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Integrative, Alternative & Complementary Medicine, Second Edition

Thiazide Diuretics

by Daniel Azof, , MD

Category: Drug interactions

Definition: Thiazide diuretics are commonly used to treat hypertension by increasing loss of fluids from the body.

Interactions: Calcium, coenzyme Q10, licorice, magnesium, potassium, zinc

Drugs in this family: Bendroflumethiazide (Naturetin), benzthiazide (Exna), chlorothiazide (Diurigen, Diuril), chlorthalidone (Hygroton, Thalitone), hydrochlorothiazide (Esidrix, Ezide, HydroDIURIL, Hydro-Par, Microzide, Oretic), hydroflumethiazide (Diucardin, Saluron), indapamide (Lozol), methyclothiazide (Aquatensen, Enduron), metolazone (Mykrox, Zaroxolyn), polythiazide (Renese), quinethazone (Hydromox), trichlormethiazide (Diurese, Metahydrin, Naqua)

Potassium

Effect: Probable Need for Supplementation

Thiazide diuretics cause a constant and significant loss of potassium. The classic treatment for this is to eat bananas and drink orange juice. Potassium supplements are also frequently prescribed. Medications that combine thiazides and potassium-sparing diuretics might produce an unpredictable effect on potassium levels in the body. No one taking such medications should increase potassium intake except on the advice of a physician.

Magnesium

Effect: Supplementation Possibly Helpful

Long-term use (use for more than six months) of thiazide diuretics might lead to magnesium deficiency. In turn, this loss of magnesium could increase the depletion of potassium. Because magnesium deficiency is common in any case, if one takes thiazide diuretics it can be beneficial to take magnesium supplements at the U.S. Dietary Reference Intake dosage.

Calcium

Effect: Possible Dangerous Interaction

When taken over the long term, thiazide diuretics tend to increase levels of calcium by decreasing the amount excreted by the body and, indirectly, by affecting vitamin D. However, greatly increased calcium levels in the body can cause dangerous side effects such as dizziness, weakness, lethargy, headache, myalgia, anorexia, nausea, vomiting, and seizures. Consult with a physician on simultaneous use of calcium and vitamin D supplements with thiazide diuretics.

Coenzyme Q10 (CoQ10)

Effect: Supplementation Possibly Helpful

Preliminary evidence suggests that thiazide diuretics might impair the body’s ability to synthesize CoQ10, a substance important for normal heart function. Although it is not known for sure that taking CoQ10 supplements will provide any specific benefit, supplementing with CoQ10 on general principle might be beneficial.

Zinc

Effect: Supplementation Possibly Helpful

Reportedly, thiazide diuretics can cause loss of zinc in the urine. Since zinc deficiency is relatively common, supplementation can be helpful when using these drugs.

Licorice

Effect: Possible Dangerous Interaction

If one is using thiazide diuretics, one should not take licorice root. Licorice root could exacerbate the potassium depletion caused by thiazides. However, the special form of licorice known as DGL (deglycyrrhizinated licorice) should not cause this problem.

See also: Food and Drug Administration (FDA); Potassium-sparing diuretics; Supplements: Introduction

Further Reading

1 

Al-Ghamdi, S. M., et al. “Magnesium Deficiency: Pathophysiologic and Clinical Overview.” American Journal of Kidney Diseases 24 (1994): 737-752.

2 

Crowe, M., et al. “Hypercalcaemia Following Vitamin D and Thiazide Therapy in the Elderly.” Practitioner 228 (1984): 312-313.

3 

Dorup, I. “Magnesium and Potassium Deficiency. Its Diagnosis, Occurrence, and Treatment in Diuretic Therapy and Its Consequences for Growth, Protein Synthesis, and Growth Factors.” Acta physiologica Scandinavica Supplementum 618 (1994): 1-55.

4 

Gora, M. L., et al. “Milk-Alkali Syndrome Associated with Use of Chlorothiazide and Calcium Carbonate.” Clinical Pharmarcy 8 (1989): 227-229.

5 

Lemann, J., et al. “Hydrochlorothiazide Inhibits Bone Resorption in Men Despite Experimentally Elevated Serum 1,25-Dihydroxy Vitamin D Concentrations.” Kidney International 28 (1985): 951-958.

6 

Martin, B. J., and K. Millian. “Diuretic-Associated Hypomagnesemia in the Elderly.” Archives of Internal Medicine 147 (1987): 1768-1771.

7 

Reyes, A. J., et al. “Diuretics and Zinc.” South African Medical Journal 62 (1982): 373-375.

8 

Riis, B., and C. Christiansen. “Actions of Thiazide on Vitamin D Metabolism: A Controlled Therapeutic Trial in Normal Women Early in the Postmenopause.” Metabolism 34 (1985): 421-424.

9 

Shintani, S., et al. “Glycyrrhizin (Licorice)-Induced Hypokalemic Myopathy: Report of Two Cases and Review of the Literature.” European Neurology 32 (1992): 44-51.

10 

Whang, R., et al. “Refractory Potassium Repletion: A Consequence of Magnesium Deficiency.” Archives of Internal Medicine 152 (1192): 40-45.

Citation Types

Type
Format
MLA 9th
Azof, Daniel. "Thiazide Diuretics." Integrative, Alternative & Complementary Medicine, Second Edition, edited by Paul Moglia, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=CAM2e_0719.
APA 7th
Azof, D. (2020). Thiazide Diuretics. In P. Moglia (Ed.), Integrative, Alternative & Complementary Medicine, Second Edition. Salem Press. online.salempress.com.
CMOS 17th
Azof, Daniel. "Thiazide Diuretics." Edited by Paul Moglia. Integrative, Alternative & Complementary Medicine, Second Edition. Hackensack: Salem Press, 2020. Accessed December 14, 2025. online.salempress.com.