Diuretics are drugs increasing urine output by the kidney, thus prescribed against hypertension, left heart failure and pulmonary or systemic edema.
Furosemide is a powerful diuretic, available both in injectable and per os form.
Furosemide is of immediate action and flushes urine within 20min.
It works at the loop of Henle of kidney, inhibiting the sodium-potassium-chloride pump and leading to increased diuresis and natriuresis (increased sodium loss).
The drug also induces renal synthesis of prostaglandins, which contributes to its renal action.
Furosemide is capable of reducing all electrolytes and minerals, leading to hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, which is likely to cause cramps and metabolic alkalosis.
On the contrary, spironolactone is a potassium sparing diuretic.
It belongs to the aldosterone inhibitors, a class of diuretics which antagonize the actions of aldosterone at the distal segment of the distal tubule.
Aldosterone is a hormone that belongs to the miniralcorticoids and is secreted by the adrenal cortex.
It influences the reabsorption of sodium and excretion of potassium of the kidney, thus increasing water retention, blood pressure and blood volume.
Considering the fact that potassium is the principal intracellular ion, its retention (by spirolactone’s action), will contribute to a better cellular volume, positively affecting the maintenance of the cellular size.
Aldosterone plays an important role in the last week before a bodybuilding contest.
In order to inhibit aldosterone and eliminating water retention, we trick the body with an intentional increased intake of sodium chloride.
This apparently will suppress any sodium retention the following days.
Usually we quit from extra sodium intake, the very last day of glycogen depletion, just before the carb loading phase.
Abuse of spironolactone might lead to life threatening side effects, due to dramatic elevation of potassium (hyperkalemia) and metabolic acidosis.
Myocardium is quite sensitive to this metabolic imbalance and can easily undergo severe arrhythmias (ventricular tachycardia, fibrillation) or even cardiac arrest.
ECG changes in a patient with hyperkalemia are an ominous portent of potentially fatal arrhythmias.
The fact that the adrenal cortex produces a fair amount of dehydroepiandrosterone (DHEA), it is understandable, that abuse of spironolactone will lead to dose-dependent gynecomastia.
The anti-androgenic property of spironolactone (breast tenderness and enlargement) is even more apparent in women who lack the gonads (testicles) and substantially their testosterone is produced by the ovaries and adrenals.
Women use spironolactone in order to reduce the aesthetic androgenic side effects of androgenic anabolic steroids (AAS), specifically hirsutism.
Spironolactone acts suspensively on the steroid hormone synthesis and leads to hypogonadism with decreased sperm count and motility.
Spironolactone is not of immediate action and stable concentrations are achieved within almost three days of treatment initiation.
For better metabolism, the dosage should be splitτed into am/pm timing.
The appropriate timing for spironolactone’s use would be the very first day of carb depletion phase.
Potassium rich foods (bananas or potatoes) are strictly prohibited.
Spironolactone should get gradually reduced, in order to avoid any possible rebound effect.
The most efficient method in order to achieve the best results of diuretics should be the combination of potassium sparing and non potassium sparing diuretics, hence spironolactone and furosemide.
However, dosages should be reduced to half.
Diuretics are extremely dangerous substances, responsible of hypovolemia and dehydration, spasms of striated muscles (cramps), hypotension (drop of systemic blood pressure) and severe arrhythmias.
A notable example of the cardiovascular collapse caused by abuse of diuretics was the tragic death of ‘’the giant killer’’, Arab Mohamed Venaziza at the Dutch grand prix in 1993.
Not only he abused spironolactone, but he also quitted from water intake and consumed clenbuterol in powder form, according to his close friend, Sammir Bannout.
Diuretics are preferably used before night sleep, in order to avoid any possible fainting episode, due to hypotension.
Potatoes and bananas, rich in potassium, can help in case of hypokalemia.
Diuretics are useful in the days of carbohydrate overload, in order to avoid the risk of possible water retention under the skin.
The morning of the contest, in case there is still water retention, the combination of a moderate dose of furosemide (10mg) along with spironolactone (12.5mg), is a safe way to eliminate extra water.
A solution of electrolytes with dextrose-maltodextrin might be lifesaving.
Note that dehydrated muscles are not capable of proper contraction.
In such cases, calcium tablets and liquid magnesium are good choices.