HydroCHLOROthiazide (Lexi-Drugs)

Special Alerts
  Hydrochlorothiazide Safety AlertJanuary 2019
Pronunciation

(hye droe klor oh THYE a zide)

Brand Names: US

Microzide [DSC]

Brand Names: Canada

APO-Hydro; BIO-Hydrochlorothiazide; MINT-Hydrochlorothiazide; PMS-Hydrochlorothiazide; TEVA-Hydrochlorothiazide; Urozide

Pharmacologic Category

AntihypertensiveDiuretic, Thiazide

Dosing: Adult

Calcium nephrolithiasis (off-label use): 50 mg daily in 1 or 2 divided doses (AUA Guidelines [Pearle 2014])

Edema: Oral: 25 to 100 mg daily in 1 to 2 divided doses; may administer intermittently on alternate days or on 3 to 5 days each week.

Fluid retention (mild) in heart failure: Oral: Initial: 25 mg once or twice daily; maximum daily dose: 200 mg (ACCF/AHA [Yancy 2013])

Hypertension: Oral: Initial: 12.5 to 25 mg once daily; titrate as needed based on patient response up to 50 mg daily in 1 or 2 divided doses (ACC/AHA [Whelton 2017]); maximum dosage: 50 mg/day

Dosing: Geriatric

Use with caution (Beers Criteria [AGS 2015]).

Oral: Initial: 12.5 mg once daily; titrate as necessary in increments of 12.5 mg. Minimal increase in response and more electrolyte disturbances are seen with doses >50 mg daily.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling (use is contraindicated with anuria). The following adjustments have been recommended (Aronoff 2007):

CrCl ≥10 mL/minute: No dosage adjustment necessary. Usually ineffective with CrCl <30 mL/minute unless in combination with a loop diuretic.

CrCl <10 mL/minute: Use not recommended.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. However, use with caution and monitor for precipitation of hepatic coma.

Dosing: Pediatric

Bronchopulmonary dysplasia: Limited data available: Infants: Oral: 3 to 4 mg/kg/day in 2 divided doses (Albersheim 1989; Engelhardt 1989)

Edema (diuresis):

Infants <6 months: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; some infants may require 3 mg/kg/day in 2 divided doses; maximum daily dose: 37.5 mg/day

Infants ≥6 months and Children <2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 37.5 mg/day

Children ≥2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 100 mg/day

Adolescents: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses (van der Vorst 2006); maximum adult daily dose: 200 mg/day is recommended for heart failure-related edema (ACCF/AHA [Yancy 2013])

Hypertension:

Manufacturer’s labeling:

Infants <6 months: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; some infants may require 3 mg/kg/day in 2 divided doses; maximum daily dose: 37.5 mg/day

Infants ≥6 months and Children <2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 37.5 mg/day

Children ≥2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 100 mg/day

Alternate dosing: Infants, Children, and Adolescents: Oral: Initial: 1 mg/kg/day once daily; may increase to maximum daily dose: 3 mg/kg/day or 50 mg/day, whichever is lower (NHBPEP 2004; NHLBI 2011)

Hypercalciuria: Limited data available: Infants, Children, and Adolescents: Oral: Initial: 1 to 2 mg/kg/day in 1 to 2 divided doses; titrate until goal urinary calcium excretion goals reached and symptoms resolve; treatment usually continued for 1 year; usual adult dose: 25 to 100 mg/day (Copelovitch 2012; Santos-Victoriano 1998)

Nephrogenic diabetes insipidus; congenital: Limited data available: Infants, Children, and Adolescents: Oral: 2 mg/kg/day in combination with amiloride; some patients may require 3 mg/kg/day in divided doses. Dosing based on a retrospective descriptive analysis (n=30, age range: 1 month to 40 years) and a pediatric case series (n=4) in patients receiving hydrochlorothiazide in combination with amiloride (Kirchlechner 1999; Van Lieburg 1999). In adults; usual dose range is 25 mg once or twice daily (Irwin 2008).

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; however, the following adjustments have been recommended (Aronoff 2007):

Infants, Children, and Adolescents:

GFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary

GFR <30 mL/minute/1.73 m2: Use not recommended; use is contraindicated with anuria

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; however, use with caution and monitor for precipitation of hepatic coma.

