Dynamed

Hydrochlorothiazide

  • Updated 2013 Jan 18 12:19:26 PM: Hydrochlorothiazide brands data updated
  • AHFS section updated
  • AHFS section updated

 

Related Summaries

 

General Information

Description

Thiazide diuretic and antihypertensive agent.

Class

Class: Thiazide Diuretics

Abbreviation

HCTZ

Uses and Efficacy

Uses

Hypertension

Used alone or in combination with other antihypertensive agents for all stages of hypertension.

Thiazide diuretics are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, angiotensin II receptor antagonists, and calcium-channel blockers. While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes. Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).

The optimum BP threshold for initiating antihypertensive drug therapy is controversial. Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg; JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age. Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age, application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg; current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.

Black hypertensive patients generally tend to respond better to monotherapy with thiazide diuretics or calcium-channel blockers than to other antihypertensive drug classes (e.g., ACE inhibitors, angiotensin II receptor antagonists). However, diminished response to these other drug classes is largely eliminated when administered concomitantly with a thiazide diuretic or calcium-channel blocker.

Thiazides may be preferred in hypertensive patients with osteoporosis. Secondary beneficial effect in hypertensive geriatric patients of reducing the risk of osteoporosis secondary to effect on calcium homeostasis and bone mineralization.

Thiazide diuretics (unlike potassium-sparing diuretics) may be used in patients who are at an increased risk for developing hyperkalemia (e.g., those receiving an ACE inhibitor).

Edema (General)

Management of edema resulting from various causes; diagnose etiology before use.

Edema caused by renal disease or by corticosteroids or estrogens may be relatively resistant to treatment.

Ineffective in patients with Scr or BUN concentrations greater than twice normal.

May be ineffective in patients with a GFR of <15–25 mL/minute; even when GFR is 25–50 mL/minute, more potent (e.g., loop) diuretics may be indicated.

No substantial difference in clinical effects or toxicity of comparable thiazide or thiazide-like diuretics, except metolazone may be more effective in edema with renal impairment.

Edema in Heart Failure

Management of edema associated with heart failure.

Used in conjunction with moderate sodium restriction (≤3 g of sodium daily), an ACE inhibitor, and usually a β-adrenergic blocking agent, with or without a cardiac glycoside.

Beneficial effects are additive with those of cardiac glycosides and/or ACE inhibitors.

Unless contraindicated or not tolerated, all patients with mild to severe heart failure secondary to left ventricular systolic dysfunction (ejection fraction less than 35–40%) generally should receive therapy with a diuretic in conjunction with an ACE inhibitor with or without a cardiac glycoside or a β-adrenergic blocking agent.

Diuretic therapy and sodium restriction are not routinely necessary in patients with left ventricular systolic dysfunction and no or minimal overt signs or symptoms of heart failure (NYHA functional class I heart failure); diuretics should be added to ACE inhibitor therapy if volume overload develops or if symptoms of heart failure continue.

Concomitant diuretic therapy usually is indicated in patients with symptomatic heart failure (NYHA class II or greater) because of the likelihood of sodium and fluid retention.

Do not use diuretics as monotherapy in heart failure even if symptoms (e.g., peripheral edema, pulmonary congestion) are well controlled; diuretics alone do not prevent progression of heart failure.

Diuretics produce rapid symptomatic benefits, relieving pulmonary and peripheral edema more rapidly (within hours or days) than cardiac glycosides, ACE inhibitors, or β-blockers (in weeks or months).

Once fluid retention has resolved in heart failure, diuretic therapy should be maintained to prevent recurrence of fluid retention. Ideally, diuretic therapy should be adjusted according to changes in body weight (as an indicator of fluid retention) rather than maintained at a fixed dosage.

Diuretics should be continued in heart failure and comorbid conditions (e.g., hypertension) where ongoing therapy with the drugs is indicated.

Edema Secondary to Nephrotic Syndrome

May be useful if the patient fails to respond to corticosteroid therapy.

More likely to become refractory to thiazides than edema associated with heart failure, and more potent diuretics may be required.

Edema in Pregnancy

Generally responds well to thiazides except when caused by renal disease.

Thiazides should not be used for routine therapy in pregnant women with mild edema who are otherwise healthy.

Diabetes Insipidus

Has been used widely in the treatment of diabetes insipidus .

Effective in both the neurohypophyseal and nephrogenic forms of the disease, decreasing urine volume by up to 50%.

Particularly useful in nephrogenic diabetes insipidus, since this form of the disease is unresponsive to vasopressin or lypressin and chlorpropamide.

Useful in patients who are allergic or refractory to vasopressin or lypressin and has been used in combination with one of these hormones and a low-salt diet in patients who excrete an exceptionally large volume of urine.

Renal Tubular Acidosis

Has been used with success in the treatment of electrolyte disturbances associated with renal tubular acidosis .

Renal Calculus Formation

Has been used with success in the prophylaxis of renal calculus formation associated with hypercalciuria .

