg. Past 10 years having issues with electrolyte imbalance and palpitations. Last few years very hard to keep electrolytes in balance by supplementing with HydraLyte, potassium 600mg, calcium and magnesium supplements, and increasing salt which in itself is not good for high blood pressure. Have had lower leg edema and burning for many years as well as palpitations. Difficult to keep hydrated. Last year or so now have had dry chronic cough, shortness of breath, dizziness, muscle tightness and pain and cramps, fatigue and lack of energy regardless of exercise. I’m trying to get off by taking one pill every other day and I’m feeling the effects with my breathing and generalized swelling. I just think it’s a nasty pill to ever get on and harder to get off. Thank you

  • I been taking spironolactone for a few months now and i think its it’s causing my weight gain. I went to the Doctor yesterday and she tells me I’m obese. What i exercise everyday . for 30 to 45 minutes. I am on other medications. But this one I’m not sure about.

  • Very healthy 55+ adult with low level hypertension had been on 12.5 mg of HCTZ daily with no problems for several years. A few months ago dosage upped to 25 mg daily. 6 weeks later ended up in ER with near fainting and severe dizziness. After very extensive testing nothing found except low potassium. Potassium level had dropped from 4.4 after 2 weeks of 25 mg daily to 3.4 four weeks later. Symptoms worsened to include neurological type symptoms such as muscle twitching/spasms, numbness and tingling in hands/feet/face and severe dizziness and brain fog with a couple more near fainting episodes. My primary case physician at a top medical facility in the country does not think HCTZ would do this. Didn’t even put me on a potassium supplement until another physician retested potassium level (4 weeks later) and found it at 3.3. I found a medical paper written by a neurologist documenting neurological symptoms of acid/base (low potassium causes high pH level) and electrolyte imbalances. Authors point out that even though these imbalances can cause many neurological symptoms, a neurological exam will show nothing. The symptoms in the paper fit quite well. Have stopped the HCTZ on my own and monitoring BP daily. Waiting to see if symptoms subside. My life has been completely derailed for 2 months now. Completely frustrated with the cavalier attitude of physicans about this medication. Primary care physician doesn’t even think it is worth retesting potassium level.

  • My Kidney function was falling so my doctor stopped the diuretic. Suddenly. What is this risk of stopping suddenly? My blood pressure has increased 10 points. Should I ask for a loop diuretic? Unfortunately my long term doctor has just retired!

  • I have been taking HCTZ for about 4 years now, and I have heart palpitations sometimes. they usually go away after awhile. Lately they seem to be lasting to long. It is an atrocity that doctors and nurse practitioners know what these drugs will do, and yet continue to prescribe them. I will definitely get off this mess.

  • Took hydrochlorothiazide 12.5 for one month = after two weeks, developed pheriferal neuropathy, brought on by being chronic dehydrated, burning hands, feet, dry skin all over my body, drinking 40 glasses of water a day and still dehydrated; as soon as I on my own stopped taking, the pheriferal neuropathy stopped; but as of this moment , 10 days after stopping the medication, despite drinking lots of water and electrolytes solucion, I continue to suffer from chronic dehydration…less severe, but dehydrated still.
    Been to E.R. twice in less than a month, counless times to my local clinic, all the blood tests, the urinalysis, come back ” normal” yet , I still get my tongue swollen, irritated throat, dry skin, burning lower legs,soles, hands, and the worse part; my family, the doctors, tell me that I am delusional, that is all in my head, base on the normal results of all my lab tests. Once I introduced electrolytes along with drinking a lot of water, my symptoms have improved some. I am at my wit’s end with my medical situation, stressed out, depressed, crying because of my new found bad health. ( My urine looks ” normal, it doesn’t have an odor” as long as I keep drinking fluids…when I go to bed, first time I wake up and urinate, my urine has a strong odor like rotten fish odor. Before while drinking only water, it was dark yellow and very strong odor; Once I started drinking electrolytes, it no longer was dark; but has the odor still. I never had this symptoms ever in my life before I was given hydrochlorothiazide! And only one month of using and it has destroy my health.

  • I began taking Spironolactone for acne as suggested by my dermatologist. After three weeks I noticed my eyes looked sunken in & tired. I looked like I had aged ten years. I thought it was stress & lack of sleep but after three months of taking the spironolactone I realized it was the medication. The periorbital fat pads under my eyes are gone. My skin has lost elasticity & is thin around my neck, chin & arm pits & inner thighs. My eyes and scalp are very dry. I stopped the medicine two months ago & finally had a normal cycle. I have been to my primary care doctor, dermatologist & even an ophthalmologist/eye surgeon. Each denied it was the spironolactone but I have before and after pictures and the results are evident. I wish I never took this medicine. I’m 36 years old, in good health & workout regularly. This medicine stole my beauty & confidence! I’m so sorry I ever listened to my doctor. This medicine ruined me.

  • I’ve been on hydrochrlorothyazide for 12 years, since I was 29, for high blood pressure. I’ve been hospitalized numerous times for extremely low potassium, dehydration, kidney stones, full body cramping, and major hair loss. My new doctor took me off of the thyazide and put me on a different blood pressure medication. I’m currently going through the withdrawals of the thyazide now for 5 days. last week I was 142, and today I weighed 157, due to water weight. My face and stomach are very swollen. I wish that I had never touched the hydrochlorothyazide, and I encourage anyone think twice before starting this medication for a long period of time.

  • This chlorthalidone 25mg will mess you up for life why do FDA have this medical out there this is a killer drug if it don’t kill you it will make you want to kill your self after it have f… You up I stop taking it and still having pain. They have these medical to kill you are make you kill your self. They all ready know what it will do to you when they give it to you. They don’t care.

  • I was on Furosemide for over 10 years and my vascular specialist recommended Swellnomore which is a natural diuretic but also anti-inflammatory supplemenmt. My wife and I have both been on it for over 6 montyhs and my edema and swelling has completely disappeared. With no side effects at all. But its pretty expensive. But we are happy to pay extra for a healthier alternative.

  • I have been taking 25mg hydrochlorothiazide for kidney stones for 2 months and so far I have experienced vision problems, extreme constipation (even with the 2 stool softeners a day my dr prescribed), non-existent libido, headaches and fatigue/weakness. Not sure if the fatigue is associated with the medication or the inability to have a BM. Awful medication. Will ask tomorrow for a 24-hour urine culture to see if my numbers have changed. Need to get to get off this medication sooner rather than later.

  • I have been on a variety of diuretics for 20+ years trying to supplement my other hypertension medications. I now have high uric acid numbers and high hemoglobin/red blood cell numbers. My doctor believes this is attributed to my long term diuretic use. So now I’m not only battling hypertension but gout and the possibility of stroke heart attack and blood clots.

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