Use: Labeled Indications

Edema: Treatment of edema due to heart failure, hepatic cirrhosis (see “Note“), various forms of renal dysfunction (eg, nephrotic syndrome, acute glomerulosclerosis, chronic renal failure) (see “Note“), corticosteroid and estrogen therapy

Note: The use of hydrochlorothiazide in the treatment of edema for hepatic cirrhosis has largely been replaced by spironolactone. The use of hydrochlorothiazide in the management of edema in patients with renal dysfunction has largely been replaced by the use of loop diuretics (eg, furosemide).

Hypertension: Management of mild to moderate hypertension

Guideline recommendations: The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends if monotherapy is warranted, in the absence of comorbidities (eg, cerebrovascular disease, chronic kidney disease, diabetes, heart failure, ischemic heart disease, etc), that thiazide-like diuretics or dihydropyridine calcium channel blockers may be preferred options due to improved cardiovascular endpoints (eg, prevention of heart failure and stroke). ACE inhibitors and ARBs are also acceptable for monotherapy. Combination therapy may be required to achieve blood pressure goals and is initially preferred in patients at high risk (stage 2 hypertension or atherosclerotic cardiovascular disease [ASCVD] risk ≥10%) (ACC/AHA [Whelton 2017]).

Use: Off-Label: Adult

  Calcium nephrolithiasisLevel of Evidence [B, G]

Data from a randomized, double-blind, placebo-controlled study supports the use of hydrochlorothiazide for the prevention of recurrent calcium nephrolithiasis Ref. Additional trials may be necessary to further define the role of hydrochlorothiazide in the treatment of this condition.

Based on the American Urologic Association (AUA) guidelines for the medical management of kidney stones, hydrochlorothiazide is effective and recommended for the prevention of recurrent calcium stones in patients with high or relatively high urine calcium concentrations.

  Lithium-induced diabetes insipidusLevel of Evidence [C]

Data from a limited number of patients studied (case reports) suggest that hydrochlorothiazide may be beneficial for the treatment of lithium-induced diabetes insipidus Ref. Additional data may be necessary to further define the role of hydrochlorothiazide in this condition.

Level of Evidence Definitions
  Level of Evidence Scale
Clinical Practice Guidelines

Diabetes Mellitus:

American Diabetes Association, “Standards of Medical Care in Diabetes – 2018,” January 2018

Heart Failure:

ACCF/AHA, “2013 ACCF/AHA Guideline for the Management of Heart Failure,” June 2013

Canadian Cardiovascular Society, “2012 Heart Failure Management Guidelines Update: Focus on Acute and Chronic Heart Failure,” 2012

“HFSA 2010 Comprehensive Heart Failure Practice Guideline,” July 2010

Hypertension:

“2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults,” November 2017.

AHA/ACC/ASH, “Treatment of Hypertension in Patients with Coronary Artery Disease: A Scientific Statement by the American Heart Association, American College of Cardiology and American Society of Hypertension,” May 2015

“ACCF/AHA Expert Consensus Document on Hypertension in the Elderly,” 2011

AHA/ACC/CDC, “AHA/ACC/CDC Science Advisory: An Effective Approach to High Blood Pressure Control” November 2013

Eighth Joint National Committee (JNC 8), “2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults,” December 2013.

“National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents,” May 2005

Ischemic Heart Disease:

ACC/AHA/AATS/PCNA/SCAI/STS, “2014 Focused Update of the Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease,” July 2014

ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, “2012 Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease,” November 2012

Kidney Stones:

American College of Physicians (ACP), “Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults,” November 2014

American Urological Association (AUA), “Medical Management of Kidney Stones: AUA Guideline,” March 2014

Administration: Oral

Administer early in day to avoid nocturia. Take the last dose of multiple doses no later than 6 PM unless instructed otherwise.

Administration: Pediatric

Oral: May administer with food or milk; administer early in day to avoid nocturia; if multiple daily dosing, the last dose should not be administered later than 6 PM unless instructed otherwise.

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F). Protect from light and moisture.

