Yes

Diuretic, Thiazide

Management of mild to moderate hypertension; treatment of edema in congestive heart failure and nephrotic syndrome

D

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

Avoid in severe renal disease (ineffective). 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. 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%: Endocrine & metabolic: Hypokalemia

<1% (Limited to important or life-threatening symptoms): Hypotension, drowsiness, photosensitivity, rash, fluid and electrolyte imbalances (hypocalcemia, hypomagnesemia, hyponatremia), hyperglycemia, anorexia, polyuria, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, rarely blood dyscrasias, hepatitis, paresthesia, prerenal azotemia, uremia

Symptoms of overdose include hypermotility, diuresis, lethargy

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.

The diuretic mechanism of action is primarily inhibition of sodium, chloride, and water reabsorption in the renal distal tubules, thereby producing diuresis with a resultant reduction in plasma volume

Onset of diuretic effect: Within ~2 hours

Peak effect: Within ~4 hours

Duration of action: 12-24 hours

Oral:

Adults:

Edema:

Initial: 50 mg 1-2 times/day

Maintenance: 25-200 mg/day (use divided doses when >100 mg/day)

Hypertension:

Initial: 50 mg twice daily

Maintenance: 50-100 mg/day; maximum: 200 mg/day

Assess weight, I & O reports daily to determine fluid loss; blood pressure, serum electrolytes, BUN, creatinine

ammonia (B), amylase (S), calcium (S), chloride (S), glucose, uric 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 drowsiness

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

No information available to require special precautions

No effects or complications reported

May be taken with food or milk; take early in day to avoid nocturia; take the last dose of multiple doses no later than 6 PM unless instructed otherwise. A few people who take this medication become more sensitive to sunlight and may experience skin rash, redness, itching or severe sunburn, especially if sun block SPF greater than or equal to 15 is not used on exposed skin areas.

Take blood pressure with patient lying down and standing

Tablet: 50 mg