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hydrochlorothiazide (Rx)Brand and Other Names:Microzide, HydroDiuril, more...Hydro, Esidrix, HCTZ, Oretic

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet/capsule

  • 12.5mg
  • 25mg
  • 50mg
more...

Hypertension

12.5-50 mg PO once daily

Edema

25-100 mg PO once daily or twiced daily; not to exceed 200 mg/day

Hypertension in Heart Failure (Off-label)

25 mg PO qDay or twice daily; not to exceed 200 mg/day

Mild Fluid Retention in Heart Failure (Off-label)

25 mg PO qDay or twice daily; not to exceed 200 mg/day

Dosing Considerations

Overdose management

  • Normal saline may be used for volume replacement
  • Dopamine or norepinephrine may be used to treat hypotension
  • If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
  • If no symptoms are noted after 6 hours, discontinue treatment

Dosing Modifications

Renal impairment

  • CrCl <10 mL/min: Avoid use
  • CrCl ≥10 mL/min: Dose adjustment not necessary; not effective with CrCl <30 mL/min unless used in combination with loop diuretic

Dosage Forms & Strengths

tablet/capsule

  • 12.5mg
  • 25mg
  • 50mg
more...

Hypertension

<6 months: 1-3 mg/kg/day PO divided q12hr; not to exceed 37.5 mg/day  

6 months-2 years: 1-2 mg/kg/day PO in single daily dose or divided twice daily; not to exceed 37.5 mg/day

2-12 years: 1-3 mg/kg/day; not to exceed 3 mg/kg/day (100 mg/day)

Edema

<6 months: 1-3 mg/kg/day PO divided q12hr; not to exceed 37.5 mg/day  

6 months-2 years: 1-3 mg/kg/day PO in single daily dose or divided twice daily; not to exceed 37.5 mg/day

2-12 years: 1-3 mg/kg/day; not to exceed 3 mg/kg/day (100 mg/day)

Increased hypotension and side effects in elderly

Potential for electrolyte imbalance in elderly; monitor serum electrolytes

Diuresis

12.5-25 mg/day PO; titrated in increments of 12.5 mg/day

Increased electrolyte disturbances are seen with dosages >50 mg/day

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Interactions

Interaction Checker

hydrochlorothiazide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anaphylaxis

            Anorexia

            Confusion

            Disorder of hematopoietic structure

            Dizziness

            Epigastric distress

            Fatigue

            Headache

            Hepatotoxicity

            Hypercalcemia

            Hypercholesterolemia

            Hyperglycemia

            Hyperlipidemia

            Hyperuricemia

            Hypokalemia

            Hypomagnesemia

            Hypotension

            Interstitial nephritis

            Metabolic acidosis

            Muscle weakness or cramps

            Nausea

            Necrotizing angiitis

            Pancreatitis

            Phototoxicity

            Pneumonitis

            Pulmonary edema

            Purpura

            Rash

            Respiratory distress

            Stevens-Johnson syndrome

            Toxic epidermal necrolysis

            Vertigo

            Vomiting

            Xanthopsia

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            Warnings

            Contraindications

            Documented hypersensitivity to hydrochlorothiazide or sulfonamides

            Anuria

            Cautions

            Use with caution in diabetes mellitus, fluid or electrolyte imbalance, hypercholesterolemia, hyperuricemia or gout, hypercalcemia, hypotension, systemic lupus erythematosus, liver or renal disease, hypokalemia, parathyroid disease

            May aggravate digitalis toxicity

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

            Avoid concurrent use with lithium (reduction of lithium dosage by 50% may be necessary)

            Risk of male sexual dysfunction

            Causes systemic lupus exacerbation or activation

            Azotemia may occur with severe renal disease

            Acute transient myopia and acute angle-closure glaucoma have been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is sulfonamide)

            FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur

            Photosensitization may occur

            Electrolyte disturbances (eg, hypokalemia, hyponatremia, hypochloremic alkalosis) may occur

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug excreted in breast milk; use with caution (American Academy of Pediatrics states that it is "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; inhibits sodium reabsorption in distal renal tubules, resulting in increased excretion of water and of sodium, potassium, and hydrogen ions

            Absorption

            Onset: Diuresis, ~2 hr; hypertension, 3-4 days

            Peak plasma time: 1-2.5 hr

            Peak effect: Diuresis, 4-6 hr

            Bioavailability: 65-75%

            Distribution

            Protein bound: 40-68%

            Vd: 3.6-7.8 L/kg

            Metabolism

            Minimally metabolized

            Elimination

            Half-life: 5.6-14.8 hr

            Dialyzable: Hemodialysis, no

            Excretion: Urine

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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