<unk>  also can lead to gout caused by hyperuricemia. Hyperglycemia is also a common side effect. The tendency, as for all loop diuretics, to cause low serum potassium concentration (hypokalemia) has given rise to combination products, either with potassium or with the potassium-sparing diuretic amiloride (Co-amilofruse). Other electrolyte abnormalities that can result from<unk>  use include hyponatremia, hypochloremia, hypomagnesemia, and hypocalcemia. In the treatment of heart failure, many studies have shown that the long-term use of<unk>  can cause varying degrees of thiamine deficiency, so thiamine supplementation is also suggested.<unk>  is a known ototoxic agent generally causing transient hearing loss but can be permanent. Reported cases of<unk>  induced hearing loss appeared to be associated with rapid intravenous administration, high dosages, concomitant renal disease and coadministration with other ototoxic medication. However, a recently reported longitudinal study showed that participants treated with loop diuretics over 10 years were 40% more likely to develop hearing loss and 33% more likely of progressive hearing loss compared to participants who did not use loop diuretics. This suggests the long-term consequences of loop diuretics on hearing could be a more significant than previously thought and<unk> rther research is required in this area. Other precautions include: nephrotoxicity, sulfonamide (sulfa) allergy, and increases free thyroid hormone effects with large doses. Interactions<unk>  has potential interactions with these medications: * Aspirin and other salicylates * Other diuretics (e.g. ethacrynic acid, hydrochlorothiazide) * Synergistic effects with other antihypertensives (e.g. doxazosin) * Sucralfate Potentially hazardous interactions with other drugs: * Analgesics: increased risk of kidney damage (nephrotoxicity) with nonsteroidal anti-inflammatory drugs; antagonism of diuretic effect with NSAIDs * Antiarrhythmics: a risk of cardiac toxicity exists with antiarrhythmics if hypokalemia occurs; the effects of lidocaine and mexiletine are antagonized. * Antibacterials: increased risk of ototoxicity with aminoglycosides, polymyxins and vancomycin; avoid concomitant use with lymecycline * Antidepressants: increased risk of hypokalemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclic antidepressants * Antiepileptics: increased risk of hyponatremia with carbamazepine * Antifungals: increased risk of hypokalemia with amphotericin * Antihypertensives: enhanced hypotensive effect; increased risk of first dose hypotensive effect with alpha-blockers; increased risk of ventricular arrhythmias with sotalol if hypokalemia occurs * Antipsychotics: increased risk of ventricular arrhythmias with amisulpride, sertindole, or pimozide (avoid with pimozide) if hypokalemia occurs; enhanced hypotensive effect with phenothiazines * Atomoxetine: hypokalemia increases risk of ventricular arrhythmias * Cardiac glycosides: increased toxicity if hypokalemia occurs * Cyclosporine: variable reports of increased nephrotoxicity, ototoxicity and hepatotoxicity * Lithium: risk of toxicity.
Furosemide
Amiloride
Bumetanide
Chlorothiazide
Cyclothiazide
Spironolactone
Torasemide
Tolvaptan