OBJECT DRUGS

Diuretics:

• Bumetanide (Bumex)
• Furosemide (Lasix)
• Thiazides
• Torsemide (Demadex)

PRECIPITANT DRUGS

Binding Resins:

• Cholestyramine (Questran, etc.)
• Colestipol (Colestid)

Comment:

Cholestyramine and colestipol dramatically reduce furosemide and thiazide absorption and diuretic effect. The effect of binding resins on other diuretics is not established, but it may be prudent to take the same precautions with them as well. The effect of colesevelam (Welchol) on diuretic absorption is not established; it may bind less tightly to other drugs than other binding resins do, but these diuretics appear to be particularly susceptible. Ezetimibe (Zetia) appears less likely to bind with other drugs than the binding resins.

Class 3: Assess Risk & Take Action if Necessary

• Circumvent/Minimize:: Minimize the interaction by giving the diuretic 2 hours before or 6 hours after the binding resin; keep a constant interval between diuretic and binding resin.
• Monitor: Monitor for altered diuretic response if binding resins are initiated, discontinued, or dose is changed, or if the interval between doses of the diuretic and binding resin is changed.