Yes: Tablet

Diuretic, Thiazide

Management of mild to moderate hypertension, or edema associated with congestive heart failure, pregnancy, or nephrotic syndrome in patients unable to take oral hydrochlorothiazide; when a thiazide is the diuretic of choice

C (per manufacturer);D (Based on expert analysis)

Clinical effects on the fetus: Crosses the placenta. Hypoglycemia, thrombocytopenia, hemolytic anemia, electrolyte disturbances reported. May exhibit a tocolytic effect. Generally, use of diuretics during pregnancy is avoided due to risk of decreased placental perfusion.

Breast-feeding/lactation: Crosses into breast milk; may suppress lactation with high doses. American Academy of Pediatrics considers compatible with breast-feeding.

Hypersensitivity to chlorothiazide or any component, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy

Use with caution in severe renal disease. Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. I.V. use is generally not recommended (but is available). Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

1% to 10%:

Cardiovascular: Orthostatic hypotension

Endocrine & metabolic: Hypokalemia

Dermatologic: Photosensitivity

Gastrointestinal: Anorexia, epigastric distress

<1% (Limited to important or life-threatening symptoms): Dizziness, headache, weakness, restlessness, purpura, rash, urticaria, necrotizing angiitis, vasculitis, cutaneous vasculitis, alopecia, exfoliative dermatitis (I.I.), toxic epidermal necrolysis (I.V.), Stevens-Johnson syndrome, hyperuricemia or gout, hyponatremia, sexual ability (decreased), hyperglycemia, glycosuria, electrolyte imbalance, nausea, vomiting, cholecystitis, pancreatitis, diarrhea or constipation, polyuria, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, hematuria (I.V.), paresthesia, muscle cramps or spasm, uremia, renal failure, pulmonary edema

Symptoms of overdose include hypermotility, diuresis, lethargy, confusion, muscle weakness, coma

Following GI decontamination, therapy is supportive with I.V. fluids, electrolytes, and I.V. pressors if needed

Angiotensin-converting enzyme inhibitors: Increased hypotension if aggressively diuresed with a thiazide diuretic.

Beta-blockers increase hyperglycemic effects in Type 2 diabetes mellitus.

Cyclosporine and thiazides can increase the risk of gout or renal toxicity; avoid concurrent use.

Digoxin toxicity can be exacerbated if a thiazide induces hypokalemia or hypomagnesemia.

Lithium toxicity can occur by reducing renal excretion of lithium; monitor lithium concentration and adjust as needed.

Neuromuscular-blocking agents can prolong blockade; monitor serum potassium and neuromuscular status.

NSAIDs can decrease the efficacy of thiazides reducing the diuretic and antihypertensive effects.

Reconstituted solution is stable for 24 hours at room temperature; precipitation will occur in <24 hours in pH <7.4

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

Onset of diuresis: Oral: 2 hours

Duration of diuretic action: Oral: 6-12 hours; I.V.: ~2 hours

Absorption: Oral: Poor

Half-life: 1-2 hours

Time to peak serum concentration: Within 4 hours

Infants <6 months:

Oral: 20-40 mg/kg/day in 2 divided doses

I.V.: 2-8 mg/kg/day in 2 divided doses

Infants >6 months and Children:

Oral: 20 mg/kg/day in 2 divided doses

I.V.: 4 mg/kg/day

Adults:

Oral: 500 mg to 2 g/day divided in 1-2 doses

I.V.: 100-500 mg/day (for edema only)

Elderly: Oral: 500 mg once daily or 1 g 3 times/week

Avoid natural licorice; may need to decrease sodium and calcium, may need to increase potassium, zinc, magnesium, and riboflavin in diet; do not change your diet on your own while taking this medication, especially if you are taking potassium supplements or medications to reduce potassium loss; too much potassium can be as harmful as too little

Serum electrolytes, renal function, blood pressure; assess weight, I & O reports daily to determine fluid loss

creatine phosphokinase [CPK] (S), ammonia (B), amylase (S), calcium (S), chloride (S), cholesterol (S), glucose, acid (S), chloride (S), magnesium, potassium (S), sodium (S)

Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. They may act synergistically to lower blood pressure when combined with an ACE inhibitor or beta-blocker. The initial concern about thiazide diuretic-induced hypokalemia, glucose intolerance, and lipid profiles does not appear to be of substantial clinical consequence in the treatment of hypertension. The benefits of this class of agents in the treatment of hypertension is established and compares well with other first-line therapeutic agents.

May cause dizziness

Rare reports of agranulocytosis; use caution with clozapine and carbamazepine; thiazides decrease lithium clearance resulting in elevated serum lithium levels and potential toxicity; monitor serum lithium levels

No information available to require special precautions

No effects or complications reported

Take once daily dose of chlorothiazide in morning or last of daily doses in early evening to avoid night-time disturbances. Additional potassium may be recommended; follow dietary suggestions of prescriber. You will be more sensitive to sunlight; use sunblock, wear protective clothing, or avoid direct sunlight. You may experience dizziness, weakness, or drowsiness; use caution when driving or engaging in tasks that require alertness until response to drug is known. You may experience postural hypotension; use caution when rising from sitting or lying position or when climbing stairs. Report muscle twitching or cramps; acute loss of appetite; GI distress; severe rash, redness, or itching of skin; sexual dysfunction; palpitations; or respiratory difficulty. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. Consult prescriber if breast-feeding.

Take blood pressure with patient lying down and standing; avoid extravasation of parenteral solution since it is extremely irritating to tissues

Powder for injection, lyophilized, as sodium: 500 mg

Suspension, oral: 250 mg/5 mL (237 mL)

Tablet: 250 mg, 500 mg