hydrochlorothiazide

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hydrochlorothiazide

 [hi″dro-klor″o-thi´ah-zīd]
a thiazide diuretic used as an antihypertensive agent and for treatment of edema.

hydrochlorothiazide

Apo-Hydro (CA), Diuchlor H (CA), Hydro-Par, Microzide, Neo-Codema (CA), Novo-Hydrazide (CA), PMS-Hydrochlorothiazide (CA), Urozide (CA)

Pharmacologic class: Thiazide diuretic

Therapeutic class: Diuretic, antihypertensive

Pregnancy risk category B

Action

Increases sodium and water excretion by inhibiting sodium reabsorption in distal tubules; promotes excretion of chloride, potassium, magnesium, and bicarbonate. Also may produce arteriolar dilation, reducing blood pressure.

Availability

Capsules: 12.5 mg

Oral solution: 10 mg/ml, 100 mg/ml

Tablets: 12.5 mg, 25 mg, 50 mg, 100 mg

Indications and dosages

Edema caused by heart failure, renal dysfunction, cirrhosis, corticosteroid therapy, or estrogen therapy

Adults: 25 to 100 mg P.O. daily as a single dose or in divided doses. Maximum dosage is 200 mg/day.

Mild to moderate hypertension

Adults: Initially, 12.5 mg daily P.O.; then, based on blood pressure response, may give 12.5 to 50 mg/day P.O. Higher dosages may be given in refractory cases.

Children ages 2 to 12: 1 to 2 mg/kg/day P.O. in single dose or two divided doses, not to exceed 100 mg/day

Children younger than age 2: 1 to 2 mg/kg P.O. as single dose or divided doses, not to exceed 37.5 mg/day; infants less than age 6 months may require dosage of 3 mg/kg/day in two divided doses.

Off-label uses

• Hypercalcemia
• Ménière's disease

Contraindications

• Hypersensitivity to drug, other thiazides, sulfonamides, or tartrazine
• Renal decompensation or anuria

Precautions

Use cautiously in:
• renal or severe hepatic impairment, fluid or electrolyte imbalances, gout, systemic lupus erythematosus, hyperparathyroidism, glucose tolerance abnormalities, bipolar disorder
• elderly patients
• pregnant or breastfeeding patients.

Administration

• Give with food or milk if GI upset occurs.
• Administer early in day so diuretic effect doesn't disturb sleep.

Adverse reactions

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

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

EENT: nystagmus

GI: nausea, vomiting, epigastric distress, anorexia, pancreatitis

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

Hematologic: anemia, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia

Hepatic: jaundice, hepatitis

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

Musculoskeletal: muscle cramps

Skin: photosensitivity, urticaria, rash, dermatitis, purpura, alopecia, flushing

Other: fever, weight loss, anaphylaxis

Interactions

Drug-drug.Adrenocorticotropic hormone, corticosteroids: increased risk of intensified electrolyte depletion, particularly hypokalemia

Allopurinol: increased risk of hypersensitivity reaction

Amphotericin B, corticosteroids, digoxin, mezlocillin, piperacillin, ticarcillin: increased risk of hypokalemia

Antihypertensives, barbiturates, nitrates, opioids: increased hypotension

Cholestyramine, colestipol: decreased hydrochlorothiazide absorption

Digoxin: increased risk of hypokalemia

Insulin, oral hypoglycemics: possible decreased hypoglycemic effect

Lithium: decreased excretion and increased blood level of lithium

Nondepolarizing skeletal muscle relaxants (such as tubocurarine): increased skeletal muscle relaxant effect

Nonsteroidal anti-inflammatory drugs: decreased hydrochlorothiazide efficacy

Vasopressors: decreased pressor effect

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

Cholesterol, low-density lipoproteins, magnesium, potassium, protein-bound iodine, sodium, triglycerides, urinary calcium: decreased levels

Drug-herbs.Dandelion: interference with diuretic activity

Ginkgo: decreased antihypertensive effect

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

Drug-behaviors.Alcohol use: increased hypotension

Sun exposure: increased risk of photo-sensitivity

Patient monitoring

• Monitor blood pressure, fluid intake and output, and daily weight.
• Assess electrolyte levels, especially potassium. Monitor for signs and symptoms of hypokalemia.
• Monitor blood urea nitrogen and creatinine levels.
• Check blood glucose level in diabetic patients.
• Assess for signs and symptoms of gout attacks in patients with gouty arthritis.

Patient teaching

• Advise patient to take with food or milk if GI upset occurs.
• Tell patient to take early in day to avoid nighttime urination.
• Instruct patient to track intermittent doses on calendar.
• Tell patient to weigh himself daily, at same time on same scale and wearing same clothes.

Instruct patient to report decreased urination, swelling, unusual bleeding or bruising, dizziness, fatigue, numbness, and muscle weakness or cramping.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• 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.

hy·dro·chlo·ro·thi·a·zide

(hī'drō-klōr'ō-thī'ă-zīd),
A potent orally effective diuretic and antihypertensive agent related to chlorothiazide; can cause hypokalemia and hyperglycemia.

hydrochlorothiazide

/hy·dro·chlo·ro·thi·a·zide/ (-klor″o-thi´ah-zīd) a thiazide diuretic, used for treatment of hypertension and edema.

hydrochlorothiazide

(hī′drə-klôr′ə-thī′ə-zīd′)
n.
A diuretic drug, C7H8ClN3O4S2, used in the treatment of hypertension.

hydrochlorothiazide

[-klôr′ōthī′əzīd]
a thiazide diuretic.
indications It is prescribed in the treatment of mild to moderate hypertension and edema caused by congestive heart failure or protein loss by the kidney (nephritic syndrome).
contraindications Anuria or known hypersensitivity to this drug, to other thiazide medication, or to sulfonamide derivatives prohibits its use.
adverse effects Among the more serious adverse effects are hypoglycemia, hyperglycemia, hyperuricemia, and hypersensitivity reactions.

hy·dro·chlo·ro·thi·a·zide

(hī'drō-klōr'ō-thī'ă-zīd)
A potent orally effective diuretic andantihypertensive agent related to chlorothiazide.

hydrochlorothiazide

A drug used to increase the output of urine so as to relieve the body of surplus water. A thiazide DIURETIC drug. The drug is on the WHO official list. A brand name is Hydrosaluric. Hydrochlorothiazide is formulated in conjunction with a variety of drugs. It is available with potassium under the brand name Amil-Co; with another diuretic as Dyazide, Moduret 25, Moduretic, Triam-Co; with ANGIOTENSIN CONVERTING ENZYME inhibitor drugs as Accuretic, Acezide, Capozide, Carace 10 Plus, Innozide and Zestoretic 20; with BETA BLOCKER drugs as Co-Betaloc, Kalten, Moducren and Monozide 10; and with an angiotensin II antagonist drug as Cozaar-Comp.

hy·dro·chlo·ro·thi·a·zide

(hī'drō-klōr'ō-thī'ă-zīd)
A potent orally effective diuretic and antihypertensive agent related to chlorothiazide; can cause hypokalemia and hyperglycemia.

hydrochlorothiazide,

n brand names: Esidrix, HydroDIURIL;
drug class: thiazide diuretic;
action: acts on distal tubule by increasing excretion of water, sodium, chloride, potassium;
uses: edema, hypertension, diuresis, congestive heart failure.

hydrochlorothiazide

a thiazide diuretic; sometimes used for an antidiuretic effect in the treatment of diabetes insipidus in dogs.
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