Diuretics

Caution. Should be used with caution in older adults as these medications can induce or worsen hyponatremia or syndrome of inappropriate antidiuretic hormone (SIADH). Blood sodium level monitoring should be considered, especially if other drugs known to reduce sodium levels are also being used.

Avoid in patients with late-stage dementia.


Amiloride

Avoid at CrCl <30mL/min. In patients with renal insufficiency, there is a risk of hyperkalemia.

Anon: The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNCV). Arch Intern Med 1993; 153:154-183.


Spironolactone

Avoid at CrCl <30mL/min. In patients with renal insufficiency, there is a risk of hyperkalemia.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf;

Vardeny O, et.al. Influence of Baseline and Worsening Renal Function on Efficacy of Spironolactone in Patients With Severe Heart Failure: Insights From RALES (Randomized Aldactone Evaluation Study). Journal of the American College of Cardiology. 60:20 2012: 2082-2089


Triamterene

Avoid at CrCl <30mL/min. In patients with renal insufficiency, there is a risk of hyperkalemia.

Anon: The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNCV). Arch Intern Med 1993; 153:154-183.