chlorothiazide (redirected from Chlorothiazide sodium)

chlorothiazide /chlo·ro·thi·a·zide/ (klor″o-thi´ah-zīd) a thiazide diuretic used in the form of the base or the sodium salt to treat hypertension and edema.

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chlorothiazide

[-thī′əzīd]

a thiazide diuretic chemically related to sulfonamides. It is an antihypertensive.

indications It is prescribed in the treatment of hypertension and edema.

contraindications Anuria or known hypersensitivity to thiazide medication or to sulfonamide derivatives prohibits its use.

adverse effects Among the more serious adverse reactions are hypokalemia, hyperglycemia, and hyperuricemia. Hypersensitivity reactions may occur.

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chlorothiazide (klor´thī´zīd´),

n brand name: Diuril;
drug class: thiazide diuretic;
action: acts on distal tubule by increasing excretion of water, sodium chloride, potassium;
uses: edema and hypertension, diuresis.

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chlorothiazide

a thiazide diuretic. Called also Diuril.

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chlorothiazide

Diuril

Pharmacologic class: Thiazide

Therapeutic class: Diuretic, antihypertensive

Pregnancy risk category B

Action

Increases sodium and water excretion and inhibits sodium reabsorption in distal tubule, thereby promoting excretion of chloride, potassium, magnesium, and bicarbonate

Availability

Oral suspension: 250 mg/5 ml

Powder for injection: 500 mg

Tablets: 250 mg, 500 mg

⊘Indications and dosages

➣ Edema associated with heart failure, renal dysfunction, cirrhosis, corticosteroid therapy, or estrogen therapy

Adults: 0.5 to 1 g P.O. daily as a single dose or in two divided doses

Children ages 3 to 6 months: 10 to 20 mg/kg P.O. daily as a single dose or in two divided doses

➣ Mild to moderate hypertension

Adults: 0.5 to 1 g P.O. daily as a single dose or in divided doses. Adjust dosage to blood pressure response.

Children: 10 to 20 mg/kg P.O. daily as a single dose or in two divided doses, not to exceed 375 mg/day (2.5 to 7.5 ml or ½ to 1½ tsp of oral suspension) in infants up to age 2, or 1 g/day in children ages 2 to 12. Infants younger than 6 months may require up to 30 mg/kg daily in two divided doses.

Contraindications

• Hypersensitivity to drug, other thiazides, benzodiazepines, sulfonamides, or tartrazine
• Anuria
• Gout
• Systemic lupus erythematosus
• Glucose tolerance abnormalities
• Hyperparathyroidism
• Bipolar disorder
• Breastfeeding

Precautions

Use cautiously in:
• renal or severe hepatic impairment
• pregnant patients.

Administration

• Be aware that drug is given I.V. in emergency use and for patients unable to receive oral form. I.V. dosage is individualized; use smallest dosage needed to achieve response.
• Know that drug is not safe for I.M. or subcutaneous use, and that I.V. use in children is not recommended.
• Be aware that drug may be ineffective in patients with renal insufficiency.
• Rarely, patients may require up to 2 g/day in divided doses.

Route	Onset	Peak	Duration
P.O.	2 hr	4 hr	6-12 hr
I.V.	15 min	30 min	Unknown

Adverse reactions

CNS: dizziness, drowsiness, lethargy, headache, insomnia, nervousness, vertigo, paresthesia, confusion, fatigue, asterixis, encephalopathy

CV: hypotension, ECG changes, chest pain, thrombophlebitis, arrhythmias

EENT: nystagmus

GI: nausea, vomiting, abdominal cramps, pancreatitis, anorexia

GU: polyuria, nocturia, erectile dysfunction, loss of libido

Hematologic: blood dyscrasias

Hepatic: jaundice, hepatitis

Metabolic: dehydration, hypovolemia, hyperglycemia, hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, hyperuricemia, gout attack, hypochloremic alkalosis

Musculoskeletal: muscle cramps or spasms

Skin: photosensitivity, rash, urticaria, flushing

Other: fever, weight loss, hypersensitivity reactions

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin: additive hypokalemia

Antihypertensives, barbiturates, nitrates, opiates: increased hypotension

Cholestyramine, colestipol: increased chlorothiazide absorption

Digoxin: increased risk of hypokalemia

Lithium: decreased lithium excretion, lithium toxicity

Nonsteroidal anti-inflammatory drugs: decreased chlorothiazide efficacy

Drug-diagnostic tests. Bilirubin, serum and urine glucose (in diabetic patients), calcium, creatinine, uric acid: increased levels

Cholesterol, low-density lipoproteins (LDLs), triglycerides: decreased levels

Magnesium, potassium, protein-bound iodine, sodium: decreased levels

Urine calcium: decreased level

Drug-herbs. Ginkgo: decreased antihypertensive effect

Licorice, stimulant laxative herbs (aloe, cascara sagrada, senna): increased risk of hypokalemia

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Sun exposure: increased risk of photosensitivity

Patient monitoring

• Monitor blood pressure.
• Assess electrolyte, bilirubin, creatinine, uric acid, magnesium, cholesterol, LDL, and triglyceride levels.
• Monitor urine calcium level.
• Evaluate blood and urine glucose levels in patients with diabetes.

Patient teaching

• Advise patient to take drug in morning to avoid sleep interruptions caused by nighttime voiding.
☞ Instruct patient to immediately report yellowing of eyes or skin, nausea, vomiting, diarrhea, fatigue, or lethargy.
• Advise patient not to stop taking drug abruptly. Advise him to discuss dosage-tapering schedule with prescriber.
• Caution patient to use alcohol cautiously, if at all.
• Inform patient that drug makes him prone to dehydration. Tell him to stay indoors in hot weather and to increase fluid intake if he sweats more than usual.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.