When do combinations of diuretics make sense?

Fuster, Daniel Guido (2009). When do combinations of diuretics make sense? Therapeutische Umschau, 66(11), pp. 725-9. Bern: Huber 10.1024/0040-5930.66.11.725

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Diuretics are commonly prescribed by physicians to contract the ECF volume. In two clinical situations combining different classes of diuretics make sense: First, if a loop diuretic at maximal dose alone does not lead to sufficient diuresis or second, if the side effect of a diuretic needs to be corrected by adding a diuretic of another class. The latter is clinically often used to counteract loop or thiazide diuretic-induced hypokalemia by the addition of a potassium sparing diuretic. Key to a reasonable combination of diuretics is understanding of the pharmaco-kinetics and knowledge of the molecular targets of the diuretics involved.

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