Efficacy for Prevention of Urinary Stone Recurrence

  • thiazide diuretics may reduce rate of recurrent stone formation in patients with calcium stones and idiopathic hypercalciuria (level 2 [mid-level] evidence)
    • based on Cochrane review of trials with methodologic limitations
    • systematic review of 5 randomized trials evaluating pharmacologic interventions for ≥ 4 months for preventing complications and decreasing urologic symptoms in 316 adults with idiopathic hypercalciuria
    • all trials had unclear allocation concealment, 4 trials lacked blinding
    • all trials included patients with idiopathic hypercalciuria and recurrent stones, no trials evaluated primary prophylaxis
    • 4 trials compared thiazides or indapamide vs. standard treatment or dietary recommendations
      • proportion of patients stone-free 75.7% vs. 45% in analysis of 4 trials with 285 patients (p < 0.0001, NNT 4)
      • proportion of patients stone-free 74.4% vs. 43% in analysis of 3 thiazide trials with 245 patients (p = 0.0016, NNT 4)
      • mean reduction in stone formation -0.18 stones/patient/year (95% CI -0.3 to -0.06 stones/patient/year) in analysis of 3 trials with 247 patients (p = 0.003)
      • mean reduction in stone formation -0.16 stones/patient/year (95% CI -0.3 to -0.03 stones/patient/year) in analysis of 2 thiazide trials with 207 patients (p = 0.003)
      • indapamide trial (40 patients) had results similar to thiazide but did not reach statistical significance
    • potassium phosphate reduced calciuria and vitamin D levels in 1 placebo-controlled trial in 31 patients
    • Reference - Cochrane Database Syst Rev 2009 Jan 21;(1):CD004754
    • specific details for 2 largest trials in Cochrane review
      • trichlormethiazide reported to decrease urinary calcium and rate of stone formation (level 3 [lacking direct] evidence)
        • based on randomized trial without blinding and with unclear statistical analysis
        • 210 patients with calcium urolithiasis and idiopathic hypercalciuria were randomized to trichlormethiazide 4 mg/day vs. no treatment
        • 35 patients excluded, 175 patients analyzed
        • analysis based on number of stones and not number of patients
        • comparing trichlormethiazide vs. control
          • total number of patients analyzed 82 vs. 93
          • mean follow-up 2.21 years vs. 2.14 years (range 6 months to 5.7 years)
          • total number of new stones 24 vs. 57 (not significant)
          • rate of new stone formation 0.13 vs. 0.31 stones per patient-year (p < 0.05)
        • significant decrease in urinary calcium output reported
        • Reference - Br J Urol 1992 Jun;69(6):571
      • hydrochlorothiazide may decrease rate of recurrent calcium lithiasis (level 2 [mid-level] evidence)
        • based on randomized trial without blinding not published in English
        • 150 patients with recurrent calcium lithiasis randomized to observation vs. hydrochlorothiazide 50 mg/day vs. hydrochlorothiazide 50 mg/day plus potassium citrate 20 mEq/day and followed for 3 years
        • 52% had hypercalciuria on urine studies, most common metabolic disorder was absorptive hypercalciuria type I
        • hydrochlorothiazide groups had significantly lower number of recurrences and need for new sessions of extracorporeal lithotripsy, statistically significant in subgroup with hypercalciuria
        • Reference - Actas Urol Esp 2006 Mar;30(3):305, Arch Esp Urol 2001 Nov;54(9):1047 [Spanish]
  • hydrochlorothiazide may decrease recurrent stone formation (level 2 [mid-level] evidence)
    • based on randomized trial with borderline statistical significance
    • 50 recurrent stone formers randomized to hydrochlorothiazide 25 mg vs. placebo twice daily for median 3 years
    • 25% hydrochlorothiazide vs. 55% placebo group had new stone (p = 0.05, NNT 4)
    • thiazide associated with longer stone-free interval (p < 0.01)
    • trial not specific to patients with hypercalciuria, results independent of urinary calcium
    • Reference - Acta Med Scand 1984;215(4):383
    • DynaMed commentary -- trial excluded from Cochrane review because all patients with hypercalciuria were in hydrochlorothiazide group so no subgroup analysis for hypercalciuria possible

Dosage and Administration

Administration

Administer orally.

Dosage

Individualize according to requirements and response. Use lowest dosage necessary to produce desired clinical effect.

If added to potent hypotensive agent regimen, initially reduce hypotensive dosage to avoid the possibility of severe hypotension.

Pediatric Patients

Hypertension and Diuresis

Oral

Infants <6 months of age: Up to 3 mg/kg daily, in 2 divided doses; up to 37.5 mg daily.

Infants 6 months to 2 years of age: Usually, 1–2 mg/kg daily, in a single or 2 divided doses, up to 37.5 mg daily.

Children 2–12 years of age: 1–2 mg/kg daily, in a single or 2 divided doses, up to 100 mg daily.

Alternatively, some experts recommend an initial dosage of 1 mg/kg once daily. May increase as necessary up to a maximum of 3 mg/kg (up to 50 mg) once daily.

Adults

Hypertension

Usual Dosage

Oral

Manufacturers recommend initial dosage of 12.5–25 mg daily; may increase to 50 mg daily given in 1 or 2 divided doses.

Initial dosages of 12.5–25 mg once daily and target dosages of 25–100 mg daily (in 1 or 2 divided doses) were used in randomized controlled studies; however, the JNC 8 expert panel recommends a target dosage of 25–50 mg daily for optimal balance between efficacy and safety.

If adequate response is not achieved with monotherapy, add another antihypertensive agent.

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.

Fixed-combination Therapy

Oral

Initially, administer each drug separately to adjust dosage; may use fixed combination if optimum maintenance dosage corresponds to drug ratio in combination preparation. Alternatively, may initiate therapy with a fixed-combination preparation.

Edema

Oral

Usually, 25–100 mg daily in 1–3 divided doses.

Many patients also may respond to intermittent therapy (e.g., alternate days, 3–5 days weekly); decreased risk of excessive diuretic response and resulting electrolyte imbalance.

General

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.
  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.
  • If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug. May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug.
  • Consider initiating antihypertensive therapy with a combination of drugs if patient's BP exceeds goal BP by >20/10 mm Hg.
  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies. (See Hypertension under Uses.)

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment; caution because of risk of precipitating hepatic coma.

Renal Impairment

No specific dosage recommendations for renal impairment; caution because of risk of precipitating azotemia.

Geriatric Patients

Initiate therapy at the lowest dosage (12.5 mg daily); may adjust dosage in increments of 12.5 mg if needed.

Prescribing Limits

Pediatric Patients

Hypertension and Diuresis

Oral

Infants <2 years of age: Maximum 37.5 mg daily.

Children 2–12 years of age: Maximum 100 daily.

Some experts recommend maximum of 3 mg/kg (up to 50 mg) once daily.

Adults

Hypertension

Oral

Dosages >50 mg daily associated with marked hypokalemia and not recommended.

Cautions and Adverse Effects

Contraindications

  • Anuria.
  • Known hypersensitivity to hydrochlorothiazide, other thiazides, or any ingredient in the formulation.
  • Although manufacturers state allergy to other sulfonamide derivatives is a contraindication, evidence to support cross-sensitivity is limited, and history of sensitivity to sulfonamide anti-infectives (“sulfa sensitivity”) should not be considered an absolute contraindication.

Warnings/Precautions

Warnings

Hypotensive Agents

May potentiate effects of other hypotensive agents. Although additive or potentiated antihypertensive effects usually are used to therapeutic advantage, hypotension could occur. (See Interactions.)

Lupus Erythematosus

Possible exacerbation or activation of systemic lupus erythematosus.

Lithium

Generally, do not use with lithium salts. (See Interactions.)

Sensitivity Reactions

Hypersensitivity

May occur with or without history of allergy or bronchial asthma.

Sulfonamide cross-sensitivity unlikely. (See Contraindications under Cautions.)

General Precautions

Electrolyte Imbalance

Monitor for fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia).

Observe for signs of electrolyte imbalance (e.g., dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains, cramps, muscular fatigue, hypotension, tachycardia, nausea, vomiting).

Perform periodic serum electrolyte determinations (particularly of potassium, sodium, chloride, and bicarbonate); institute measures to maintain normal serum concentrations if necessary.

Serum and urinary electrolyte measurements are especially important with diabetes mellitus, vomiting, diarrhea, parenteral fluid therapy, or expectations of excessive diuresis.

Weekly (or more frequent) electrolyte measurement recommended early in treatment; possible to extend interval between measurements to ≥3 months when electrolyte response has stabilized.

