Dynamed

Hydrochlorothiazide

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

 

Related Summaries

 

General Information

Description

Thiazide diuretic and antihypertensive agent.

Class

Class: Thiazide Diuretics

Abbreviation

HCTZ

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

Uses and Efficacy

Uses

Hypertension

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

Thiazides have well-established benefits, can be useful in achieving goal BP alone or combined with other antihypertensive drugs, enhance the antihypertensive efficacy of multidrug regimens, and are more affordable than other agents.

JNC 7 recommends that thiazides be used as initial therapy for the treatment of uncomplicated hypertension in most patients, either alone or combined with other classes of antihypertensive drugs with demonstrated benefit (e.g., ACE inhibitors, angiotensin II receptor antagonists, β-blockers, calcium-channel blockers).

Most hypertension outcome studies have involved thiazides, which generally have been unsurpassed in preventing cardiovascular complications of hypertension and are relatively inexpensive and well tolerated.

The principal goal of preventing and treating hypertension is to reduce the risk of cardiovascular and renal morbidity and mortality, including target organ damage. The higher the baseline BP, the more likely the development of MI, heart failure, stroke, and renal disease.

Effective antihypertensive therapy reduces the risk of stroke by about 34–40%, MI by about 20–25%, and heart failure by more than 50%.

Antihypertensive drug therapy is recommended for all patients with SBP/DBP ≥140/90 mm Hg who fail to respond to lifestyle/behavioral modifications.

Initial antihypertensive therapy with drugs generally is recommended for anyone with diabetes mellitus, chronic renal impairment, or heart failure having SBP ≥130 mm Hg or DBP≥80 mm Hg.

Black hypertensive patients generally tend to respond better to monotherapy with diuretics or calcium-channel blockers than to monotherapy with ACE inhibitors, angiotensin II receptor antagonists, or β-blockers.

Thiazides are 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).

Although hypertension during pregnancy responds well to thiazides, and the drugs had been used widely in the past for preeclampsia and eclampsia, such use no longer is recommended and other antihypertensives (e.g., methyldopa, hydralazine, labetalol) currently are preferred.

Although rarely induces acute gout, generally avoid or use with caution in hypertensive patients with a history of gout or elevated uric acid concentrations.

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 CHF

Management of edema associated with CHF.

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 CHF 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 CHF 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 CHF, 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 CHF 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 CHF, 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

Usual Dosage

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.

Hypertension

Oral

Initially, 1 mg/kg once daily. Increase dosage as necessary up to a maximum of 3 mg/kg (up to 50 mg) once daily.

Adults

Hypertension

BP Monitoring and Treatment Goals

Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.

Avoid large or abrupt reductions in BP.

Adjust dosage at approximately monthly intervals (more aggressively in high-risk patients [stage 2 hypertension, comorbid conditions]) if BP control is inadequate at a given dosage; it may take months to control hypertension adequately while avoiding adverse effects of therapy.

SBP is the principal clinical end point, especially in middle-aged and geriatric patients. Once the goal SBP is attained, the goal DBP usually is achieved.

The goal is to achieve and maintain a lifelong SBP <140 mm Hg and a DBP <90 mm Hg if tolerated.

The goal in hypertensive patients with diabetes mellitus or renal impairment is to achieve and maintain a SBP <130 mm Hg and a DBP <80 mm Hg.

Monotherapy

Oral

Initially, 12.5–25 mg daily.

Gradually increase until the desired therapeutic response is achieved or adverse effects become intolerable, up to 50 mg daily.

If adequate response is not achieved at maximum dosage, add or substitute another hypotensive agent.

Maintenance

Usually, 12.5–50 mg once daily.

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.

Administer each drug separately whenever dosage adjustment is necessary.

Alternatively, may initially use certain (low-dose hydrochlorothiazide/other antihypertensive) fixed combinations for potentiation of antihypertensive effect and minimization of potential dose-related adverse effects of each drug.

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.

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

Usual Dosage

Oral

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

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

Hypertension

Oral

Maximum 3 mg/kg (up to 50 mg) once daily.