Extemporaneously Prepared

Note: Compounding instructions and stability based on data for compounding hydrochlorothiazide and spironolactone 5 mg/mL oral suspension

5 mg/mL Oral Suspension (ASHP Standard Concentration) (ASHP 2017)

A 5 mg/mL oral suspension may be made with hydrochlorothiazide tablets and one of three different vehicles (cherry syrup; a 1:1 mixture of Ora-Sweet and Ora-Plus; or a 1:1 mixture of Ora-Sweet SF and Ora-Plus). Crush twenty-four 25 mg tablets in a mortar and reduce to a fine powder. Add 25 mL of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL. Label “shake well” and “protect from light.” Stable for 60 days (Allen 1996).

Allen LV Jr, Erickson MA 3rd. Stability of labetalol hydrochloride, metoprolol tartrate, verapamil hydrochloride, and spironolactone with hydrochlorothiazide in extemporaneously compounded oral liquids. Am J Health Syst Pharm. 1996;53(19):2304-2309.[PubMed 8893069]

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience constipation, diarrhea, dizziness, lack of appetite, nausea, vomiting, or headache. Have patient report immediately to prescriber signs of high blood sugar (confusion, fatigue, more thirst, hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness or passing out, tachycardia, more thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in the amount of urine produced, dry mouth, dry eyes, or nausea or vomiting), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), signs of lupus (rash on the cheeks or other body parts, sunburn easy, muscle or joint pain, angina or shortness of breath, or swelling in the arms or legs), shortness of breath, dark urine, jaundice, chills, pharyngitis, burning or numbness feeling, bruising, bleeding, severe loss of strength and energy, skin changes, vision changes, or eye pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Medication Safety Issues
  Sound-alike/look-alike issues:
  International issues:
  Geriatric Patients: High-Risk Medication:
Contraindications

Hypersensitivity to hydrochlorothiazide, any component of the formulation, or sulfonamide-derived drugs; anuria

Note: Although some product labeling states this medication is contraindicated with other sulfonamide-containing drug classes, the scientific basis of this statement has been challenged. See “Warnings/Precautions” for more detail.

Canadian labeling: Additional contraindications (not in US labeling): Increasing azotemia and oliguria during treatment of severe progressive renal disease; breast-feeding

Documentation of allergenic cross-reactivity for thiazide-related diuretics is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Electrolyte disturbances: Hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia may occur. Development of electrolyte disturbances can be minimized when used in combination with other electrolyte sparing antihypertensives (eg, ACE inhibitors or angiotensin receptor blockers) (Sica 2011).

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated by hydrochlorothiazide. This risk may be increased with doses ≥25 mg (Gurwitz 1997).

• Hypersensitivity reactions: Hypersensitivity reactions may occur with hydrochlorothiazide. Risk is increased in patients with a history of allergy or bronchial asthma.

• Ocular effects: May cause acute transient myopia and acute angle-closure glaucoma, typically occurring within hours to weeks following initiation. Discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain; additional treatments may be needed if uncontrolled intraocular pressure persists. Risk factors may include a history of sulfonamide or penicillin allergy.

• Photosensitivity: Photosensitization may occur.

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension (Bornstein 2016; Inder 2015).

• Ascites due to cirrhosis: Use with extreme caution or avoid hydrochlorothiazide in the management of ascites due to cirrhosis; may lead to rapid development of hyponatremia when used in combination with spironolactone and furosemide (AASLD [Runyon 2012]).

• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in progressive or severe liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercalcemia: Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported.

• Hypokalemia: Use with caution in patients with hypokalemia; correct before initiating therapy.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.

• Renal impairment: Cumulative effects may develop, including azotemia, in patients with impaired renal function. Avoid in severe renal disease (ineffective).

• Systemic lupus erythematosus (SLE): May cause SLE exacerbation or activation.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Surgical patients: If given the morning of surgery, hydrochlorothiazide may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Dosage form specific issues:

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer’s labeling.

Geriatric Considerations

Hydrochlorothiazide is not effective in patients with a CrCl <30 mL/minute, therefore, it may not be a useful agent in many elderly patients.