Hypokalemia

May occur after brisk diuresis, when cirrhosis is present, or with prolonged therapy; inadequate oral electrolyte intake may contribute.

May cause cardiac arrhythmias, exaggerate cardiac response to cardiac glycoside toxicity (increase ventricular irritability).

Use potassium-sparing diuretics and/or potassium supplementation to avoid or treat hypokalemia.

Hypochloremia

Generally mild, usually does not require specific treatment except in renal or hepatic impairment.

Chloride replacement may be required for metabolic acidosis.

Hyponatremia

Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate treatment usually is water restriction rather than salt administration except when hyponatremia is life-threatening.

In actual salt depletion, appropriate replacement is treatment of choice.

Gout

Hyperuricemia or, rarely, precipitation of gout may occur; generally avoid or use with caution in patients with history of gout or elevated uric acid concentrations.

Hyperglycemia

In diabetic patients, dosage adjustment of insulin or oral hypoglycemics may be required; hyperglycemia may occur and latent diabetes mellitus may become evident.

Sympathectomy

Antihypertensive effect may be enhanced after sympathectomy.

Hypomagnesemia

May increase magnesium urinary excretion, resulting in hypomagnesemia.

Hypercalcemia

May decrease calcium urinary excretion, cause slight intermittent serum calcium increase in absence of known calcium metabolism disorder; marked hypercalcemia may indicate hyperparathyroidism.

Discontinue prior to performing parathyroid tests.

Hyperlipidemia

May increase cholesterol and triglyceride concentrations.

Clinical importance of these changes is unknown. Diet low in saturated fat and cholesterol usually compensates.

Hypotensive Effects

Orthostatic hypotension rarely occurs.

Specific Populations

Pregnancy

Category B.

Diuretics are considered second-line agents for control of chronic hypertension in pregnant women; if initiation of antihypertensive therapy is necessary during pregnancy, other antihypertensives (i.e., methyldopa, nifedipine, labetalol) are preferred.

Diuretics are not recommended for prevention or management of gestational hypertension or preeclampsia.

Edema associated with pregnancy generally responds well to thiazides except when caused by renal disease; however, do not use as routine therapy in pregnant women with mild edema who are otherwise healthy.

Lactation

Distributed into milk. Manufacturer states to discontinue nursing or the drug; however, considered to be compatible with breast-feeding.

Pediatric Use

No controlled studies in children; use is supported by experience and published literature about hypertension treatment in children.

Geriatric Use

Elderly may be at increased risk of dilutional hyponatremia, especially underweight females with poor oral fluid and electrolyte intake or excessive low-sodium nutritional supplement intake. (See Hyponatremia under Cautions.)

Increased incidence of adverse effects and excessive reduction in BP in those >65 years of age. (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use with caution in hepatic impairment or progressive liver disease (particularly with associated potassium deficiency); electrolyte imbalance may precipitate hepatic coma.

Discontinue immediately if signs of impending hepatic coma appear.

Renal Impairment

Use with caution in severe renal impairment; thiazides decrease GFR and may precipitate azotemia. Effects may be cumulative in impaired renal function.

Consider interruption or discontinuance if progressive renal impairment (rising nonprotein nitrogen, BUN, or Scr) occurs.

Common Adverse Effects

Potassium depletion, hyperuricemia (usually asymptomatic rarely leading to gout). Hypochloremic alkalosis in patients at risk (e.g., hypokalemic patients). Hyperglycemia and glycosuria in diabetics.

Interactions

Specific Drugs and Laboratory Tests

Drug or Test Interaction Comments
Alcohol Increased risk of postural hypotension with thiazides b  
Amphetamine Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., amphetamine) with concurrent use b Urine pH change is not great during thiazide use and, toxic blood concentrations of amines usually do not occur b Monitor for signs of toxicity after initiation of thiazides in patients receiving amphetamine b
Amphotericin B Additive/potentiated potassium loss b Severe potassium depletion may occur when used concomitantly b
Anticoagulants, oral Postulated that may antagonize oral anticoagulant effects b Confirmatory evidence is lacking b
Antidiabetic agents (sulfonylureas) Thiazide hyperglycemic effect may exacerbate diabetes mellitus, increase antidiabetic agent requirements, and/or cause temporary loss of diabetic control or secondary failure to antidiabetic agent b  
Barbiturates Increased risk of postural hypotension with thiazides b  
Cholestyramine or colestipol resin May bind thiazides, reduce their GI absorption, with cholestyramine reportedly producing greater binding in vitro b Administer thiazides at least 2 hours before cholestyramine or colestipol when used concomitantly b
Corticosteroids Additive/potentiated potassium loss b Severe potassium depletion may occur when used concomitantly b
Corticotropin Additive/potentiated potassium loss b Severe potassium depletion may occur when used concomitantly b
Diazoxide May potentiate diazoxide hyperglycemic, hypotensive, and hyperuricemic effects b Use concomitantly with caution b
Digitalis glycosides Thiazide-induced electrolyte disturbances (principally hypokalemia, but also hypomagnesemia and hypercalcemia) may increase digitalis toxicity risk b Perform periodic electrolyte determinations with concomitant use; correct hypokalemia if warranted b
Hypotensive agents Increased hypotensive effects of most other hypotensive agents b Addition of thiazide to stabilized regimen with potent hypotensive agent (e.g., guanethidine sulfate, methyldopa, ganglionic blocking agent) may cause severe postural hypotension b Usually used to therapeutic advantage b
Insulin May exacerbate diabetes mellitus, increase insulin requirements, cause temporary loss of diabetic control, or secondary failure to insulin b  
Lithium Thiazides (sometimes used with lithium to reduce lithium-induced polyuria) reduced renal lithium clearance within several days b Can increase serum lithium concentrations and the risk of lithium intoxication b Occasionally used to therapeutic advantage to reduce lithium-induced polyuria, but reduce lithium dosage by about 50% and monitor serum lithium carefully. b Generally, avoid concomitant use because of increased lithium toxicity risk. b
Methenamine Urinary alkalinization may decrease the effectiveness of methenamine compounds which require a urinary pH of ≤5.5 for optimal activity b Monitor urine pH during concurrent therapy b
Neuromuscular blocking agents (e.g., tubocurarine chloride or gallamine triethiodide [both no longer commercially available in the US]) May cause prolonged neuromuscular blockade b Confirmatory evidence lacking b
NSAIAs Increased risk of NSAIA-induced renal failure secondary to prostaglandin inhibition and decreased renal blood flow b NSAIAs may interfere with the natriuretic, diuretic, and antihypertensive response to diuretics b Monitor closely for possible adverse effects and/or attenuation of diuretic-induced therapeutic effects during concomitant use b
Opiates Increased risk of postural hypotension with thiazides b  
Probenecid Blocks thiazide-induced uric acid retention b Also blocks renal tubular secretion of thiazide, but effect on thiazide duration of action apparently not studied b Apparently enhances excretion of calcium, magnesium, and citrate during thiazide therapy, but urinary calcium concentrations remain below normal b Sodium, potassium, ammonia, chloride, bicarbonate, phosphate, and titratable acid excretion apparently not affected by concomitant probenecid and thiazide therapy b Used to therapeutic advantage b
Quinidine Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., quinidine) with concurrent use b Urine pH change is not great during thiazide use, and toxic blood concentrations of amines usually do not occur b Monitor for signs of toxicity after initiation of thiazide b
Test, Amylase (serum) Values may be increased substantially in both asymptomatic patients and in patients developing acute pancreatitis who are receiving thiazides b  
Test, Corticosteroids (urinary) (Glenn-Nelson technique) Decreased values by interfering in vitro with the absorbance in the modified Glenn-Nelson technique for urinary 17-hydroxycorticosteroids; may also decrease urinary cortisol excretion b Importance of effect on urinary corticosteroids is unclear b
Test, Estrogens (spectrophotometric assay of total urinary estrogen; assay of estradiol) Hydrochlorothiazide causes falsely decreased values by interfering with formation of the Kober chromogen, and with the assay of estriol by degrading estriol at the acid hydrolytic stage of the assay; does not occur with chlorothiazide b  
Test, Histamine for pheochromocytoma False-negative results b  
Test, Parathyroid function tests May elevate serum calcium in the absence of known disorders of calcium metabolism b Discontinue thiazides prior to performing parathyroid function tests b
Test, Phenolsulfonphthalein (PSP) Thiazides compete with PSP for secretion by the proximal renal tubules b Importance unknown b
Test, Phentolamine False-negative results b  
Test, Protein-bound iodine (PBI) Values may be decreased, although usually not to subnormal b  
Test, Triiodothyronine resin uptake Decreased slightly, but 24-hour I 131 uptake is not affected b  
Test, Tyramine False-negative results b  
Vasopressors (e.g., norepinephrine) Possible decreased arterial responsiveness to vasopressor amines b Clinical importance not established; b decrease in pressor response not sufficient to preclude vasopressor use 109

