NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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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
Total Formulary
METOLAZONE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2345.htm

2.2.2 Loop diuretics

Preferred list
Total Formulary

2.2.3 Potassium-sparing diuretics and aldosterone antagonists

Preferred list
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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2371.htm

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 ≤30%) is restricted to prescribers working with specialised heart failure teams only for use in patients intolerant to spironolactone.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129013.htm

2.2.4 Potassium-sparing diuretics with other diuretics

Total Formulary

2.2.5 Osmotic diuretics

Total Formulary
MANNITOL (intravenous infusion)

Restrictions: Restricted to specialist use only.

Prescribing Notes:

For inhaled mannitol for cystic fibrosis see section 3.7 Mucolytics

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2394.htm

2.2.6 Mercurial diuretics

No medicines are included in this section

2.2.7 Carbonic anhydrase inhibitors

No medicines are included in this section

2.2.8 Diuretics with potassium

No medicines are included in this section