Modern diuretics and diuretic therapy

In the past decade considerable improvement in diuretics and diuretic therapy has occurred. At the beginning of the era almost everyone agreed that the most useful, effective, and least toxic diuretic was meralluride given parenterally. Although even today meralluride still retains a high place in any diuretic program, there have appeared some very effective rivals which in certain circumstances have replaced it. These developments have been rapid, involve many complex factors, and unless basic principles are understood may confuse the physician. It is therefore desirable to consider the diuretic agents and establish an acceptable plan for their use. Although there may be some minor disagreement, for the most part, the most effective, widely used, and least toxic diuretics are: meralluride (Mercuhydrin), mercaptomerin (Thiomerin), chlormerodrin (Neohydrin) of the mercurial group, aminometradine (Mictine) and aminoisometradine (Rolicton) of the pyrimidines of the aminouracil type, and acetazolamide (Diamox), chlorothiazide (Diuril), hydrochlorothiazide (Hydrodiuril, Esidrix, Oretic), flumethiazide (Ademol), hydroflumethiazide (Saluron), and benzydroflumethiazide (Naturetin) of the sulfonamide group. Although the sym-triazines have yielded several active diuretic compounds, only one of the group, chloranzanil (Daquin), has shown sufficient merit and relative lack of toxicity to be used clinically. It occupies a very limited place in therapy at present. Since the mercurials were the first highly effective diuretics and are still frequently the most desirable in severe, acutely edematous states, it is proper to consider them first. Furthermore, they serve as a standard against which any new diuretic should be compared for over-all effectiveness. Although there are many mercurials available, clinical usage has concentrated for the most part on meralluride, mercaptomerin, and chlormerodrin. Although there are some newer oral preparations which show merit, their status is as yet experimental.