Mechanism of Action/Pharmacokinetics

Actions

  • Exact mechanism of diuretic action is unclear; may act by altering metabolism of the tubular cells.
  • Enhances excretion of sodium, chloride, and water by interfering with the transport of sodium ions across the renal tubular epithelium.
  • Primary site of diuretic action appears to be the cortical diluting segment of the nephron.
  • GFR decreases, but unclear whether secondary to a direct effect on renal vasculature or to the decrease in intravascular fluid volume or an increase in tubular pressure caused by the inhibition of sodium and water reabsorption. The fall in GFR is not important in the mechanism of action.
  • Enhances urinary excretion of potassium secondary to increased amount of sodium at distal tubular site of sodium-potassium exchange.
  • Increases urinary bicarbonate excretion (although to a lesser extent than chloride excretion) but change in urinary pH is usually minimal; diuretic efficacy is not affected by the acid-base balance of the patient.
  • Hypocalciuric effect is thought to result from a decrease in extracellular fluid (ECF) volume, although calcium reabsorption in the nephron may be increased; also, slight or intermittent elevations in serum calcium concentration.
  • Rate of uric acid excretion is decreased, probably because of competitive inhibition of uric acid secretion or a decrease in ECF volume and a secondary increase in uric acid reabsorption.
  • Hypotensive activity in hypertensive patients; also augments the action of other hypotensive agents. Precise mechanism of hypotensive action has not been determined, but postulated that part of this effect is caused by direct arteriolar dilation.

Pharmacokinetics

Absorption

Bioavailability

Variable absorption from GI tract.

Onset

Diuretic effect: Within 2 hours; peak effect in 3–6 hours.

Hypotensive effect: Generally 3–4 days.

Duration

Diuretic effect: 6–12 hours.

Food

Food decreases rate and extent of absorption of Microzide® capsules.

Distribution

Extent

Distributed in the extracellular space.

Does not cross blood-brain barrier.

Readily crosses the placenta.

Distributed into breast milk.

Elimination

Metabolism

Not metabolized.

Elimination Route

Excreted unchanged in urine; ≥61% eliminated in 24 hours.

Half-life

5.6–15 hours.

Special Populations

In patients with uncompensated heart failure or impaired renal function, excretion may be delayed. Effect of hemodialysis on elimination of the drug has not been determined.

Stability and Compatibility

Storage

Oral

Capsules

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.

Oral Solution

Tight containers at <40°C, preferably at 15–30°C. Avoid freezing.

Tablets

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.