The AHA/ACC/ASH 2015 scientific statement on the treatment of hypertension in patients with CAD warns to use caution to avoid decreases in DBP <60 mm Hg especially in patients >60 years of age since reduced coronary perfusion may occur. When lowering SBP in older hypertensive patients with wide pulse pressures, very low DBP values (<60 mm Hg) may result. In patients with obstructive CAD, clinicians should lower blood pressure slowly and carefully monitor for any untoward signs or symptoms, especially those resulting from myocardial ischemia and worsening heart failure (AHA/ACC/ASH [Rosendorff 2015]).

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. Hydrochlorothiazide crosses the placenta. Maternal use may cause may cause fetal or neonatal jaundice, thrombocytopenia, or other adverse events observed in adults. Use of thiazide diuretics to treat edema during normal pregnancies is not appropriate; use may be considered when edema is due to pathologic causes (as in the nonpregnant patient); monitor. Untreated chronic maternal hypertension is associated with adverse events in the fetus, infant, and mother (ACOG 2013). Women who required thiazide diuretics for the treatment of hypertension prior to pregnancy may continue their use (ACOG 2013).

Breast-Feeding Considerations

Hydrochlorothiazide is present in breast milk.

The relative infant dose (RID) of hydrochlorothiazide is 0.6% to 1.2% when compared to an infant therapeutic dose of 1 to 2 mg/kg/day.

In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).

The RID of hydrochlorothiazide was calculated using a mean milk concentration of 80 ng/mL from a single case report, providing an estimated daily infant dose via breast milk of 0.012 mg/kg/day. This milk concentration was obtained following maternal administration of oral hydrochlorothiazide 50 mg once daily for 3.5 years. Hydrochlorothiazide was not detected in the infant serum (Miller 1982).

Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother. Hydrochlorothiazide is considered compatible with breastfeeding; however, large doses should be avoided if possible because lactation may be inhibited (WHO 2002).

Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

Frequency not defined; the occurrence of adverse events are dose related, with the majority occurring with doses ≥25 mg.

Cardiovascular: Hypotension, necrotizing angiitis, orthostatic hypotension

Central nervous system: Dizziness, headache, paresthesia, restlessness, vertigo

Dermatologic: Alopecia, erythema multiforme, exfoliative dermatitis, skin photosensitivity, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Glycosuria, hypercalcemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hyponatremia

Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, pancreatitis, sialadenitis, vomiting

Genitourinary: Impotence

Hematologic & oncologic: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, purpura, thrombocytopenia

Hepatic: Jaundice

Hypersensitivity: Anaphylaxis

Neuromuscular & skeletal: Muscle spasm, weakness

Ophthalmic: Transient blurred vision, xanthopsia

Renal: Interstitial nephritis, renal failure, renal insufficiency

Respiratory: Respiratory distress, pneumonitis, pulmonary edema

Miscellaneous: Fever

<1%, postmarketing, and/or case reports: Allergic myocarditis, eosinophilic pneumonitis, hepatic insufficiency, malignant neoplasm of lip (Friedman 2012), skin carcinoma (Pedersen 2018), systemic lupus erythematosus

Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects

None known.

Drug Interactions 

Ajmaline: Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy

Alcohol (Ethyl): May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Allopurinol: Thiazide and Thiazide-Like Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Allopurinol. Specifically, Thiazide Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Risk D: Consider therapy modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticholinergic Agents: May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).Risk C: Monitor therapy

Barbiturates: May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benazepril: HydroCHLOROthiazide may enhance the hypotensive effect of Benazepril. HydroCHLOROthiazide may enhance the nephrotoxic effect of Benazepril. Benazepril may decrease the serum concentration of HydroCHLOROthiazide. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. Risk D: Consider therapy modification

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Risk X: Avoid combination

Calcium Salts: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy

CarBAMazepine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia. Risk C: Monitor therapy

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor therapy

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Cyclophosphamide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor therapy

Dexketoprofen: May enhance the adverse/toxic effect of Sulfonamides. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy

Diazoxide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dofetilide: HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. Risk X: Avoid combination

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Ipragliflozin: May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor therapy

Ivabradine: Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy

Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Risk C: Monitor therapy

Levosulpiride: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. Risk X: Avoid combination

Licorice: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Lithium: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. Risk D: Consider therapy modification

