Certain medications need to be taken with plenty of water. Depending on the medication, there are different reasons for this:
- The medication could cause you to become dehydrated (e.g., lithium).
- The medication could damage the kidneys or lead to kidney stones if too much of it reached the kidney at the same time (e.g., indinavir). Water helps to “dilute” the extra medication so that too much medication does not go through the kidneys at once.
In general, all medications should be taken with a full glass of water, unless your doctor or pharmacist recommends otherwise. If your medication needs to be taken with “plenty of water,” you may need to drink more than a full glass of water with your medication. This varies with the medication, but can be as much as 1.5 L every day, as is recommended for indinavir.
It is also important to drink enough water throughout the day to avoid dehydration. People’s needs will vary, but most people need 6 to 8 glasses a day, and even more if it is hot, or when they are physically active.
Often called water pills, these drugs help lower blood pressure and are a mainstay for treating heart failure.
Diuretics, commonly called "water pills," are the oldest and some of the least expensive class of drugs used to treat high blood pressure. They help the kidneys eliminate sodium and water from the body. This process decreases blood volume, so the heart has less to pump with each beat, which in turn lowers blood pressure. People with heart failure, who often gain weight because their bodies hold onto excess fluid (a condition called edema), are often prescribed diuretic medications.
Not surprisingly, one of the most common side effects of taking water pills is frequent urination. Other possible side effects include lightheadedness, fatigue, bowel changes, and muscle cramps. Men may occasionally experience erectile dysfunction.
In addition to getting rid of extra salt in your body, diuretic medications also affect levels of potassium. This mineral plays a key role in controlling blood pressure, as well as nerve and muscle function. In general, your kidneys help regulate potassium levels in your blood. But age, diabetes, heart failure, and certain other conditions may impair kidney function. And while some water pills tend to lower potassium levels, others have the opposite effect.
Thiazide diuretics, such as chlorothiazide (Diuril), chlorthalidone (Hygroton), and hydrochlorothiazide (Esidrix, HydroDiuril, Microzide) tend to deplete potassium levels. So do loop diuretics, such as bumetanide (Bumex) and furosemide (Lasix). If you take these medications, your doctor will likely encourage you to eat more potassium rich foods and beverages and limit salt intake.
Potassium-sparing diuretics, which include amiloride (Midamor), spironolactone (Aldactone), and eplerenone (Inspra), avoid the potential problem of potassium loss. But the opposite problem can occur. If potassium levels become too high, it can cause dangerous heart rhythm problems and even cardiac arrest.
People with high blood pressure or heart failure are often advised to limit how much salt or sodium they consume. One way to do that is to use salt substitutes, but these products are high in potassium—a quarter teaspoon of one brand contains about 800 mg of potassium. So, people who take potassium-sparing diuretics should avoid these products.
If you take any diuretic medication, ask your doctor whether you need periodic testing of your potassium and kidney function.
To learn more about managing hypertension, buy "Controlling Your Blood Pressure: What to do when your doctor says you have hypertension."
– By Julie Corliss
Executive Editor, Harvard Heart Letter
Author
Posts
March 6, 2019 at 6:53 pm #16128
Many of us are on diuretics to help with water retention and may have been told specific amounts of fluid that we should stick to during the day. I have never been given an exact amount of fluid that would be “appropriate” for me. My doctors just base it off of how I’m physically feeling.
It can be difficult when figuring out how much water is enough and how much water is “too much” for your body. There are times when I drink 6 cups of water a day and don’t have much bloat, and other days I drink just a few cups and have a lot of bloating and swelling. I try to stick to a good amount of water (usually around 6 cups a day). I try to avoid getting dehydrated. I know when my body needs water because I start to experience symptoms of dehydration like cramping of the muscles, dizziness, and low blood pressure.
How much water do you usually drink in a day? Do you track your fluid intake? Do your doctors give you specific guidelines for water and fluid if you are on diuretics?