Preparations

Tables of Preparations

Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Capsules 12.5 mg* Hydrochlorothiazide Capsules  
      Microzide® Watson
  Tablets 12.5 mg* Hydrochlorothiazide Tablets  
    25 mg* Hydrochlorothiazide Tablets  
    50 mg* Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Amiloride Hydrochloride and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 5 mg of Anhydrous Amiloride Hydrochloride and Hydrochlorothiazide 50 mg* Amiloride Hydrochloride and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Captopril and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 25 mg Captopril and Hydrochlorothiazide 15 mg* Captopril and Hydrochlorothiazide Tablets  
    25 mg Captopril and Hydrochlorothiazide 25 mg* Captopril and Hydrochlorothiazide Tablets  
    50 mg Captopril and Hydrochlorothiazide 15 mg* Captopril and Hydrochlorothiazide Tablets  
    50 mg Captopril and Hydrochlorothiazide 25 mg* Captopril and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Enalapril Maleate and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 5 mg Enalapril Maleate and Hydrochlorothiazide 12.5 mg* Enalapril Maleate and Hydrochlorothiazide Tablets  
    10 mg Enalapril Maleate and Hydrochlorothiazide 25 mg* Enalapril Maleate and Hydrochlorothiazide Tablets  
      Vaseretic® Valeant
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Methyldopa and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets, film-coated 250 mg Methyldopa and Hydrochlorothiazide 15 mg* Methyldopa and Hydrochlorothiazide Tablets  
    250 mg Methyldopa and Hydrochlorothiazide 25 mg* Methyldopa and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Metoprolol Tartrate and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 50 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg* Lopressor® HCT (scored) Validus
      Metoprolol Tartrate and Hydrochlorothiazide Tablets  
    100 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg* Lopressor® HCT (scored) Validus
      Metoprolol Tartrate and Hydrochlorothiazide Tablets  
    100 mg Metoprolol Tartrate and Hydrochlorothiazide 50 mg* Lopressor® HCT (scored) Validus
      Metoprolol Tartrate and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Propranolol Hydrochloride and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 40 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg* Propranolol Hydrochloride and Hydrochlorothiazide Tablets  
    80 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg* Propranolol Hydrochloride and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Spironolactone and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets, film-coated 25 mg Spironolactone and Hydrochlorothiazide 25 mg* Aldactazide® Pfizer
      Spironolactone and Hydrochlorothiazide Tablets  
    50 mg Spironolactone and Hydrochlorothiazide 50 mg Aldactazide® (scored) Pfizer
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Triamterene and Hydrochlorothiazide (Co-triamterzide):
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Capsules 37.5 mg Triamterene and Hydrochlorothiazide 25 mg* Dyazide® GlaxoSmithKline
      Triameterene and Hydrochlorothiazide Capsules  
  Tablets 37.5 mg Triamterene and Hydrochlorothiazide 25 mg* Maxzide® (scored) Mylan
      Triameterene and Hydrochlorothiazide Tablets  
    75 mg Triamterene and Hydrochlorothiazide 50 mg* Maxzide® (scored) Mylan
      Triameterene and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Other Hydrochlorothiazide Combinations:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 12.5 mg with Candesartan 16 mg Atacand® HCT AstraZeneca
    12.5 mg with Candesartan 32 mg Atacand® HCT AstraZeneca
    12.5 mg with Fosinopril Sodium 10 mg Fosinopril Sodium and Hydrochlorothiazide Tablets  
    12.5 mg with Fosinopril Sodium 20 mg Fosinopril Sodium and Hydrochlorothiazide Tablets  
    12.5 mg with Irbesartan 150 mg Avalide® Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)
    12.5 mg with Irbesartan 300 mg Avalide® Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)
    12.5 mg with Lisinopril 10 mg* Lisinopril and Hydrochlorothiazide Tablets  
      Prinzide® Merck
      Zestoretic® AstraZeneca
    12.5 mg with Lisinopril 20 mg* Lisinopril and Hydrochlorothiazide Tablets  
      Prinzide® Merck
      Zestoretic® AstraZeneca
    12.5 mg with Telmisartan 40 mg Micardis® HCT Boehringer Ingelheim
    12.5 mg with Telmisartan 80 mg Micardis® HCT Boehringer Ingelheim
    12.5 mg with Valsartan 80 mg Diovan® HCT Novartis
    12.5 mg with Valsartan 160 mg Diovan® HCT Novartis
    12.5 mg with Valsartan 320 mg Diovan® HCT Novartis
    25 mg with Irbesartan 300 mg Avalide® Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)
    25 mg with Lisinopril 20 mg* Lisinopril and Hydrochlorothiazide Tablets  
      Prinzide® Merck
      Zestoretic® AstraZeneca
    25 mg with Telmisartan 80 mg Micardis® HCT Boehringer Ingelheim
    25 mg with Valsartan 160 mg Diovan® HCT Novartis
    25 mg with Valsartan 320 mg Diovan® HCT Novartis
  Tablets, film-coated 6.25 mg with Benazepril Hydrochloride 5 mg* Benazepril Hydrochloride and Hydrochlorothiazide Tablets  
      Lotensin® HCT (scored) Novartis
    6.25 mg with Bisoprolol Fumarate 2.5 mg* Bisoprolol Fumarate and Hydrochlorothiazide Tablets  
      Ziac® Duramed
    6.25 mg with Bisoprolol Fumarate 5 mg* Bisoprolol Fumarate and Hydrochlorothiazide Tablets  
      Ziac® Duramed
    6.25 mg with Bisoprolol Fumarate 10 mg* Bisoprolol Fumarate and Hydrochlorothiazide Tablets  
      Ziac® Duramed
    12.5 mg with Benazepril Hydrochloride 10 mg* Benazepril Hydrochloride and Hydrochlorothiazide Tablets  
      Lotensin® HCT (scored) Novartis
    12.5 mg with Benazepril Hydrochloride 20 mg Benazepril Hydrochloride and Hydrochlorothiazide Tablets  
      Lotensin® HCT (scored) Novartis
    12.5 mg with Eprosartan Mesylate 600 mg (of eprosartan) Teveten® HCT Abbott
    12.5 mg with Losartan Potassium 50 mg Hyzaar® Merck
    12.5 mg with Losartan Potassium 100 mg Hyzaar® Merck
    12.5 mg with Moexipril Hydrochloride 7.5 mg* Moexipril Hydrochloride and Hydrochlorothiazide Tablets  
      Uniretic® (scored) UCB
    12.5 mg with Moexipril 15 mg* Moexipril Hydrochloride and Hydrochlorothiazide Tablets  
      Uniretic® (scored) UCB
    12.5 mg with Olmesartan Medoxomil 20 mg Benicar® HCT Daiichi-Sankyo
    12.5 mg with Olmesartan Medoxomil 40 mg Benicar® HCT Daiichi-Sankyo
    12.5 mg with Quinapril Hydrochloride 10 mg (of quinapril)* Accuretic® (scored) Pfizer
      Quinapril Hydrochloride and Hydrochlorothiazide Tablets  
    12.5 mg with Quinapril Hydrochloride 20 mg (of quinapril)* Accuretic® (scored) Pfizer
      Quinapril Hydrochloride and Hydrochlorothiazide Tablets  
    25 mg with Benazepril Hydrochloride 20 mg* Benazepril Hydrochloride and Hydrochlorothiazide Tablets  
      Lotensin® HCT (scored) Novartis
    25 mg with Eprosartan Mesylate 600 mg (of eprosartan) Teveten® HCT Abbott
    25 mg with Losartan Potassium 100 mg Hyzaar® Merck
    25 mg with Moexipril Hydrochloride 15 mg* Moexipril Hydrochloride and Hydrochlorothiazide Tablets  
      Uniretic® (scored) UCB
    25 mg with Olmesartan Medoxomil 40 mg Benicar® HCT Daiichi-Sankyo
    25 mg with Quinapril Hydrochloride 20 mg (of quinapril)* Accuretic® (scored) Pfizer
      Quinapril Hydrochloride and Hydrochlorothiazide Tablets  
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2015. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Accuretic 10-12.5MG Tablets (PFIZER U.S.): 30/$66.99 or 90/$200.98

Accuretic 20-12.5MG Tablets (PFIZER U.S.): 30/$67.41 or 90/$174.54

Accuretic 20-25MG Tablets (PFIZER U.S.): 30/$64.04 or 90/$192.12

Aldactazide 25-25MG Tablets (PFIZER U.S.): 30/$41.99 or 90/$103.97

Aldactazide 50-50MG Tablets (PFIZER U.S.): 30/$67.99 or 90/$187.97

Amiloride-Hydrochlorothiazide 5-50MG Tablets (MYLAN): 90/$31.99 or 180/$51.97

Amturnide 300-10-25MG Tablets (NOVARTIS): 30/$109.99 or 90/$305.96

Atacand HCT 16-12.5MG Tablets (ASTRAZENECA LP): 30/$110.99 or 90/$315.97

Atacand HCT 32-12.5MG Tablets (ASTRAZENECA LP): 30/$115.99 or 90/$325.97

Atacand HCT 32-25MG Tablets (ASTRAZENECA LP): 30/$121.99 or 90/$340.98

Avalide 150-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$117.99 or 90/$336.99

