For peripheral edema, which diuretic is often considered first drug of choice?

• A. Hydrochlorothiazide
• B. Furosemide
• C. Spironolactone
• D. Bumetanide

Answer: (A)

Hydrochlorothiazide is the best first option for mild peripheral edema because it provides steady, modest diuresis by inhibiting the Na-Cl cotransporter in the distal convoluted tubule. This mechanism reduces sodium and water reabsorption enough to lessen edema without the more aggressive fluid removal and electrolyte shifts seen with loop diuretics. It’s effective for everyday, non-urgent edema and has a favorable safety and tolerability profile for long-term use.

Loop diuretics like furosemide or bumetanide are much stronger and are preferred when edema is substantial or acute decompensation is present, such as in severe heart failure or significant fluid overload, though with higher risks of dehydration and electrolyte disturbances. Spironolactone is a potassium-sparing diuretic mainly used in situations where hyperaldosteronism is involved or as add-on therapy to mitigate potassium loss from loops in heart failure; it isn’t the typical first-line choice for simple peripheral edema.