GGC Medicines: Diuretics

Key to symbols

The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP

The medicine should only be used and prescribed by a specialist

Indicates the preferred choice within a class or group of medicines

2. Cardiovascular system

2.2. Diuretics

2.2.1. Thiazides and related diuretics

The choice of therapeutic class for the management of hypertension is dependent on individual patient parameters. See the NHSGGC Guidelines for the Management of Hypertension, available on the Clinical Guidelines store on StaffNet - see link in Navigation Panel.

Preferred List

BENDROFLUMETHIAZIDE

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Total Formulary

METOLAZONE

Restrictions:

Restricted to specialist initiation.

Prescribing Notes:

Now available as licensed product Xaqua which is the preferred preparation in NHSGGC.

Xaqua tablets are scored and can be halved. The bioavailability between Xaqua and other unlicensed formulations can vary by up to two-fold.

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2.2.2. Loop diuretics

Preferred List

FUROSEMIDE

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Total Formulary

BUMETANIDE

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2.2.3. Potassium-sparing diuretics and aldosterone antagonists

Preferred List

AMILORIDE

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SPIRONOLACTONE

Prescribing Notes:

Used in heart failure and in Conn’s syndrome or decompensated liver diseases (ascites). Combination with ACE inhibitors, angiotensin-II receptor antagonists (AIIRAs) or potassium supplements may result in hyperkalaemia (monitor).

Near Patient Testing (NPT) arrangements for GPs may be in place for this medicine. See the relevant section in the Prescribing Resources page for current information.

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Total Formulary

EPLERENONE

Restrictions:

Please see prescribing notes below.

Prescribing Notes:

Eplerenone is currently formulary for two indications:

The use in patients with left ventricular systolic dysfunction accompanied by evidence of heart failure, both manifesting within 3-14 days of myocardial infarction is restricted to specialist initiation and a consultant signature is required.
The use in addition to standard optimal therapy, to reduce the risk of cardiovascular mortality and morbidity in adult patients with NYHA class II (chronic) heart failure and left ventricular systolic dysfunction (LVEF ≤40%) should be in concordance with the NHSGGC Heart Failure treatment guideline.

Near Patient Testing (NPT) arrangements for GPs may be in place for this medicine. See the relevant section in the Prescribing Resources page for current information.

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