Avalide 300-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$131.99 or 90/$378.98

Avalide 300-25MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$122.95 or 90/$345.09

Benazepril-Hydrochlorothiazide 10-12.5MG Tablets (SANDOZ): 30/$22.99 or 90/$56.96

Benazepril-Hydrochlorothiazide 20-12.5MG Tablets (SANDOZ): 30/$26.99 or 90/$69.96

Benazepril-Hydrochlorothiazide 20-25MG Tablets (SANDOZ): 30/$27.99 or 90/$71.97

Benazepril-Hydrochlorothiazide 5-6.25MG Tablets (SANDOZ): 30/$25.91 or 90/$67.18

Benicar HCT 20-12.5MG Tablets (SANKYO): 30/$96.99 or 90/$275.96

Benicar HCT 40-12.5MG Tablets (SANKYO): 30/$135.99 or 90/$391.96

Benicar HCT 40-25MG Tablets (SANKYO): 30/$135.99 or 90/$376.98

Bisoprolol-Hydrochlorothiazide 10-6.25MG Tablets (SANDOZ): 30/$22.99 or 90/$59.97

Bisoprolol-Hydrochlorothiazide 2.5-6.25MG Tablets (UNICHEM PHARMACEUTICALS): 90/$59.99 or 180/$105.97

Bisoprolol-Hydrochlorothiazide 5-6.25MG Tablets (UNICHEM PHARMACEUTICALS): 90/$19.96 or 180/$39.92

Captopril-Hydrochlorothiazide 25-15MG Tablets (MYLAN): 90/$47.99 or 270/$114.97

Captopril-Hydrochlorothiazide 25-25MG Tablets (MYLAN): 90/$44.99 or 270/$125.99

Captopril-Hydrochlorothiazide 50-15MG Tablets (TEVA PHARMACEUTICALS USA): 60/$53.99 or 180/$154.98

Captopril-Hydrochlorothiazide 50-25MG Tablets (MYLAN): 60/$54.99 or 180/$155.97

Dyazide 37.5-25MG Capsules (GLAXO SMITH KLINE): 30/$45.99 or 90/$110.97

Enalapril-Hydrochlorothiazide 10-25MG Tablets (TARO): 30/$27.99 or 90/$72.97

Enalapril-Hydrochlorothiazide 5-12.5MG Tablets (APOTEX): 30/$23.99 or 90/$64.99

Exforge HCT 10-160-12.5MG Tablets (NOVARTIS): 30/$128.99 or 90/$372.95

Exforge HCT 5-160-12.5MG Tablets (NOVARTIS): 30/$117.99 or 90/$341.97

Exforge HCT 5-160-25MG Tablets (NOVARTIS): 30/$119.99 or 90/$339.99

Fosinopril Sodium-HCTZ 10-12.5MG Tablets (GLENMARK PHARMACEUTICALS): 60/$99.99 or 180/$279.96

Fosinopril Sodium-HCTZ 20-12.5MG Tablets (GLENMARK PHARMACEUTICALS): 60/$89.99 or 180/$249.97

Hydrochlorothiazide 12.5MG Capsules (WATSON LABS): 30/$14.99 or 60/$22.98

Hydrochlorothiazide 12.5MG Tablets (ACTAVIS ELIZABETH): 100/$27.99 or 200/$43.97

Hydrochlorothiazide 25MG Tablets (QUALITEST): 100/$12.99 or 200/$15.96

Hydrochlorothiazide 50MG Tablets (IVAX PHARMACEUTICALS): 100/$15.99 or 200/$23.97

Hyzaar 100-12.5MG Tablets (MERCK SHARP &amp; DOHME): 30/$130.66 or 90/$373.29

Hyzaar 100-25MG Tablets (MERCK SHARP &amp; DOHME): 30/$130.00 or 90/$385.98

Hyzaar 50-12.5MG Tablets (MERCK SHARP &amp; DOHME): 90/$279.99 or 180/$536.00

Irbesartan-Hydrochlorothiazide 300-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$115.99 or 90/$325.97

Lisinopril-Hydrochlorothiazide 10-12.5MG Tablets (LUPIN PHARMACEUTICALS): 30/$23.99 or 60/$39.98

Lisinopril-Hydrochlorothiazide 20-12.5MG Tablets (LUPIN PHARMACEUTICALS): 30/$21.99 or 90/$59.97

Lisinopril-Hydrochlorothiazide 20-25MG Tablets (LUPIN PHARMACEUTICALS): 30/$21.99 or 90/$59.97

Lopressor HCT 100-50MG Tablets (NOVARTIS): 30/$81.99 or 90/$224.97

Lopressor HCT 50-25MG Tablets (NOVARTIS): 60/$120.99 or 180/$349.96

Losartan Potassium-HCTZ 100-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$95.99 or 90/$265.96

Losartan Potassium-HCTZ 100-25MG Tablets (SANDOZ): 30/$97.99 or 90/$268.98

Losartan Potassium-HCTZ 50-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$69.99 or 90/$193.97

Lotensin HCT 10-12.5MG Tablets (NOVARTIS): 30/$62.99 or 90/$175.98

Lotensin HCT 20-12.5MG Tablets (NOVARTIS): 30/$63.99 or 90/$168.97

Lotensin HCT 20-25MG Tablets (NOVARTIS): 30/$65.99 or 90/$179.97

Maxzide 75-50MG Tablets (MYLAN): 30/$87.99 or 90/$241.96

Maxzide-25 37.5-25MG Tablets (MYLAN): 30/$43.99 or 90/$109.97

Methyldopa-Hydrochlorothiazide 250-25MG Tablets (MYLAN): 60/$22.99 or 180/$46.97

Metoprolol-Hydrochlorothiazide 100-25MG Tablets (MYLAN): 30/$50.99 or 90/$132.96

Metoprolol-Hydrochlorothiazide 100-50MG Tablets (MYLAN): 30/$55.99 or 90/$149.97

Metoprolol-Hydrochlorothiazide 50-25MG Tablets (MYLAN): 60/$63.99 or 180/$168.97

Micardis HCT 40-12.5MG Tablets (BOEHRINGER INGELHEIM): 30/$123.99 or 90/$339.96

Micardis HCT 80-12.5MG Tablets (BOEHRINGER INGELHEIM): 30/$122.00 or 90/$335.97

Micardis HCT 80-25MG Tablets (BOEHRINGER INGELHEIM): 30/$123.99 or 90/$349.97

Microzide 12.5MG Capsules (WATSON LABS): 30/$42.02 or 90/$107.51

Moexipril-Hydrochlorothiazide 15-12.5MG Tablets (WATSON LABS): 100/$109.98 or 300/$315.96

