Yes

Diuretic, Thiazide

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

D

Hypersensitivity to trichlormethiazide, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy

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

Respiratory: Dyspnea (<5%)

<1% (Limited to important or life-threatening symptoms): Hypotension, photosensitivity, lichenoid dermatitis, fluid and electrolyte imbalances (hypocalcemia, hypomagnesemia, hyponatremia); hyperglycemia, rarely blood dyscrasias, prerenal azotemia

Symptoms of overdose include hypotension, dizziness, electrolyte abnormalities, lethargy, confusion, muscle weakness

Following GI decontamination, therapy is supportive with I.V. fluids, electrolytes, and I.V. pressors if needed; dialysis is unlikely to be effective

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 of the thiazides is primarily inhibition of sodium, chloride, and water reabsorption in the renal distal tubules, thereby producing diuresis with a resultant reduction in plasma volume. The antihypertensive mechanism of action of the thiazides is unknown. It is known that doses of thiazides produce greater reduction in blood pressure than equivalent diuretic doses of loop diuretics. There has been speculation that the thiazides may have some influence on vascular tone mediated through sodium depletion, but this remains to be proven.

Onset of of diuretic effect: Within 2 hours

Peak: 4 hours

Duration: 12-24 hours

Adults: Oral: 1-4 mg/day; initially doses may be given twice daily.

May be administered with food or milk

ammonia (B), amylase (S), calcium (S), chloride (S), cholesterol (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.

None reported

May decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels; may cause photosensitivity; use caution with concurrent psychotropics; use sunblock or wear protective clothing

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.

Assess weight, I & O reports daily to determine fluid loss; take blood pressure with patient lying down and standing

Tablet: 2 mg, 4 mg