11 Renal, Urinary, and Reproductive Medications
Connects renal, urinary, erectile-dysfunction, and reproductive medications with their classes, uses, and distinguishing safety concerns.
and electrolyte effects
increase the kidney’s excretion of sodium and water. They are used mainly for hypertension and fluid overload. Blood pressure, kidney function, and electrolytes should be monitored as appropriate. Brand names below are familiar examples; availability and product names can vary.
Classes and distinguishing concerns
Loop : Furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex) produce strong diuresis and are used for edema, including heart-failure-related fluid overload. They can lower potassium, and high doses may cause ototoxicity.
Thiazide and thiazide-like : Hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), and metolazone (Zaroxolyn) are commonly used for hypertension and edema. They can lower potassium and sodium and may raise uric acid.
Potassium-sparing aldosterone antagonists: Spironolactone (Aldactone, Carospir) and eplerenone (Inspra) are used for heart failure, hypertension, edema, or excess aldosterone. They can raise potassium; spironolactone may also cause breast tenderness or gynecomastia.
Potassium-sparing ENaC blockers: Amiloride (Midamor) and triamterene (Dyrenium) are often used with another diuretic to limit potassium loss. They carry a risk of high potassium.
Carbonic anhydrase inhibitor: Acetazolamide (Diamox) is used for glaucoma, altitude illness, and selected fluid or acid–base disorders. It can cause metabolic acidosis and potassium loss.
Osmotic diuretic: Mannitol (Osmitrol) is an intravenous medication used in selected settings to reduce intracranial or intraocular pressure. Fluid and electrolyte shifts should be monitored.
Loop and thiazide tend to waste potassium, while potassium-sparing drugs tend to retain it. This pattern does not determine an individual patient’s laboratory results: kidney function and other medicines also matter.
Bladder, prostate, and urinary symptom medicines
Medications for overactive bladder, benign prostatic hyperplasia (BPH), and urinary discomfort have different actions and safety considerations.
Overactive bladder
Oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), and solifenacin (Vesicare) are or anticholinergic medicines used for overactive bladder with urgency and frequency. Dry mouth and constipation are common class effects; oxybutynin relaxes bladder muscle.
Mirabegron (Myrbetriq) is a beta-3 adrenergic agonist for overactive bladder that relaxes bladder muscle. Blood pressure may need monitoring.
BPH and urinary flow
Tamsulosin (Flomax) and alfuzosin (Uroxatral) are alpha-1 blockers for BPH. They relax smooth muscle in the prostate and bladder neck to improve urine flow, and may cause dizziness or orthostatic hypotension.
Finasteride (Proscar) and dutasteride (Avodart) are 5-alpha-reductase inhibitors for BPH. They gradually reduce prostate size, and benefit may take months. Finasteride is also used at a different dose for male-pattern hair loss.
Urinary discomfort
(Pyridium; over-the-counter brands include Azo) is a urinary tract analgesic for short-term relief of urinary burning and discomfort. It is not an antibiotic and does not cure a urinary tract infection. It may turn urine orange-red and interfere with some urine tests.
Erectile dysfunction medicines
Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) are phosphodiesterase-5 (PDE-5) inhibitors. They improve erectile response by increasing blood flow during sexual stimulation; they do not increase sexual desire. Tadalafil is also used for BPH symptoms.
must not be combined with nitrate medicines because the combination can cause a dangerous drop in blood pressure. Use caution when they are taken with alpha blockers or other blood-pressure-lowering drugs. Common effects include headache, flushing, nasal congestion, and dizziness.
Hormonal and menstrual treatments
Hormonal treatments may be used for contraception, menstrual suppression, menstrual pain, endometriosis, heavy bleeding, and menopausal symptoms. Choice of treatment depends on the goal and, for contraceptive methods, patient goals and contraindications.
Contraception and menstrual symptoms
Contraceptive and menstrual-suppression options include combined hormonal pills, a patch, or a vaginal ring; progestin-only pills; depot medroxyprogesterone (Depo-Provera); an etonogestrel implant (Nexplanon); and a levonorgestrel intrauterine device (IUD) (Mirena). These are estrogen–progestin or progestin-only hormonal methods. Some methods also reduce menstrual bleeding or cramps.
For dysmenorrhea and endometriosis, ibuprofen (Advil, Motrin) and naproxen (Aleve) are nonsteroidal anti-inflammatory drugs (NSAIDs) that relieve pain. Hormonal contraceptives and progestins can suppress hormones and reduce symptoms. Selected gonadotropin-releasing hormone (GnRH) medicines alter ovarian hormone signaling and may cause low-estrogen effects.
Heavy menstrual bleeding
Treatment options for heavy menstrual bleeding, including bleeding associated with fibroids, include (Lysteda), hormonal contraception, a levonorgestrel IUD, and selected GnRH agonists or antagonists. reduces menstrual blood loss. GnRH-based treatments can reduce bleeding; bone loss and hot flashes are important concerns, and add-back hormones may be used with some regimens.
Menopausal symptoms
Estradiol (Estrace and other products) and estrogen–progestin products such as Prempro are hormone therapy options. Systemic estrogen can treat vasomotor symptoms. A patient with a uterus generally needs a progestin with systemic estrogen to protect the endometrium. Local vaginal estrogen is used for selected genitourinary symptoms.
Infections and their treatments
Vulvovaginal candidiasis, , and pelvic inflammatory disease require different treatment approaches. Symptoms should not automatically be assumed to indicate a yeast infection; diagnosis and treatment selection should be clinical.
Vulvovaginal candidiasis: Fluconazole (Diflucan) and topical miconazole (Monistat) or clotrimazole (Gyne-Lotrimin) are azole antifungals. The correct treatment depends on the patient and circumstances.
: Metronidazole (Flagyl) or clindamycin (Cleocin) are antibiotic treatments. Unlike yeast infection, is not treated with antifungal medication.
Pelvic inflammatory disease (PID): A clinician prescribes combination antibiotic therapy for this potentially serious reproductive-tract infection. Completing treatment and partner evaluation are important.