Yes

Diuretic, Thiazide

Management of mild to moderate hypertension when used alone or in combination with other agents; treatment of edema associated with congestive heart failure, nephrotic syndrome, or pregnancy. Recent studies have found chlorthalidone effective in the treatment of isolated systolic hypertension in the elderly.

B (per manufacturer); D (based on expert analysis)

Hypersensitivity to chlorthalidone or any component; cross-sensitivity with other thiazides or sulfonamides; anuria; renal decompensation; pregnancy

Use with caution in patients with hypokalemia, renal disease, hepatic disease, gout, lupus erythematosus, or diabetes mellitus. Use with caution in severe renal diseases. Correct hypokalemia before initiating therapy.

1% to 10%:

Endocrine & metabolic: Hypokalemia

Dermatologic: Photosensitivity

Gastrointestinal: Anorexia, epigastric distress

<1% (Limited to important or life-threatening symptoms): Dizziness, headache, weakness, restlessness, insomnia, purpura, rash, urticaria, necrotizing angiitis, vasculitis, cutaneous vasculitis, hyperuricemia or gout, hyponatremia, sexual ability (decreased), hyperglycemia, glycosuria, nausea, vomiting, cholecystitis, pancreatitis, diarrhea or constipation, polyuria, aplastic anemia, leukopenia, agranulocytosis, thrombocytopenia, hepatic function impairment, paresthesia, muscle cramps or spasm

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.

Sulfonamide-derived diuretic that inhibits sodium and chloride reabsorption in the cortical-diluting segment of the ascending loop of Henle

Peak effect: 2-6 hours

Absorption: Oral: 65%

Distribution: Crosses placenta; appears in breast milk

Metabolism: In the liver

Half-life: 35-55 hours; may be prolonged with renal impairment, with anuria: 81 hours

Elimination: ~50% to 65% excreted unchanged in urine

Oral:

Adults: 25-100 mg/day or 100 mg 3 times/week

Elderly: Initial: 12.5-25 mg/day or every other day; there is little advantage to using doses >25 mg/day

Dosage adjustment in renal impairment: Cl_cr <10 mL/minute: Administer every 48 hours

This product may cause a potassium loss; your physician may prescribe a potassium supplement, another medication to help prevent the potassium loss, or recommend that you eat foods high in potassium, especially citrus fruits; 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

Assess weight, I & O records daily to determine fluid loss; blood pressure, serum electrolytes, renal function

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.

None reported

Rare reports of blood dyscrasias; 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 prescribed dose with food early in the day. Include orange juice or bananas in your diet, but do not take potassium supplements without consulting prescriber. You may experience postural hypotension (use caution when rising from lying or sitting position, when climbing stairs, or when driving); photosensitivity (use sunblock, wear protective clothing and eyewear, and avoid direct sunlight); decreased accommodation to heat (avoid excessive exercise in hot weather). Report muscle weakness, tremors, or cramping; persistent nausea or vomiting; swelling of extremities; significant increase in weight; respiratory difficulty; rash; unusual weakness or fatigue; or easy bruising or bleeding. 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

Tablet: 25 mg, 50 mg, 100 mg

Hygroton®: 25 mg, 50 mg, 100 mg

Thalitone®: 15 mg, 25 mg

Freis ED, "The Efficacy and Safety of Diuretics in Treating Hypertension," Ann Intern Med, 1995, 122(3):223-6.

Hulley SB, Furberg CD, Gurland B, et al, "Systolic Hypertension in the Elderly Program (SHEP): Antihypertensive Efficacy of Chlorthalidone," Am J Cardiol, 1985, 56(15):913-20.

Mulley BA, Parr GD, Pau WK, et al, "Placental Transfer of Chlorthalidone and its Elimination in Maternal Milk," Eur J Clin Pharmacol, 1978, 13:129-31.

SHEP Cooperative Research Group, "Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension," JAMA, 1991, 265(24):3255-64.