chlorothiazide (Rx)

Brand and Other Names:Diuril
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

oral suspension

  • 250mg/5mL

powder for injection

  • 500mg

tablet

  • 250mg
  • 500mg

Edema

0.5-1 g (10 to 20 mL) PO/IV qDay or q12hr;

Dosing consideration

  • 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

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

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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

            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

            Use with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia; cumulative effects of drug may develop in patients with impaired renal function.

            Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma

            Thiazides may add to or potentiate the action of other antihypertensive drugs

            Sensitivity reactions may occur in patients with or without a history of allergy or bronchial asthma; the possibility of exacerbation or activation of systemic lupus erythematosus has been reported

            Lithium generally should not be given with diuretics

            Although any chloride deficit is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease), chloride replacement may be required in the treatment of metabolic alkalosis

            Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction, rather than administration of salt, except in rare instances when the hyponatremia is life-threatening; in actual salt depletion, appropriate replacement is therapy of choice

            Hyperuricemia may occur or acute gout may be precipitated in certain patients receiving thiazides

            In diabetic patients dosage adjustments of insulin or oral hypoglycemic agents may be required; hyperglycemia may occur with thiazide diuretics; latent diabetes mellitus may become manifest during thiazide therapy

            The antihypertensive effects of drug may be enhanced in the post-sympathectomy patient

            If progressive renal impairment becomes evident, consider withholding or discontinuing diuretic therapy;

            Thiazides have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia

            Thiazides may decrease urinary calcium excretion; thiazides may cause intermittent and slight elevation of serum calcium in absence of known disorders of calcium metabolism; marked hypercalcemia may be evidence of hidden hyperparathyroidism; thiazides should be discontinued before carrying out tests for parathyroid function

            Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy

            Hypokalemia

            • Hypokalemia may develop, especially with brisk diuresis, when severe cirrhosis is present or after prolonged therapy; interference with adequate oral electrolyte intake will contribute to hypokalemia
            • Hypokalemia may cause cardiac arrhythmias and may also sensitize or exaggerate response of heart to toxic effects of digitalis (eg, increased ventricular irritability)
            • Hypokalemia may be avoided or treated by use of potassium-sparing diuretics or potassium supplements such as foods with a high potassium content

            Electrolyte imbalance

            • All patients receiving diuretic therapy should be observed for evidence of fluid or electrolyte imbalance, including, hyponatremia, hypochloremic alkalosis, and hypokalemia
            • Serum and urine electrolyte determinations are particularly important when patient is vomiting excessively or receiving parenteral fluids
            • Warning signs or symptoms of fluid and electrolyte imbalance, irrespective of cause, include dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting
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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.

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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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            Formulary

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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.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.