HomeAnswersCardiologyuric acid levelCan Aldactone affect uric acid levels?

Uric acid is increasing. Can I shift to Aldactone from HCTZ?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ilir Sharka

Medically reviewed by

Dr. K. Shobana

Published At June 28, 2018
Reviewed AtFebruary 17, 2024

Patient's Query

Hello doctor,

I am a hypertensive 31-year-old. ECG, TMT normal, echo normal except mild concentric LVH. On Telmisartan/ Amlodipine (80/5) at night and Amlodipine/Hydrochlorothiazide (5/12.5) in morning. HCTZ was started one month back but after monitoring Na, K are alright but uric acid is on the increasing trend. So, instead of HCTZ can I shift to Aldactone? I do feel I have slight (very mild) edema, maybe Amlodipine-induced edema as I am on 10 mg daily. Earlier, despite Telmisartan and Amlodipine, my BP was high but when HCTZ was added, it was working perfectly for me. My BP now is in the range of 120/80. So, I do not want to remove the diuretic. One of my medical friends suggested Aldactone may be introduced. It has no effect on uric acid, is that right? Kindly help me.

Answered by Dr. Ilir Sharka

Hello,

Welcome to icliniq.com.

I agree with you that Hydrochlorothiazide increases uric acid levels, while Amlodipine may increase the leg swelling (peripheral edema). Coming to this point, Aldactone can be added to your therapy, but it has a weak antihypertensive effect and it may lead to high potassium levels. For this reason, it is important checking regularly potassium levels while taking Aldactone. If your blood pressure values remain still high while on Aldactone, I would recommend adding Moxonidine to your therapy. You should discuss with your doctor about the above treatment options. I remain at your disposal whenever you have any other questions.

Patient's Query

Hello doctor,

Thanks a lot for your response. You said Aldactone may increase potassium and it is a weak antihypertensive drug. So, what is Aldactone used for primarily? Since HCTZ increases uric acid, is there any such diuretic which has little or no effect on uric acid. I am looking for a diuretic which does not affect uric acid. You said Moxonidine can be added. What class Moxonidine belongs to? When is it recommended? iI it safe enough for long-term use for decades just like ARBs and CCBs?

Answered by Dr. Ilir Sharka

Hello,

Welcome to icliniq.com.

Aldactone is used to save potassium, especially when combined with diuretics which lower potassium levels, primarily in heart failure. Another diuretic is Furosemide (Lasix) which does not increase uric acid levels and helps against peripheral edema. Moxonidine is a central antihypertensive drug and it is safe to use for a long time.

Patient's Query

Hello doctor,

Thanks a lot. I hope I am not disturbing you at this hour. From what you say, diuretics which has less or no effect on uric acid are Aldactone and Furosemide (Lasix). Am I right? Can Lasix be used for BP or edema issues? Is Lasix prescribed for BP generally? Is Lasix an alternative to thiazides? Since I am already using Telmisartan and Amlodipine for BP what third agent would you recommend to me in my case? My history in brief - no diabetes, normal thyroid, normal electrolytes, normal LFT and KFT. I do have Hb E trait passed on to me from my mom. Slightly stressful life. No other abnormalities.

Answered by Dr. Ilir Sharka

Hello,

Welcome back to icliniq.com.

You are not disturbing me at all. Regarding diuretics, Lasix may have some implication on uric acid. It can be used for high blood pressure or edema. Anyway, for a long time treatment, I would recommend using Torasemide (instead of Lasix or Moxonidine) which has less adverse effects compared to other diuretics. Torasemide is a diuretic drug which can help against edema and also reduce blood pressure values. I would recommend starting with a low dose and increasing slowly up to 10 mg daily. I would also recommend reducing the dose of Amlodipine and even stop it, to help reduce leg swelling. Considering your young age, high blood pressure values are exceptional. For this reason, I would recommend performing some tests to investigate other possible causes underlying high blood pressure such as fasting glucose, kidney and liver function tests, blood electrolytes, cortisol and aldosterone plasma levels for possible adrenal gland dysfunction, Thyroid hormone levels for possible thyroid gland dysfunction and A renal artery angio CT (computed tomography) scan for fibrodysplasia. You should discuss with your doctor on these tests. Kind regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ilir Sharka
Dr. Ilir Sharka

Cardiology

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