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Mecamylamine: Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. Risk X: Avoid combination

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy

OXcarbazepine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Promazine: Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Risk D: Consider therapy modification

Topiramate: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Management: Monitor for increased topiramate levels/adverse effects (e.g., hypokalemia) with initiation/dose increase of a thiazide diuretic. Closely monitor serum potassium concentrations with concomitant therapy. Topiramate dose reductions may be necessary. Risk D: Consider therapy modification

Toremifene: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. Risk C: Monitor therapy

Valsartan: HydroCHLOROthiazide may enhance the hypotensive effect of Valsartan. Valsartan may increase the serum concentration of HydroCHLOROthiazide. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. Risk C: Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Test Interactions

May interfere with parathyroid function tests and may decrease serum iodine (protein bound) without signs of thyroid disturbance; may lead to false-negative aldosterone/renin ratio (ARR) (Funder 2016)

Monitoring Parameters

Blood pressure, dizziness, lightheadedness; sodium, potassium, BUN, creatinine; skin to assess for photosensitivity, skin cancer

Hypertension: The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (ACC/AHA [Whelton 2017]):

Confirmed hypertension and known cardiovascular disease or 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%: Target blood pressure <130/80 mm Hg is recommended.

Confirmed hypertension without markers of increased ASCVD risk: Target blood pressure <130/80 mm Hg may be reasonable.

Diabetes and hypertension: The American Diabetes Association (ADA) guidelines (ADA 2018):

Patients ≥18 to ≤65 years: Goal of therapy is systolic blood pressure (SBP) <140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg.

Patients ≥18 to ≤65 years and at high risk of cardiovascular disease: Goal of therapy is SBP <130 mm Hg and DBP <80 mm Hg (if can be achieved without undue treatment burden).

Patients ≥65 years (healthy or complex/intermediate health): Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

Patients ≥65 years (very complex/poor health): Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

Advanced Practitioners Physical Assessment/Monitoring

Obtain serum electrolytes and renal function tests. Monitor blood pressure, fluid status, weight, and electrolyte balance on a regular basis throughout therapy. Observe for symptoms of gout.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Monitor blood pressure. Monitor blood pressure (standing, sitting, and lying), fluid status (I & O, edema, and weight), and electrolyte balance as ordered. Educate patient to record weight and I & Os daily to determine fluid loss. Monitor for and instruct patient to report any symptoms of gout.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Microzide: 12.5 mg [DSC]

Generic: 12.5 mg

Tablet, Oral:

Generic: 12.5 mg, 25 mg, 50 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Urozide: 25 mg, 50 mg, 100 mg [contains FD&C YELLOW #6 ALUMINUM LAKE]

Generic: 12.5 mg, 25 mg, 50 mg, 100 mg

Anatomic Therapeutic Chemical (ATC) Classification
  • C03AA03
Generic Available (US)

Yes

Pricing: US

Capsules (hydroCHLOROthiazide Oral)

12.5 mg (per each): $0.10 – $0.42

Tablets (hydroCHLOROthiazide Oral)

12.5 mg (per each): $0.42 – $0.82

25 mg (per each): $0.08 – $0.13

50 mg (per each): $0.13 – $0.16

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions

Pharmacodynamics/Kinetics

Onset of action: Diuresis: Infants: 2 to 6 hours (Chemtob 1989); Adults: ~2 hours

Peak effect: 4 to 6 hours

Duration: Infants: 8 hours (Chemtob 1989); Adults: 6 to 12 hours

Absorption: Well absorbed; absorption is reduced in patients with CHF.

Distribution: 3.6 to 7.8 L/kg (correlates with dose administered and concentration achieved)

Protein binding: ~40% to 68%

Metabolism: Not metabolized

Bioavailability: 65% to 75%

Half-life elimination: ~6 to 15 hours

Time to peak: ~1 to 5 hours

Excretion: Urine (≥61% as unchanged drug)

Pharmacodynamics/Kinetics: Additional Considerations

Renal function impairment: Hydrochlorothiazide plasma concentration is increased and the half-life is prolonged.

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Hypotension; Patients may experience orthostatic hypotension as they stand up after treatment; especially if lying in dental chair for extended periods of time. Use caution with sudden changes in position during and after dental treatment.