Adults

Hypertension

Oral

Maximum before switching/adding alternative drug is 50 mg daily.

Higher dosages had been used in the past (up to 200 mg daily) but no longer are recommended because of the risk of adverse effects (e.g., markedly decreased serum potassium). Instead, switch to or add alternative drug.

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

Severe Renal Impairment

Use with caution; thiazides decrease GFR and may precipitate azotemia.

Effects may be cumulative in impaired renal function.

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.

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 precipitation of gout may occur.

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.

Although hypertension during pregnancy responds well to thiazides, and the drugs had been used widely in the past for preeclampsia and eclampsia, such use no longer is recommended and other antihypertensives (e.g., methyldopa, hydralazine, labetalol) currently are preferred. Diuretics are not recommended for pregnancy-induced hypertension because of the maternal hypovolemia associated with this form of hypertension; decreased placental perfusion is possible. Diuretics are considered second-line agents for control of chronic hypertension in pregnant women.

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

Edema associated with pregnancy generally responds well to thiazides except when caused by renal disease.

Lactation

Distributed into milk. Discontinue nursing or the drug.

Although hydrochlorothiazide use generally is considered compatible with breast-feeding, thiazides can reduce milk volume and thus suppress lactation.

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 Warnings/Precautions.)

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 caution. (See Hepatic Impairment under Warnings.)

Renal Impairment

Use caution. (See Severe Renal Impairment under Warnings.)

Consider interruption or discontinuance if progressive renal impairment (rising nonprotein nitrogen, BUN, or serum creatinine) 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 phenolsulfonphthalein (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 CHF 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
  Solution 50 mg/5 mL* Hydrochlorothiazide Solution  
  Tablets 25 mg* Hydrochlorothiazide Tablets  
      HydroDIURIL® (scored) Merck
    50 mg* Hydrochlorothiazide Tablets  
      HydroDIURIL® (scored) Merck
* 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  
      Moduretic® (scored) Merck
* 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* Capozide® (scored) Par
      Captopril and Hydrochlorothiazide Tablets  
    25 mg Captopril and Hydrochlorothiazide 25 mg* Capozide® (scored) Par
      Captopril and Hydrochlorothiazide Tablets  
    50 mg Captopril and Hydrochlorothiazide 15 mg* Capozide® (scored) Par
      Captopril and Hydrochlorothiazide Tablets  
    50 mg Captopril and Hydrochlorothiazide 25 mg* Capozide® (scored) Par
      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  
      Vaseretic® Biovail
    10 mg Enalapril Maleate and Hydrochlorothiazide 25 mg* Enalapril Maleate and Hydrochlorothiazide Tablets  
      Vaseretic® Biovail
* 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* Aldoril® Merck
      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) Novartis
    100 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg Lopressor® HCT (scored) Novartis
    100 mg Metoprolol Tartrate and Hydrochlorothiazide 50 mg Lopressor® HCT (scored) Novartis
Propranolol Hydrochloride and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 40 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg* Inderide® (scored) Wyeth
      Propranolol Hydrochloride and Hydrochlorothiazide Tablets  
    80 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg* Inderide® (scored) Wyeth
      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
Timolol Maleate and Hydrochlorothiazide:
Routes Dosage Forms Strengths Brand Names Manufacturer
Oral Tablets 10 mg Timolol Maleate and Hydrochlorothiazide 25 mg Timolide® Merck
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  
    50 mg Triamterene and Hydrochlorothiazide 25 mg* Triamterene and Hydrochlorothiazide Capsules  
  Tablets 37.5 mg Triamterene and Hydrochlorothiazide 25 mg* Maxzide® (scored) Mylan Bertek
      Triameterene and Hydrochlorothiazide Tablets  
    75 mg Triamterene and Hydrochlorothiazide 50 mg* Maxzide® (scored) Mylan Bertek
      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 Capsules 25 mg with Hydralazine Hydrochloride 25 mg Hydra-Zide® Par
    50 mg with Hydralazine Hydrochloride 50 mg Hydra-Zide® Par
    50 mg with Hydralazine Hydrochloride 100 mg Hydra-Zide® Par
  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  
      Monopril® HCT Bristol-Myers Squibb
    12.5 mg with Fosinopril Sodium 20 mg Fosinopril Sodium and Hydrochlorothiazide Tablets  
      Monopril® HCT (scored) Bristol-Myers Squibb
    12.5 mg with Irbesartan 150 mg Avalide® Bristol-Myers Squibb, (also promoted by Sanofi-Aventis)
    12.5 mg with Irbesartan 300 mg Avalide® Bristol-Myers Squibb, (also promoted by Sanofi-Aventis)
    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 Uniretic® (scored) Schwarz
    12.5 mg with Moexipril 15 mg Uniretic® HCT (scored) Schwarz
    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
    12.5 mg with Quinapril Hydrochloride 20 mg (of quinapril) Accuretic® (scored) Pfizer
    15 mg with Hydrochlorothiazide 250 mg* Methyldopa 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 Hydrochlorothiazide 250mg* Aldoril® Merck
      Methyldopa and Hydrochlorothiazide Tablets  
    25 mg with Moexipril Hydrochloride 15 mg Uniretic® (scored) Schwarz
    25 mg with Olmesartan Medoxomil 40 mg Benicar® HCT Daiichi-Sankyo
    25 mg with Quinapril Hydrochloride 20 mg (of quinapril) Accuretic® (scored) Pfizer
    25 mg with Spironolactone 25 mg* Aldactazide® () Pfizer
      Spironolactone and Hydrochlorothiazide Tablets  
    50 mg with Spironolactone 50 mg Aldactazide® (scored) Pfizer
* 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 02/2014. 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.

