Question:

I am on hydrochlorthiazide to help treat blood pressure and kidney stones.  Can I take an OTC diuretic and it work just as well?

Answer:

Once you have had a kidney stone, the main treatment is to prevent recurrence. 50% of patients will have another stone within 5 years of the first episode. It is important to maintain a high-volume, dilute urine output to reduce the likelihood of stone formation. If urine is clear as water, it is a good indicator that your fluid intake is sufficient.

You should:

• Drink plenty of water every day, so your urine looks as dilute as water all the time.
• Take the preventive therapy your doctor may prescribe, such as HCTZ.
• Ask questions regarding your treatment or any side effects you are experiencing
• Always have water with you, especially if you are exercising or working in hot weather.

Hydrochlorothiazide (HCTZ) is a commonly used diuretic or water pill that is available by prescription. It is often the first medications physicians use to treat high blood pressure. It is also used in patients with kidney stones to prevent recurrence of stones caused by excessive excretion of calcium. HCTZ decreases the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. This drug works best when sodium intake is low. It is a good idea to watch how much salt is in your diet while on this medication.

There are few over-the-counter (OTC) diuretics. Pamabrom, probably the most commonly used OTC product, is a mild diuretic. It is present in a few medications to treat fluid retention associated with menstruation. Alcohol and caffeine are other agents with a diuretic action.

Prescription diuretics are more potent than OTC diuretics. They reliably increase excretion of fluid and salt from the body and are generally well tolerated. They are only available with a prescription because they are potent and can cause some adverse reactions.

It is best to avoid using OTC diuretics while taking hydrochlorothiazide. They are unlikely to help and could possibly increase the risk of recurrent stones. It is very important to maintain adequate fluid intake as dehydration is possible with any diuretic. As always, you should following the directions of your physician. For more information regarding the medications and any side effects you may experience, contact your physician or pharmacist.

This response was prepared by Jen Ulm, a PharmD student at the NetWellness.org College of Pharmacy

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