Effects on Bleeding

No information available to require special precautions

Index Terms

HCTZ (error-prone abbreviation); Hydrodiuril

References

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(23):2981-97.[PubMed 12479763]

American College of Obstetricians and Gynecologists (ACOG), Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88.[PubMed 24150027]

American Diabetes Association (ADA). Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S1-S159. http://care.diabetesjournals.org/content/41/Supplement_1. Accessed June 18, 2018.

American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227-2246. doi:10.1111/jgs.13702.[PubMed 26446832]

Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52.[PubMed 27060684]

Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed, Philadelphia, PA: American College of Physicians, 2007, 43.

Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. doi: 10.1210/jc.2015-1710.[PubMed 26760044]

Brackett CC, Singh H, Block JH. Likelihood and mechanisms of cross-allergenicity between sulfonamide antibiotics and other drugs containing a sulfonamide functional group. Pharmacotherapy. 2004;24(7):856-870.[PubMed 15303450]

Chemtob S, Kaplan BS, Sherbotie JR, et al, “Pharmacology of Diuretics in the Newborn,” Pediatr Clin North Am, 1989, 36(5):1231-50.[PubMed 2677940]

Constandis DD, Schriever HG. “Severe Lithium-Induced Diabetes Insipidus in a Surgical Patient Treated with Hydrochlorothiazide,” Am J Surg, 1981, 141:741-3.[PubMed 7246868]

Fihn SD, Gardin JM, Abrams J, et al, “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons,” Circulation, 2012, 126(25):3097-137.[PubMed 23166211]

Friedman GD, Asgari MM, Warton EM, et al, “Antihypertensive Drugs and Lip Cancer in Non-Hispanic Whites,” Arch Intern Med, 2012, 6:1-6.[PubMed 22869299]

Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061.[PubMed 26934393]

Go AS, Bauman M, King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention [published online November 15, 2013]. Hypertension.[PubMed 24243703]

Gurwitz JH, Kalish SC, Bohn RL, et al. Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol. 1997;50(8):953-959.[PubMed 9291881 ]

Hydrochlorothiazide [prescribing information]. Leading Pharma LLC; October 2015.

Hydrochlorothiazide capsules [prescribing information]. Hauppauge, NY: Sciegen Pharmaceuticals Inc; July 2015.

“Inactive” ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278.[PubMed 9024461]

Inder WJ, Meyer C, Hunt PJ. Management of hypertension and heart failure in patients with Addison’s disease. Clin Endocrinol (Oxf). 2015;82(6):789-792. doi: 10.1111/cen.12592.[PubMed 25138826]

Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126.[PubMed 10891521]

James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) [published online December 18, 2013]. JAMA.[PubMed 24352797]

Johnson KK, Green DL, Rife JP, Limon L. Sulfonamide cross-reactivity: fact or fiction? [published correction appears in Ann Pharmacother. 2005;39(7-8):1373]. Ann Pharmacother. 2005;39(2):290-301.[PubMed 15644481]

Laerum E, Larsen S. Thiazide prophylaxis of urolithiasis. A double-blind study in general practice. Acta Med Scand. 1984;215:383-389.[PubMed 6375276]

Lindenfeld J, Albert NM, Boehmer JP, et al, “HFSA 2010 Comprehensive Heart Failure Practice Guideline,” J Card Fail, 2010, 16(6):e1-194.[PubMed 20610207]

Meinardi JR, Donders SHJ. “Nephrogenic Diabetes Insipidus in a Lethargic Lithium-Treated Patient,” Neth J Med, 1997, 50:105-9.[PubMed 9121593]

Miller ME, Cohn RD, and Burghart PH, “Hydrochlorothiazide Disposition in a Mother and Her Breast-Fed Infant,” J Pediatr, 1982, 101(5):789-91.[PubMed 7131161]

National Heart, Lung, and Blood Institute, “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents,” Clinical Practice Guidelines, 2011, National Institutes of Health. Available at http://www.nhlbi.nih.gov/guidelines/cvd_ped/peds_guidelines_full.pdf. Last accessed: June 2012.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, 2004, 114(2 Suppl):555-76.[PubMed 15286277]

Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192:316-324.[PubMed 24857648]

Pedersen SA, Gaist D, Schmidt SAJ, Hölmich LR, Friis S, Pottegård A. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol. 2018;78(4):673-681.[PubMed 29217346]

pms-Hydrochlorothiazide [product monograph]. Montreal, Quebec, Canada: Pharmascience Inc.; March 2014.