March 7, 2019 at 1:38 pm #16147
I was told to keep my daily fluid intake under 2 liters, but that wasn’t just what I drink. That is to include fluid from things like fruit, soups, etc. And as far as dehydration, my doctor has told me that he actually wants me to stay borderline dehydrated in order for my PH meds to work appropriately. At first I tracked my fluid intake religiously, but now after five years or so, I can pretty much just tell. I’m on quite a bit of diuretics, but unfortunately due to a G.I. bleed and a combination of huge weight loss, I’ve run into some problems with “low volume” causing acute prerenal failure, so all my diuretics were stopped for three days this past weekend and they have been resumed at half the amount they were before. Hopefully that takes care of that issue, and maybe I’ll even be able to stay at the lower amount. (Previously I was on 80 mg of lasix twice a day with an additional one to be taken at my discretion if I had any edema.) I don’t know if anyone else has run across this, but I’ve noticed that when I take my first diuretic of the day has a huge impact on how well it works. I wasn’t told this by a physician, but a relative who was on it told me that if she took hers very early in the morning (when she first got up to pee and then went back to bed, lol!) instead of when she got up for the day, it worked like crazy … but not so much if she took it later in the morning when she stayed up and started her day. I’ve found this to be absolutely true for me, too.
March 7, 2019 at 3:59 pm #16162
Hi Robin,
It sounds like you have a good grasp on the signs your body is giving you when it is feeling off or dehydrated. I hope that he difference in the lasix dosage starts to help. It is always good when you have some type of regimen that works for you and with your body best. I always take mine when I first get up and could NEVER go to bed after taking it because I would probably pee the bed. Although, mine usually works best when I have been up and moving because it gets everything flowing in the right direction and I end up peeing more when I’ve been active at the beginning of the day !April 20, 2019 at 12:21 pm #16748
I’m consuming a more than 3L water daily, and Feeling a fresh and active on work and healthy as well.
April 20, 2019 at 3:22 pm #16749
Lesli,
That’s amazing to hear. Water has helped me so much with flushing out my system. I feel like it is the best “detox” out there. Especially after all the procedures I have been getting that require some level of anesthesia or sedation, it’s important to flush out the system as best as I can. Do you just drink these liters in water or do you use other fluids too in this intake?
March 11, 2019 at 11:15 am #16206
I’m supposed to stick under 2L but I have trouble. All of my pills give me dry mouth and I’m on a large amount of diuretics, so I end up drinking more. It’s a catch 22 with me. I had a disease other than PH that requires me to stay hydrated because of nosebleeds and then PH where they want me dried out.
March 11, 2019 at 12:25 pm #16209
Hi Jessica,
I am kind of the same way because I take medication that has the potential to dehydrate me, but I also have a condition where my blood pressure drops with standing a lot if I’m not properly hydrated and this can cause differences in blood return and blood flow to the body. so I totally can relate to what you’re saying with it being a “catch 22”. Do you end up just basing it off of how you feel? Or when your mouth is dry maybe having something like gum might help to increase some saliva production in your mouth or hard candies? This is something that has helped me !March 20, 2019 at 5:47 pm #16233
I definitely use gum and mints as a go-to when I’m somewhere that I can’t have water or am hitting my fluid “limit”. But yeah, I typically just base my fluid intake off of how I’m feeling and how thirsty I am. I drink like a horse though, so sometimes it’s super hard to judge.
March 20, 2019 at 6:31 pm #16353
Jessica,
I totally get it! I know that it can be so hard to judge how much we are actually drinking and taking in for fluids. Especially because fluid doesn’t necessarily just have to be water. I always know when I overdo it with the fluid intake though because my hands are usually swollen and my abdomen is swollen the next day! Do you get any of these symptoms if you have taken in too much?
March 11, 2019 at 11:22 am #16207
I’m allowed 2L a day and I take a lot of diuretics. I constantly feel thirsty and have dry mouth. I usually keep sugar free life savers in my pocket to help with the dryness.