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How to Cite

References for AHFS DI Essentials

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

  • 100. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1984; 144:1045-57. [IDIS 184763] [PubMed 6143542]
  • 101. 1988 Joint National Committee. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1988; 148:1023-38. [IDIS 242588] [PubMed 3365073]
  • 102. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health. (NIH publication No. 98-4080.)
  • 103. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000; 35:1021-4. [PubMed 10818056]
  • 104. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. 2000; 35:1019-20. [PubMed 10818055]
  • 105. Bakris GL, Williams M, Dworkin L et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000; 36:646-61. [IDIS 452007] [PubMed 10977801]
  • 106. Associated Press (American Diabetes Association). Diabetics urged: drop blood pressure. Chicago, IL; 2000 Aug 29. Press Release from web site. [Web]
  • 107. Appel LJ. The verdict from ALLHAT—thiazide diuretics are the preferred initial therapy for hypertension. JAMA. 2002; 288:3039-42. [IDIS 490723] [PubMed 12479770]
  • 108. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97. [IDIS 490721] [PubMed 12479763]
  • 109. Merck & Co., Inc. HydroDiuril® (hydrochlorothiazide) tablets prescribing information. West Point, PA; 1998 Jun.
  • 110. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Express. Bethesda, MD: May 14 2003. From NIH website. (Also published in JAMA. 2003; 289. [Web]
  • 111. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76. [PubMed 15286277]
  • 112. Microzide capsules (hydrocholorothiazide 12.5 mg) prescribing information. Watson Pharmaceuticals, Inc. Corona, CA; 2003 Apr.
  • a. AHFS drug information 2004. McEvoy GK, ed. Hydrochlorothiazide. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 2544-6.
  • b. AHFS drug information 2004. McEvoy GK, ed. Thiazides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 2534-42.
  • 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.
  • e. American Hospital Formulary Service drug information 84. McEvoy GK, ed. Hydrochlorothiazide. Bethesda, MD: American Society of Health-System Pharmacists; 1984: 984-5.
  • f. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Complete Version. Bethesda, MD: 2003 Nov 5. Hypertension. 2003; 42:1206-52. [PubMed 14656957]
  • g. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 6th ed. 242-245.
  • 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.