Diuretics and Lymphedema

The National Lymphedema Network states in the Position Paper, lymphedema should not be treated exclusively with drugs or dietary supplements.

Diuretics

Diuretics ("water pills") are medications that removes excess water from your whole body. But they are generally NOT recommended for treating lymphedema. That's because they don't eliminate the protein that attracts and hangs onto the extra lymph fluid. Once you stop taking the medicine, the protein pulls the fluid back to your arm, and it swells up again.

Although diuretics may be beneficial in the short-term, and may be indicated in those cases when lymphedema is associated with systemic conditions (ascites, hydrothorax, protein-loosing enteropathy). But if used long-term they may be harmful and contribute to the worsening of lymphedema-related symptoms.

Here is why: Lymphedema is an abnormal accumulation of water and protein molecules in the body’s soft tissues, which is caused by a dysfunction of the lymphatic system. Swelling (edema) other than lymphedema may be caused by a variety of conditions, such as congestive heart failure, renal diseases, or venous insufficiencies. These swellings do not contain a higher level of proteins in the accumulated fluid, and are defined as edemas.

Diuretics used for lymphedema are limited to remove the water content of the swelling, while the protein molecules remain in the soft tissues. The dehydration effect of diuretics causes a higher concentration of the protein mass in the edema fluid, which may cause the tissues to become more fibrotic and increase the potential for secondary inflammations ( the edema becomes firm ). In addition, the remaining proteins characteristically draw more water to the swollen areas as soon as the diuretic looses its effectiveness and may cause the volume of the lymphedema to increase.

The 2009 Consensus Document of the International Society of Lymphology states: “Diuretic agents are occasionally useful during the initial treatment phase of complete decongestive therapy (CDT). Long-term administration, however, is discouraged for its marginal benefits in treatment of peripheral lymphedema and potentially may induce fluid and electrolyte imbalance”