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.

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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.

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Comments
  • JOSE G.

    I AM TAKING FOR HIGH BLOOD PRESSURE WHAT IS YOU RECONDATIONS

  • Lula S.

    What natural supplement do you suggest?

  • Line L.

    I taie Thatcher médication and I have weakness and fatigue.

  • darlene f.

    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.

  • Doug W.

    December 2016 I was admitted to the ER with pancreatitis which was attributed to HTCZ.

  • Bill P.

    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.

  • Donna B.

    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!

  • Joanne S.

    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.

  • Darla R.

    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.

  • Judy A.

    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.

  • Chandan

    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

  • Debbie S.

    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.

  • Thelma H.

    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.

  • Nate L.

    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.

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