Diuréticos de alça
Revisado por Dr Doug McKechnie, MRCGPÚltima atualização por Dr Colin Tidy, MRCGPÚltima atualização 11 Mar 2024
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Loop diuretics are commonly used in the tratamento da insuficiência cardíaca. In this condition, fluid accumulates in your body, due to the heart not pumping blood around the body as well as it normally would. So, you may become breathless (as fluid accumulates in the lungs) and your ankles and legs may swell with extra fluid in the tissues (oedema).
Loop diuretics are also used to treat other conditions which cause fluid to build up in the body, such as certain liver and kidney disorders. They are also sometimes used to treat high blood pressure (hypertension). However, generally, a different type of diuretic called a thiazide diuretic is more commonly used to treat high blood pressure.
There are different types of diuretics. Loop diuretics are one type. They include furosemida, bumetanide e torasemide. Each comes in different brand names.
Em resumo
Diuretics are medicines that increase the amount of urine your kidneys pass out.
They are also known as 'water tablets' and come in three main types.
Loop diuretics make kidneys pass out more fluid, easing symptoms like oedema.
Common side-effects can include upset salt balance and stomach upset.
Diuretics can worsen diabetes or gout.
Most loop diuretics are taken once a day in the morning.
You can report side-effects using the Yellow Card Scheme.

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Diuréticos
A diuretic is a medicine which increases the amount of urine that you pass out from your kidneys. A diuretic causes an increase in urine (a diuresis). So, they are sometimes called 'water' tablets. There are three main types of diuretic:
Loop diuretics (for example, furosemide).
Diuréticos tiazídicos (for example, bendroflumethiazide). These are mainly used for treating high blood pressure (hypertension) and fluid on the legs (oedema).
Diuréticos poupadores de potássio. Potassium-sparing diuretics are weak diuretics usually prescribed in combination with other types of diuretics. They are used to increase the amount of fluid passed from the body in urine, whilst also preventing too much potassium being lost with the urine.
Loop diuretics mechanism of action
They work by making the kidneys pass out more fluid. They do this by interfering with the transport of salt and water across certain cells in the kidneys. (These cells are in a structure called the loop of Henle - hence the name loop diuretic. You have thousands of these loops in each kidney.) As more fluid is passed out by the kidneys, less fluid remains in the bloodstream. So any fluid which has accumulated in the tissues of the lungs or body is drawn back into the bloodstream to replace the fluid passed out by the kidneys. This eases symptoms such as oedema and breathlessness caused by the congestion of fluid.
Loop diuretics examples
Furosemida e bumetanide are both loop diuretics and are similar in activity. Both start to work within 1 hour of being taken by mouth and diuresis is complete within 6 hours so that, if necessary, they can be given twice in one day without interfering with sleep. When given into a vein, furosemide has a peak effect within 30 minutes. Furosemide and bumetanide are mainly used to treat insuficiência cardíaca, including edema pulmonar agudo.
Torasemide has properties similar to furosemide and bumetanide, and is used to treat edema and for pressão alta (hipertensão).
Quais são os possíveis efeitos colaterais?
Side-effects are uncommon when routine low doses are used. The higher the dose, the greater the risk of side-effects developing. The leaflet which comes in the tablet package provides a full list of possible side-effects. So, it is important to read that leaflet if you are prescribed a loop diuretic. Common or serious possible side-effects include:
The salt balance in the bloodstream sometimes being upset, which can cause a low blood level of potassium, sodium, and magnesium, and a high level of calcium. These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. You may be advised to have a blood test to check for these problems.
If you have diabetes or gout, these conditions may be made worse by diuretics.
An upset stomach.
Dizziness on standing - due to too low blood pressure (hypotension).
Outras considerações
Most loop diuretics are taken once a day in the morning. The effect of making more urine usually starts within half an hour. So, you may find you need to go to the toilet a couple of times within a few hours of taking the tablet. However, the effect of passing extra urine wears off within about six hours. So, you will not have to get up in the night to make extra trips to the toilet.
You can generally take the dose at a flexible time to suit you. So, for example, if you want to go out early in the morning for a few hours and don't want to have to find a toilet, you may be able to postpone the dose until later on in the day when it may be more convenient to find toilets.

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Perguntas frequentes
When is the best time to take loop diuretics?
Loop diuretics are generally taken once a day in the morning. Their effect of increasing urine production usually starts within half an hour and wears off within about six hours. This timing helps avoid needing to make extra trips to the toilet during the night.
Can I adjust the time I take my loop diuretic if I have plans?
Yes, you can usually take your dose at a flexible time that suits your schedule. For instance, if you have an early morning outing and prefer not to worry about finding a toilet, you can postpone your dose until later in the day when it's more convenient.
What should I do if I experience side-effects from a loop diuretic?
If you experience any side-effects, it's important to be aware of them. The leaflet provided with your medication will list all possible side-effects. You can also report any suspected side-effects through the Yellow Card Scheme online at www.mhra.gov.uk/yellowcard. This scheme helps healthcare professionals monitor medicine safety.
Are there particular medical conditions that might be affected by loop diuretics?
Yes, if you have diabetes or gout, these conditions might be made worse by taking diuretics. It's important to discuss your full medical history with your doctor when being prescribed these medications.
How quickly do loop diuretics start working and how long do their effects last?
When taken by mouth, loop diuretics like furosemide and bumetanide typically start to work within 1 hour. The increased urine production is usually complete within 6 hours. If given into a vein, furosemide can have a peak effect within 30 minutes.
Leitura adicional e referências
- Formulário Nacional Britânico (BNF); Serviços de Evidências NICE (acesso apenas no Reino Unido)
- Insuficiência cardíaca crônica em adultos - diagnóstico e manejo; Diretrizes NICE (Set 2018)
- Hipertensão em adultos: diagnóstico e manejo; NICE (agosto de 2019 - última atualização novembro de 2023)
- Oh SW, Han SY; Loop Diuretics in Clinical Practice. Electrolyte Blood Press. 2015 Jun;13(1):17-21. doi: 10.5049/EBP.2015.13.1.17. Epub 2015 Jun 30.
Sobre o autorVer biografia completa

Dr Colin Tidy, MRCGP
Médico Generalista, Autor Médico
MBBS, MRCGP, MRCP (Paediatrics), DCH
Dr Colin Tidy é um médico do NHS, baseado em Oxfordshire.
Sobre o revisorVer biografia completa

Dr Doug McKechnie, MRCGP
Redator Médico
MA, MBBS, MSc, DRCOG, MRCP(UK), MRCGP(2021), FHEA
O Dr. Doug McKechnie é um médico do NHS que trabalha em Londres. Ele trabalha em tempo integral na prática clínica e também é o Vice-Líder do módulo de Prática Clínica e Profissional na Faculdade de Medicina da University College London.
Histórico do artigo
As informações nesta página são escritas e revisadas por clínicos qualificados.
Artigo também disponível em Inglês, Alemão, Espanhol, Francês, Italiano, Português, Hindi, Hebraico, Árabe, e Sueco.
Próxima revisão prevista: 10 Mar 2028
11 Mar 2024 | Última versão

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