March 11, 2019 at 12:26 pm #16210
Hey Kimberly,
Before I read your post I posted a similar suggestion to yours about the lifesavers ! It does help me with dry mouth to have some type of lifesaver, mint, or sour hard candy to have!
March 26, 2019 at 3:01 pm #16428
Definitely a catch 22 here ! It’s often hard to maintain the balance and what works one day may not the next, for me, anyway!
I was just put on 1.25 liters per day , although they want me to be more conscious about the “ free “ water , so soups and other liquids I am cautious but more so with just free water ! I have kidney disease as well so my PH doc and Nephro try to work together ! My PH Doc for years ( previously) never had me on fluid restriction!
As I just told them both , the meds make my mouth so dry , so often I keep jolly ranchers, tic tacs, and other hard candy to suck on. Definitely don’t suck on ice , when my iron was so low I ate ice and got so bloated !
March 26, 2019 at 5:05 pm #16438
Jen,
you’re so right that what works one day for fluid intake might bloat you another day ! I find that it also depends on what I eat and the hidden sodium content in foods too. When I used to go out and drink with friends I noticed that I would INSTANTLY get swollen because of the alcohol. I haven’t drank in months because of what has been medically going on with me, but it was incredible how fast my hands would swell up and my face was always swollen the next day. If I went to a party with rings on, I would always leave with them in my pockets because it HURT when they would swell.
June 5, 2019 at 10:40 am #17637
More than 2 litres in a day,i think.
June 5, 2019 at 11:05 am #17646
That’s really good Ole! My doctors recommend around that amount to me too. Is this something your doctors have recommended? Do you have a limit on your water intake ?
June 5, 2019 at 5:15 pm #17660
I thought what @robin-webster said is interesting. I haven’t heard a doctor suggest before to stay borderline dehydrated in order for PH meds to work appropriately. That must be a difficult balance to maintain thought, keeping yourself from getting too dehydrated. Robin, I can relate to what you said about soups, fruit and other sources counting as fluid intake. When my son had PH and on a lot of diuretics his doctor was satisfied with counting these other forms of hydrating as his fluid intake count. I can’t remember what his requirement was when he had PH, I think it was 1.5-2 liters if possible.
Since post-transplant he MUST drink 2.5 to 3 liters a day of water, no substitutes. This is because he has kidney disease now caused by transplant medications. If he does not drink enough every day he starts to not feel well and when he had PH, he would get migraines from dehydration.
Drinking a specific amount of water every day is not easy. I sympathize with this challenge that you all face every day, especially when you are taking diuretics. It’s not an easy balance.
June 5, 2019 at 5:25 pm #17661
Colleen,
It can be so tricky, especially with co-existing conditions that require more hydration . Personally, I have bladder and bowel conditions chronically and i also have to take lasix (since my surgery I am not on double the dose that I was on before). I am getting a lot of my nutrients in through shakes and drinks with blended up fruits and vegetables because softer foods just feel better for my esophagus right now. But the liquid that I put into it is also added into my intake.It’s hard with the lasix though because I have chronic retention problems because of the nerves around my bladder being destroyed by a spinal condition my family and I have. So you can imagine what it’s like when I feel like I have to go more with the lasix but some of it doesn’t come out. Sometimes this requires catheterizations which is just a pain in the butt to do on my own.
June 7, 2019 at 6:03 pm #17714
I drink over 3 liters a day, they reduced the amount of water pills
Due to decline in kidney function,
Always thirsty. My CHF seems to be the same, though, I feel weaker everydayJune 7, 2019 at 6:11 pm #17716
Hi Jimi,
That seems like a lot of water but I’m glad that you’re able to drink that much. Do you get bloated from that amount that you take in? I cam barely do 2 liters and I get a lot of bloating going on if I don’t take my diuretic medication.June 7, 2019 at 7:09 pm #17720
Wow, Jimi, that’s a high fluid intake! I have chronic kidney disease and my Nephrologist and PH Doc limit my fluids and I’m always thirsty, as well.
