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Furosemide + hydrochlorothiazide is a combination of two diuretic drugs used primarily for the management of edema and hypertension, especially in patients with heart failure or those who are resistant to single-agent diuretic therapy. Furosemide is a loop diuretic that acts on the thick ascending limb of the loop of Henle in the nephron, inhibiting sodium-potassium-chloride cotransporters (NKCC2), which leads to increased excretion of sodium, chloride, potassium, and water. Hydrochlorothiazide is a thiazide diuretic that inhibits the sodium-chloride symporter (SLC12A3) in the distal convoluted tubule, reducing reabsorption of sodium and chloride and promoting water excretion. The combination provides synergistic effects by targeting different sites within the nephron to overcome diuretic resistance and achieve greater natriuresis and fluid loss than either agent alone. This regimen is particularly useful in cases where high-dose furosemide alone does not produce adequate diuresis[1][5][8]. The main risks include electrolyte disturbances such as hypokalemia.
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