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Adverse Effects Electrolyte imbalance: hypokalemia, hyponatremia, hypocalcemia Dehydration and hypotension Ototoxicity (especially with rapid IV administration or with aminoglycosides) Hyperuricemia may precipitate gout Hyperglycemia (mild) Contraindications Severe electrolyte depletion (e.g., hypokalemia, hyponatremia) Anuria (no urine output) Hypersensitivity to sulfonamides (use with caution) Drug Interactions Aminoglycosides: risk of ototoxicity Digoxin: risk of digoxin toxicity due to hypokalemia NSAIDs: reduce diuretic effect Other antihypertensives: additive hypotensive effects Key Counseling Points Take in the morning to avoid nighttime urination

Levels decline with age and drop further in chronic disease, including Parkinson's disease, liver disease, heart disease, and alcohol use disorder

Effect shows as energy increase, stamina increase, good sleep, reduction of stress, reduction of pimple pores, skin