chlorothiazide (Rx)Brand and Other Names:Diuril

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

oral suspension

  • 250mg/5mL

powder for injection

  • 500mg

tablet

  • 250mg
  • 500mg
more...

Edema

0.5-1 g (10 to 20 mL) PO/IV qDay or q12hr; many patients with edema respond to intermittent therapy (ie, administration on alternate days or 3-5 days each week; reduces risk of undesirable electrolyte imbalance)

Hypertension

0.5 -1 g (10-20 mL)/day PO/IV as single or divided dose; increase or decrease dosage based on blood pressure response

Renal Impairment

CrCl <10 mL/minute: Do not use

CrCl<30 mL/minute: Ineffective

Overdose Management

May use normal saline for volume replacement

May use dopamine or norepinephrine to treat hypotension

If dysrhythmia due to decreased K+ or Mg+ suspected replace aggressively

Discontinue treatment if no symptoms after 6hr

Other Indications & Uses

Edema associated with: CHF, cirrhosis, steroids, estrogen therapy, renal dysfunction

Off-label: Calcium nephrolithiasis, osteoporosis, diabetes insipidus

Dosage Forms & Strengths

oral suspension

  • 250mg/5mL

powder for injection

  • 500mg

tablet

  • 250mg
  • 500mg
more...

Edema

10 to 20 mg/kg (5-10 mg/lb) qDay or divided q12hr, not to exceed 375 mg/day 

Hypertension

10 to 20 mg/kg (5-10 mg/lb) qDay or divided q12hr, not to exceed 375 mg/day 

Edema

0.5-1 g (10 to 20 mL) PO/IV qDay or q12hr; many patients with edema respond to intermittent therapy (ie, administration on alternate days or 3-5 days each week; reduces risk of undesirable electrolyte imbalance)

Hypertension

0.5 -1 g (10-20 mL)/day PO/IV as single or divided dose; increase or decrease dosage based on blood pressure response

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Interactions

Interaction Checker

chlorothiazide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            <1%

            Scaling eczema

            Stevens-Johnson syndrome

            Toxic epidermal necrolysis

            Disorder of hematopoietic structure

            Hepatotoxicity

            Systemic lupus erythematosus

            Frequency Not Defined

            Hypotension

            Alopecia

            Photosensitivity

            Phototoxicity

            Rash

            Urticaria

            Hyperglycemia

            Hyperuricemia

            Constipation

            Diarrhea

            Loss of appetite

            Nausea and vomiting

            Electrolytes abnormal

            Spasticity

            Dizziness

            Headache

            Blurred vision

            Xanthopsia

            Impotence

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            Warnings

            Contraindications

            Hypersensitivity to chlorothiazide or sulfonamides

            Anuria

            Cautions

            DM, fluid or e'lyte imbalance, hyperuricemia/gout, hypotension, SLE, post-sympathectomy, liver disease, renal disease

            Avoid concurrent use with lithium

            May aggravate digitalis toxicity

            Sensitivity reactions may occur with or without history of allergy or asthma

            Patients allergic to sulfa may show cross sensitivity

            May deleteriously alter lipid/glucose metabolism

            Risk of male sexual dysfunction

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            Pregnancy & Lactation

            Pregnancy Category: C; D (expert analysis). Chlorothiazide may cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult. Use of diuretics for pregnancy-induced hypertension should be avoided due to risk of decreased placental perfusion.

            Lactation: enters breast milk/not recommended (AAP states "compatible with nursing")

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excrertion of Na+ and water, also K+ and H+ ions

            Pharmacokinetics

            Half-Life: 145-120 min

            Onset: initial effect: 2 hr, max effect: 4 hr

            Duration: 6-12 hr

            Peak Plasma Time: IV: 30 min; PO: 4 hr

            Bioavailability: Very limited

            Metabolism: Does not appear to be metabolized

            Excretion: Urine (96%)

            Dialyzable: No

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            Administration

            IV Incompatibilities

            Additive: amikacin, chlorpromazine, hydralazine, insulin regular, levorphanol, morphine sulfate, norepinephrine bitartrate, polymyxin B sulfate, procaine, prochlorperazine, promazine, promethazine, streptomycin, triflupromazine, vancomycin

            Other: multivitamins

            IV Compatibilities

            Solution: D5W, D10W, dextrose/saline, dextrose/LR, dextrose/Ringers, Ringers, LR, NS, ½NS, Na-lactate 1/6M

            Additive: Cimetidine, lidocaine, nafcillin, ranitidine

            IV Administration

            Administer IV by direct injection or infusion

            Do not administer IM or SC

            Storage

            Intact vials at 2-25°C

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            Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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