Rosendorff C, Lackland DT, Allison M, et al; American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015;9(6):453-498. doi: 10.1016/j.jash.2015.03.002.[PubMed 25840695]

Runyon BA; American Association for the Study of Liver Diseases. Practice guideline: management of adult patients with ascites due to cirrhosis: update 2012. http://aasld.org/sites/default/files/guideline_documents/adultascitesenhanced.pdf. Accessed May 6, 2015.[PubMed 23463403]

Sica DA, Carter B, Cushman W, et al, “Thiazide and Loop Diuretics,” J Clin Hypertens (Greenwich), 2011, 13:639-43.[PubMed 21896142]

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Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online ahead of print on November 13, 2017.]. Hypertension. 2017. doi: 10.1161/HYP.0000000000000065.[PubMed 29133356]

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Brand Names: International

Acortiz (MX); Acuren (BD); Apo-Hydro (MY); BPzide (IN); Chlothia (JP); Clorana (BR); Di-Ertride (SG); Di-Eudrin (VE); Dichlorzid (KR); Dichlotride (BE, DK, HK, LU, NL, PT, TH); Didralin (TR); Disalunil (BG, PL); Disothiazide (IL); Dithiazide (AU); Diubiz (PH); Diurace (PE); Diures (PH); Diuret-P (TH); Diuretyk (CR, DO, GT, HN, NI, PA, SV); Diurex (AR, PY); Diurix (BR); Diursan (PY); Diuzid (PH); Esidrex (AE, AT, BB, BE, BF, BH, BJ, BM, BS, BZ, CH, CI, CY, ES, ET, FR, GH, GM, GN, GR, GY, IN, IQ, IR, IT, JM, JO, KE, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, NE, NG, NL, NO, OM, QA, SA, SC, SD, SE, SL, SN, SR, SY, TN, TT, TZ, UG, UY, YE, ZA, ZM, ZW); Esidrix (DE); H.C.T. (ID); HCT (EC); HCTZ 25 (TH); Hidroronol (CL); Hidrosaluretil (ES); Hipotiazyd (UA); HTZ (BD); Hychlozide (TH); Hydrex (FI, JO); Hydro-Saluric (GB, IE); Hydrochlorothiazidum (PL); Hydrochlorzide (MY); Hydromed (NO); Hydrozide (HK, TH); Hypezide (BD); Hypothiazid (HU, RU); Hytaz (PH); Lonpra (CO); Maschitt (JP); Modiur (UY); Monozide (AE, JO); Newtolide (JP); Pantemon (JP); Ridaq (ZA); Rofucal (MX); Staplex (ZW); Tandiur (AR); Tiazid (PE); Unazid (HR); Urilzid (PH); Varidrex (ZW)

Hydrochlorothiazide (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(hye droe klor oh THYE a zide)

Brand Names: US

Microzide [DSC]

