Some doctors add a drug called allopurinol to the diuretics to reduce the levels of uric acid, and this is given for several years. It makes more sense to stop the diuretics. The addition of allopurinol is a prime example of ‘‘polypharmacy,’’ which adds to the handful of pills that patients are expected to take. It also adds to side effects and cost.
b. Furosemide (Lasix)
Furosemide is a powerful diuretic and is not recom¬mended for hypertension except when associated with kidney failure. In this situation it is much more effective than thiazides.
c. Dyazide
Dyazide is a combination of 25 mg of hydrochlorothiazide and 50 mg of triamterene. The latter causes retention of potassium so there is no need to take extra orange juice or foods with a high-potassium content.
d. Moduretic (Moduret in Canada)
Moduretic is a potassium-retaining drug and contains 50 mg of hydrochlorothiazide and 5 mg of the potassium retainer amiloride. A half tablet is to be taken once daily. Dyazide and Moduretic are relatively safe when kidney function is normal; if kidney function is impaired such that the serum creatinine is greater than 1.3 mg/dl (115 mmol/L), these drugs may retain too much potas¬sium. High potassium in the blood may also occur if potassium-sparing diuretics are used concomitantly with ACE inhibitors or angiotensin receptor blockers. These drugs are widely used in the management of hypertension and heart failure, and prevent the patient from having to take unpleasant tasting potassium chloride mixtures. Diuretics such as Dyazide that contain triamterene should be avoided in patients who are being treated for arthritis with indomethacin, and should not be given to patients who have had a renal stone. Moduretic and Dyazide should be avoided in elderly diabetics and in patients taking an ACE inhibitor.

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