Moexipril-Hydrochlorothiazide 15-25MG Tablets (WATSON LABS): 30/$36.99 or 90/$89.97

Moexipril-Hydrochlorothiazide 7.5-12.5MG Tablets (WATSON LABS): 30/$37.99 or 90/$95.97

Monopril HCT 10-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 60/$94.99 or 180/$259.49

Prinzide 10-12.5MG Tablets (MERCK SHARP &amp; DOHME): 30/$46.99 or 90/$125.96

Propranolol-HCTZ 40-25MG Tablets (MYLAN): 30/$30.79 or 60/$50.57

Propranolol-HCTZ 80-25MG Tablets (MYLAN): 60/$67.99 or 180/$197.97

Quinapril-Hydrochlorothiazide 10-12.5MG Tablets (MYLAN): 30/$35.99 or 90/$89.97

Quinapril-Hydrochlorothiazide 20-12.5MG Tablets (GREENSTONE): 90/$86.99 or 100/$94.96

Quinapril-Hydrochlorothiazide 20-25MG Tablets (MYLAN): 90/$90.99 or 100/$100.97

Spironolactone-HCTZ 25-25MG Tablets (MYLAN): 30/$16.99 or 60/$23.97

Tekturna HCT 300-25MG Tablets (NOVARTIS): 30/$123.41 or 90/$341.66

Teveten HCT 600-12.5MG Tablets (ABBOTT): 30/$120.99 or 90/$335.97

Teveten HCT 600-25MG Tablets (ABBOTT): 30/$109.98 or 90/$309.98

Triamterene-HCTZ 37.5-25MG Capsules (MYLAN): 100/$41.99 or 200/$68.98

Triamterene-HCTZ 37.5-25MG Tablets (MYLAN): 100/$29.99 or 200/$45.96

Triamterene-HCTZ 50-25MG Capsules (SANDOZ): 100/$169.99 or 300/$489.96

Triamterene-HCTZ 75-50MG Tablets (SANDOZ): 100/$27.99 or 300/$67.98

Tribenzor 20-5-12.5MG Tablets (SANKYO): 30/$119.99 or 90/$335.95

Tribenzor 40-10-25MG Tablets (SANKYO): 30/$152.14 or 90/$433.29

Tribenzor 40-5-12.5MG Tablets (SANKYO): 30/$152.14 or 60/$304.27

Tribenzor 40-5-25MG Tablets (SANKYO): 30/$154.49 or 90/$444.01

Uniretic 15-12.5MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$228.98

Uniretic 15-25MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$228.98

Uniretic 7.5-12.5MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$231.97

Vaseretic 10-25MG Tablets (VALEANT): 30/$110.23 or 90/$297.41

Vaseretic 5-12.5MG Tablets (BTA PHARMACEUTICALS): 30/$41.99 or 90/$125.97

Zestoretic 10-12.5MG Tablets (ASTRAZENECA): 30/$56.78 or 90/$147.40

Zestoretic 20-12.5MG Tablets (ASTRAZENECA): 30/$60.05 or 90/$163.77

Ziac 10-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$113.99 or 90/$322.99

Ziac 2.5-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$114.63 or 90/$319.88

Ziac 5-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$115.00 or 90/$318.98

Medication Cost Assistance Programs

  • medication cost assistance programs for Hydrochlorothiazide from NeedyMeds

Patient Information

Advice to Patients

  • Advise patient of signs of electrolyte imbalance (e.g., dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains or cramps, muscular fatigue, hypotension, tachycardia, GI disturbances such as nausea and vomiting).
  • Advise patients of importance of compliance with scheduled determinations of serum electrolyte concentrations (particularly potassium, sodium, chloride, and bicarbonate).
  • Advise hypertensive patients of importance of continuing lifestyle/behavioral modifications that include weight reduction (for those who are overweight or obese), dietary changes to include foods that are rich in potassium and calcium and moderately restricted in sodium (adoption of the Dietary Approaches to Stop Hypertension [DASH] eating plan), increased physical activity, smoking cessation, and moderation of alcohol intake. Advise that lifestyle/behavioral modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk and remain an indispensable part of the management of hypertension.
  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.
  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
  • Importance of informing patients of other important precautionary information. (See Cautions.)

Guidelines and Resources

MEDLINE Search

  • to search MEDLINE for (Hydrochlorothiazide) with targeted search (Clinical Queries for therapy articles), click here

References

General References Used

  • Unless otherwise stated, source material derived from AHFS Drug Information Essentials®. The AHFS Drug Information Essentials database is copyrighted by the American Society of Health-System Pharmacists, Inc. © 2010 ASHP, Bethesda, Maryland 20814. All Rights Reserved. Duplication must be expressly authorized by ASHP, unless such duplication consists of printing or downloading portions of the data inherent in the program for non-commercial use. Used with permission.
  • The American Society of Health-System Pharmacists, Inc. represents that the database provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such database and specifically disclaims all such warranties and representations. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the database is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug’s actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug in the database. The information contained in the database is not a substitute for medical care.

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team.
  • Over 500 journals and evidence-based sources (DynaMed Content Sources) are monitored directly or indirectly using a 7-Step evidence-based method for systematic literature surveillance. DynaMed topics are updated daily as newly discovered best available evidence is identified.
  • The participating members of the DynaMed Editorial Team have declared that they have no financial or other competing interests related to this topic.
  • The participating reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • McMaster University is a partner that provides support in identifying Practice-Changing DynaMed Updates. Over 1,000 practicing physicians from 61 disciplines in 77 countries rate these articles to help you find the most useful new evidence affecting your practice.
  • F1000 is a partner that provides support in identifying Practice-Changing DynaMed Updates. Over 2,000 practicing clinicians from 20 disciplines in 60 countries rate these articles to help you find the most useful new evidence affecting your practice.

How to Cite

References for AHFS DI Essentials

Only references cited for selected revisions after 1984 are available electronically.

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  • b. AHFS drug information 2015. McEvoy GK, ed. Thiazides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2015: .
  • c. AHFS drug information 2004. McEvoy GK, ed. Cardiac glycosides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 1584-91.
  • d. AHFS drug information 2004. McEvoy GK, ed. Captopril. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 1835-45.
  • h. American Academy of Pediatrics. The Transfer of Drugs and Other Chemical into Human Milk. Pediatrics. 2001; 108:776-789. [IDIS 468574] [PubMed 11533352]
  • †. Use is not currently included in the labeling approved by the US Food and Drug Administration.

