Diuretic-Related Side Effects: Development and Treatment

Domenic A. Sica, MD

In This Article

Drug Allergy

Photosensitivity dermatitis rarely occurs secondary to thiazide or furosemide therapy.[75] HCTZ more commonly causes photosensitivity than do the other thiazides.[76] Diuretics may rarely cause a more serious generalized dermatitis and, at times, even a necrotizing vasculitis. Cross-sensitivity with sulfonamide drugs may occur with all diuretics, with the exception of ethacrynic acid; however, the frequency with which cross-sensitivity occurs is much less common than was first thought and appears to be due to a predisposition to allergic reactions, rather than to specific cross-reactivity with sulfonamide-based drugs; thus, patients with a sulfonamide allergy that was not "extreme" (such as Stevens-Johnson syndrome or a necrotizing vasculitis) in its original presentation can cautiously receive a thiazide or a loop diuretic.[77]

Severe necrotizing pancreatitis is a rare, but serious and potentially life-threatening, complication of thiazide therapy. Acute allergic interstitial nephritis with fever, rash, and eosinophilia, although an uncommon complication of diuretics, is one that may result in permanent renal failure if the drug exposure is prolonged.[78] Allergic interstitial nephritis may develop abruptly or some months after therapy is begun with a thiazide diuretic or, less commonly, it can occur with furosemide.[79] Ethacrynic acid is chemically dissimilar to the other loop diuretics and can be safely substituted in diuretic-treated patients who experience any of these allergic complications.