I’m like Brittany, I know for me , I would definitely feel bloated and experience increase in shortness of breath with that much fluid. You mention that your CHF is no different, mine gets worse when I have too much fluid. I know that our bodies are all different , with that much fluid and decrease in diuretics , along with poor kidney function, I’m just surprised that amount of fluid doesn’t really affect you . It’s great that you are able to tolerate that much fluid per day .
June 10, 2019 at 11:19 am #17736
Jen, my son’s kidney disease must still be at an early stage because the opposite is true him, his doctor wants him drinking as much water as possible. He is required to drink 2.5 liters a day but if manages more, than great! So far his symptoms have been more blood pressure related so he is on 2 BP medications and a diuretic was just added last month. He hasn’t been on a diuretic since he had PH. From what I am hearing from you and Jimi, it sounds like as things progress balancing the need to keep the kidney’s hydrated but not overdoing the fluid intake is going to be tricky.
June 10, 2019 at 7:16 pm #17751
Colleen, I’m glad to hear that your son is early in his kidney disease and seems to be stable! I do recall you mentioning his main issue is high blood pressure, I hope that is better controlled now with his meds.
Yes, balancing the hydration versus dehydration and then throw in congestive heart failure , and it’s tough. I think learning what our bodies can tolerate , which is often varied, is key. For instance, this time of year, I find I swell and retain fluids quicker.
It’s very interesting how different our bodies react to these diseases and meds.
June 11, 2019 at 6:13 am #17755
Colleen,
I definitely can empathize with your son on those blood pressure medications. What medications is he taking if you don’t mind me asking? I am on metorprolol 50 mg during the day and 100 extended release at night. It is more for my heart rate control vs blood pressure control though. I know these medications can be really helpful for high blood pressure though but they unfortunately sometimes have some annoying side effects.Jen, I can’t even imagine being on that high of a level of lasix !! You must have been on those giant horse pills of potassium too. Were you electrolyte levels checked often? Even when I was just moved up to 60 mg during the day after my surgery, I had to have electrolyte levels tested and had my potassium pills that I usually just opened up and put in pudding! I also swell and retain fluid more easily with the warmer weather coming up. It’s as if my veins just seem to bulge out too in my arms and hands and my fingers get so swollen! No rings for me this time of year !
June 9, 2019 at 11:26 pm #17729
I was on 160mg of Lasix daily and
2.5mg of metolazone 2-3 times per week.
Kidney function declined and polycystic
Right kidney acting up. Now it’s 80 mg
Lasix per day. I am going to see another Nephrologist, I think the fluid intake is to much, but I wake dehydrated, glucose level is in normal
Range, no colored sodas, 1 cup coffee.If you see someone towing a portable “Jonny on the job” , that is me. Lol
My anxiety level goes up if the interstate shuts down
Goes up if the interstateJune 10, 2019 at 1:19 am #17730
I like your sense of humor Jimi although I’m sure the situations you find yourself in sometimes are not so funny. We use to tease my son that he liked touring public bathrooms because no matter where we went, he always had to go…darn Lasix. I sympathize with your kidney issues because my son is going through that now, although at the moment he is pretty stable. I’m hoping he stays that way for a long time. I hope your new nephrologist figures out a better dosing and/or medication for you. Let us know how it goes.
June 10, 2019 at 7:24 pm #17753
Lol JImi, I can relate !
I was on 360 mg of Lasix and 100 mg of Aldactone daily and then 5 mg of Metolazone several times per week. That was to help my CHF, although it took a toll on my kidneys , hence now I’m on 80-120 mg of Lasix daily and 100mg of Aldactone daily. My Nephrologist took me off the Metolazone, as it drained my electrolytes so fast.