Brands

United States Brands

  • generic hydrochlorothiazide available
  • Microzide
  • see also hydrochlorothiazide in DailyMed

Combination Products Containing This Drug (US)

  • amiloride/hydrochlorothiazide (generic)
  • fosinopril/hydrochlorothiazide (generic)
  • methyldopa/hydrochlorothiazide (generic)
  • Accuretic (quinapril, hydrochlorothiazide), also available in generic form
  • Aldactazide (spironolactone, hydrochlorothiazide), also available in generic form
  • Amturnide (aliskiren, amlodipine, hydrochlorothiazide)
  • Atacand HCT (candesartan, hydrochlorothiazide)
  • Avalide (irbesartan, hydrochlorothiazide), also available in generic form
  • Benicar HCT (olmesartan, hydrochlorothiazide)
  • Capozide 25/15 (captopril, hydrochlorothiazide), also available in generic form
  • Diovan HCT (valsartan, hydrochlorothiazide)
  • Dutoprol (metoprolol, hydrochlorothiazide), also available in generic form
  • Dyazide (triamterene, hydrochlorothiazide), also available in generic form
  • Exforge HCT (valsartan, amlodipine, hydrochlorothiazide)
  • Hydra-Zide (hydralazine, hydrochlorothiazide)
  • Hyzaar (losartan, hydrochlorothiazide), also available in generic form
  • Inderide-40/25 (propranolol, hydrochlorothiazide), also available in generic form
  • Lopressor HCT (metoprolol, hydrochlorothiazide)
  • Lotensin HCT (benazepril, hydrochlorothiazide), also available in generic form
  • Maxzide (triamterene, hydrochlorothiazide)
  • Micardis HCT (telmisartan, hydrochlorothiazide)
  • Prinzide (lisinopril, hydrochlorothiazide), also available in generic form
  • Quinaretic (quinapril, hydrochlorothiazide)
  • Tekturna HCT (aliskiren, hydrochlorothiazide)
  • Teveten HCT (eprosartan, hydrochlorothiazide)
  • Tribenzor (amlodipine, olmesartan, hydrochlorothiazide)
  • Twynsta (amlodipine, valsartan, hydrochlorothiazide)
  • Uniretic (moexipril, hydrochlorothiazide), also available in generic form
  • Vaseretic (enalapril, hydrochlorothiazide), also available in generic form
  • Zestoretic (lisinopril, hydrochlorothiazide)
  • Ziac (bisoprolol, hydrochlorothiazide), also available in generic form

Discontinued Brands (US)

  • Aldoril (methyldopa, hydrochlorothiazide)
  • Apresazide (hydralazine, hydrochlorothiazide)
  • Apresoline-Esidrix (hydralazine, hydrochlorothiazide)
  • Cam-Ap-Es (hydralazine, reserpine, hydrochlorothiazide)
  • Esidrix
  • H.R.-50 (reserpine, hydrochlorothiazide)
  • Hydrap-ES (hydralazine, reserpine, hydrochlorothiazide)
  • Hydro-D
  • Hydro-Reserp (reserpine, hydrochlorothiazide)
  • Hydro-Serp (reserpine, hydrochlorothiazide)
  • Hydrodiuril
  • Hydropres (reserpine, hydrochlorothiazide)
  • Moduretic 5-50 (amiloride, hydrochlorothiazide)
  • Monopril-HCT (fosinopril, hydrochlorothiazide)
  • Normozide (labetalol, hydrochlorothiazide)
  • Oretic
  • Prinzide (lisinopril, hydrochlorothiazide)
  • Sera-A-Gen (hydralazine, reserpine, hydrochlorothiazide)
  • Sera-Ap-ES (hydralazine, reserpine, hydrochlorothiazide)
  • Serpasil-Esidrix (reserpine, hydrochlorothiazide)
  • Timolide (timolol, hydrochlorothiazide)
  • Trandate HCT (labetalol, hydrochlorothiazide)
  • Unipres (hydralazine, reserpine, hydrochlorothiazide)
  • Viskazide (pindolol, hydrochlorothiazide)
  • Zide

Canadian Brands

Combination Products Containing This Drug (Canada)

  • methyldopa/hydrochlorothiazide (generic)
  • AMI-Hydro (amiloride, hydrochlorothiazide)
  • Accuretic (quinapril, hydrochlorothiazide)
  • Aldactazide (spironolactone, hydrochlorothiazide)
  • Altace HCT (ramipril, hydrochlorothiazide), also available in generic form
  • Atacand Plus (candesartan, hydrochlorothiazide)
  • Avalide (irbesartan, hydrochlorothiazide)
  • Co Irbesartan/HCT (irbesartan, hydrochlorothiazide)
  • Diovan HCT (valsartan, hydrochlorothiazide), also available in generic form
  • Hyzaar (losartan, hydrochlorothiazide), also available in generic form
  • Inhibace Plus (cilazapril, hydrochlorothiazide), also available in generic form
  • Micardis HCT (telmisartan, hydrochlorothiazide), also available in generic form
  • Novamilor (amiloride, hydrochlorothiazide)
  • Olmetec Plus (olmesartan, hydrochlorothiazide)
  • Prinzide (lisinopril, hydrochlorothiazide), also available in generic form`
  • Rasilez HCT (aliskiren, hydrochlorothiazide)
  • Teveten Plus (eprosartan, hydrochlorothiazide)
  • Vaseretic (enalapril, hydrochlorothiazide)
  • Viskazide (pindolol, hydrochlorothiazide)
  • Zestoretic (lisinopril, hydrochlorothiazide)

United Kingdom Brands

Combination Products Containing This Drug (UK)

  • timolol/amiloride/hydrochlorothiazide (generic)
  • Accuretic (quinapril, hydrochlorothiazide)
  • Capozide (captopril, hydrochlorothiazide), also available in generic form (co-zidocapt)
  • Capto-co (captopril, hydrochlorothiazide), also available in generic form (co-zidocapt)
  • Carace (lisonopril, hydrochlorothiazide)
  • Co-Diovan (valsartan, hydrochlorothiazide), also available in generic form
  • CoAprovel (irbesartan, hydrochlorothiazide)
  • Cozaar Comp (losartan, hydrochlorothiazide), also available in generic form
  • Dyazide (triamterene, hydrochlorothiazide)
  • Innozide (enalapril, hydrochlorothiazide), also available in generic form
  • Kalten (amiloride, atenolol, hydrochlorothiazide)
  • MicardisPlus (telmisartan, hydrochlorothiazide)
  • Moduret 25 (amiloride, hydrochlorothiazide), also available in generic form (co-amilozide)
  • Moduretic (amiloride, hydrochlorothiazide), also available in generic form (co-amilozide)
  • Olmetec Plus (olmesartan, hydrochlorothiazide)
  • Sevikar HCT (amlodipine, olmesartan, hydrochlorothiazide)
  • Triam-Co (triamterene, hydrochlorothiazide), also available in generic form (co-triamterzide)
  • Zestoretic (lisinopril, hydrochlorothiazide)

Australian Brands