Hydrochlorothiazide

Therapeutic Area:

,

Generic Name:

Hydrochlorothiazide

Dosage Form:

tablet

Drug Dose

Therapeutic Indications:

Edema, refractory: Treatment of edema due to heart failure, various forms of renal dysfunction (eg, nephrotic syndrome, acute glomerulosclerosis, chronic renal failure), or corticosteroid or estrogen therapy.

Mechanism of Action:

Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions

Method of Administration:

Initial: 25 to 100 mg daily in 1 to 2 divided doses; adjust dose based on response and tolerability; maximum daily dose: 200 mg/day

Notes

Contraindications:

Hypersensitivity to hydrochlorothiazide, any component of the formulation, or sulfonamide-derived drugs; anuria

Interactions:

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

 Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

 Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Pregnancy and Lactation:

Use of thiazide diuretics to treat edema during normal pregnancies is not appropriate; use may be considered when edema is due to pathologic causes.

Due to the potential for serious adverse reactions in the breastfeeding infant, it is recommended that a decision be made whether to discontinue breastfeeding or to discontinue the drug, considering the importance of treatment to the mother.

Warning and Precaution:

  • Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension.
  • Ascites due to cirrhosis: Use with extreme caution or avoid hydrochlorothiazide in the management of ascites due to cirrhosis; may lead to rapid development of hyponatremia when used in combination with spironolactone and furosemide.
  • Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met.
  • Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.
  • Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in progressive or severe liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.
  • Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported.
  • Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.
  • Renal impairment: Cumulative effects may develop, including azotemia, in patients with impaired renal function. Avoid in severe renal disease (ineffective).

Adverse Reactions:

Cardiovascular: Hypersensitivity angiitis, hypotension (including orthostatic)

Dermatologic: Alopecia, skin rash, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Glycosuria, hypomagnesemia

Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, vomiting

Hematologic & oncologic: Aplastic anemia, thrombocytopenia

Hypersensitivity: Anaphylaxis

Nervous system: Dizziness, headache, paresthesia, restlessness, vertigo

Neuromuscular & skeletal: Asthenia, muscle spasm

Ophthalmic: Blurred vision (transient), xanthopsia

Renal: Acute kidney injury

Storage:

Store below 30ºC and protect from light and moisture.