Brand Names: Canada

Urozide

What is this drug used for?
  • It is used to treat high blood pressure.
  • It is used to get rid of extra fluid.
  • It may be given to you for other reasons. Talk with the doctor.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to hydrochlorothiazide or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you are not able to pass urine.
  • If you are taking dofetilide.
  • If you are breast-feeding or plan to breast-feed.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
  • To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.
  • If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
  • Have your blood pressure checked often. Talk with your doctor.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
  • If you are taking this drug and have high blood pressure, talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
  • This drug is a strong fluid-lowering drug (diuretic). Sometimes too much water and major elements (potassium) in the blood may be lost. This can lead to serious health problems. Your doctor will follow you closely to change the dose to match your body’s needs.
  • You may need extra potassium. Talk with your doctor.
  • If you are on a low-salt or salt-free diet, talk with your doctor.
  • Talk with your doctor before you drink alcohol or use other drugs and natural products that slow your actions.
  • Tell your doctor if you have too much sweat, fluid loss, throwing up, or loose stools. This may lead to low blood pressure.
  • If you take cholestyramine or colestipol, talk with your pharmacist about how to take them with this drug.
  • Watch for gout attacks.
  • If you have lupus, this drug can make your lupus active or get worse. Tell your doctor right away if you get any new or worse signs.
  • If you are 65 or older, use this drug with care. You could have more side effects.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
  • Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
  • Dark urine or yellow skin or eyes.
  • Fever or chills.
  • Sore throat.
  • A burning, numbness, or tingling feeling that is not normal.
  • Shortness of breath.
  • Any unexplained bruising or bleeding.
  • Feeling very tired or weak.
  • Any skin change.
  • This drug can cause certain eye problems. If left untreated, this can lead to lasting eyesight loss. If eye problems happen, signs like change in eyesight or eye pain most often happen within hours to weeks of starting this drug. Call your doctor right away if you have these signs.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Constipation.
  • Diarrhea.
  • Dizziness.
  • Not hungry.
  • Upset stomach or throwing up.
  • Feeling tired or weak.
  • Headache.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.
  • This drug may cause you to pass urine more often. To keep from having sleep problems, try to take before 6 pm.
What do I do if I miss a dose?
  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Hydrochlorothiazide (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(hye droe klor oh THYE a zide)

Brand Names: US

Microzide [DSC]

Brand Names: Canada

Urozide

What is this drug used for?
  • It is used to treat high blood pressure.
  • It is used to get rid of extra fluid.
  • It may be given to your child for other reasons. Talk with the doctor.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child is not able to pass urine.
  • If your child is taking dofetilide.
  • If your child is breast-feeding a baby:
  • Talk with the doctor if your child is breast-feeding a baby or plans to breast-feed a baby.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Have your child avoid tasks or actions that call for alertness until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
  • To lower the chance of feeling dizzy or passing out, have your child rise slowly if your child has been sitting or lying down. Have your child be careful going up and down stairs.
  • If your child has high blood sugar (diabetes), you will need to watch his/her blood sugar closely.
  • Have your child’s blood pressure checked often. Talk with your child’s doctor.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug.
  • If your child is taking this drug and has high blood pressure, talk with the doctor before giving OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
  • This drug is a strong fluid-lowering drug (diuretic). Sometimes too much water and major elements (potassium) in the blood may be lost. This can lead to serious health problems. The doctor will follow your child closely to change the dose to match your child’s body’s needs.
  • Your child may need extra potassium. Talk with the doctor.
  • If your child is on a low-salt or salt-free diet, talk with your child’s doctor.
  • Talk with your child’s doctor before giving your child other drugs and natural products that may slow your child’s actions.
  • Alcohol may interact with this drug. Be sure your child does not drink alcohol.
  • Tell the doctor if your child has too much sweat, fluid loss, throwing up, or diarrhea. This may lead to low blood pressure.
  • If your child takes cholestyramine or colestipol, talk with the pharmacist about how to give them with this drug.
  • Watch for gout attacks.
  • If your child has lupus, this drug can make your child’s lupus active or get worse. Tell the doctor right away if your child gets any new or worse signs.
  • If your child is pregnant:
  • Tell the doctor if your child is pregnant or becomes pregnant. You will need to talk about the benefits and risks of your child using this drug while pregnant.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
  • Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
  • Dark urine or yellow skin or eyes.
  • Fever or chills.
  • Sore throat.
  • A burning, numbness, or tingling feeling that is not normal.
  • Shortness of breath.
  • Any unexplained bruising or bleeding.
  • Feeling very tired or weak.
  • Any skin change.
  • This drug can cause certain eye problems. If left untreated, this can lead to lasting eyesight loss. If eye problems happen, signs like change in eyesight or eye pain most often happen within hours to weeks of starting this drug. Call the doctor right away if your child has these signs.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Constipation.
  • Diarrhea.
  • Dizziness.
  • Not hungry.
  • Upset stomach or throwing up.
  • Feeling tired or weak.
  • Headache.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
  • This drug may cause your child to pass urine more often. To keep your child from having sleep problems, try to give this drug before 6 PM.
What do I do if my child misses a dose?
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.