Do you have that issue? I’ll definitely be following you on the road as I know you’ll have the portable john , hehe
June 11, 2019 at 6:16 am #17756
Jimi,
What are you symptoms with the kidney problems that you are experiencing right now? I have had some kidney reflux since I was a child from a conditions that I was born with of my lower back and sacral area so my bladder function has been pretty impacted for as long as I can remember. Sometimes it causes me to self catheterize which is a giant pain in the BUTT when taking lasix too. I hope you don’t find yourself having to self cath because of your kidneys. Does your kidney specialists work well with your PH docs?
June 10, 2019 at 1:05 pm #17748
The biggest issue in any treatment program is getting the providers to
Put those giant egos down and talk to each other. Most medical notes are on line easily viewed by all involved in your care. Be knowlegible of what you are prescribed and why, question the reason, share the information, remember a drastic mistake, affects you the most. I provide them notes from
The other one. If you are being hospitalized, make sure everyone is aware of your needs, your speciality meds are not readily available in most pharmacies, like with Adempas, 3 days missed, you start titrations again.June 10, 2019 at 8:42 pm #17754
Yes, so true, JImi!
I know before, I had to take all of my PH medications to the hospital, now at my PH Hospital, they have all of mine except Uptravi. That’s a move forward in the right direction , I’m thinking.
Good luck in your search for a new Nephrologist. It’s very important that we “ vibe” with all of our doctors.
June 11, 2019 at 6:20 am #17757
Really good advice Jimi!
I know for me, I am lucky that my medical team responds pretty quickly to online emails or messages in the patient portal online. That makes a world of difference especially when going through any ER or experiencing an emergency. it helps to bring specialty medications with us too because you’re right that sometimes that pharmacies have a delay in ordering medications or they don’t always have exactly what we need.I am lucky that my doctors now all are in close communication with one another but it certainly hasn’t always been like this. I had to do a lot of self advocating, doctor “shopping” for the right fit for me, and had to find a good primary care doctor. That was really key for me was having a primary who is on top of everything going on and wants to communicate with the specialists and takes the time to actually KNOW when I’m in the hospital and calls me. I feel like that’s unfortunately so rare to find a doctor to do that !
August 12, 2019 at 4:31 am #19044
drink 1000ml water per day
August 13, 2019 at 7:56 pm #19093
I drink 72 to 96 oz water per day to keep kidney hydrated, along with 80 mg Lasix and 2-3 days metolazone. Fluid retention and kidney issues are two major issues with CHF. Weather hot, nearly 100 degrees. I suddenly developed a red like bruise from wrist to shoulder on left arm. Hope to get a diagnosis this week, don’t know if it is related to Adempas and steroids
August 14, 2019 at 8:56 am #19104
Jimi,
That redness must be super concerning for you! Skin changes are definitely something to bring to the attention of your medical team so I’m really glad that you’re getting it checked out. Please keep us updated and let us know what they say and suggest for you. I hope that you are doing alright in the heat, I know that type of weather is just TERRIBLE when you are struggling with breathing. Do you get your kidneys monitored with blood work weekly? How do they manage the kidneys along with your high dose of lasix and other fluid medications you’re taking?August 14, 2019 at 8:02 pm #19122
Jimi, I’m glad that your body (and kidneys) can tolerate that much water without complications!
I’m concerned about the redness, as you mention, it could possibly be from one of the medications. I’m glad you have an appointment to check it out.
Great to see you posted again, I haven’t seen you much lately.
August 11, 2020 at 9:45 am #26667
Because we are in the “dog days” of summer here on the Texas Gulf Coast, I thought this topic might be of interest. I am on a fluid restriction and stay thirty. I also notice it more, of course, when I am outside at all.
For our new and “seasoned” members alike, how much water do you usually drink in a day? @traceyaustralianmigration-co-za, this may be helpful to you, too.
I tend to suck on ice chips and chew gum to help with dry mouth.
Author
Posts
- You must be logged in to reply to this topic.