Adult Dosing

Edema

• 500-1000 mg PO daily-bid; may be administered on alternate days or on 3-5 days each wk

Hypertension

• 500-1000 mg/day PO divided daily-bid
• Max: 2 g/day

Pediatric Dosing

Edema

• Child <6 mo: Start 10-20 mg/kg/day PO divided daily-bid, up to 30 mg/kg/day divided bid. Max: 375 mg/day
• Child 6 mo- 2 yrs: 10-20 mg/kg/day PO divided daily-bid. Max: 375 mg/day
• Child 2-12 yrs: 10-20 mg/kg/day PO divided daily-bid. Max: 1000 mg/day

Hypertension

• Child <6 mo: Start 10-20 mg/kg/day PO divided daily-bid, up to 30 mg/kg/day divided bid. Max: 375 mg/day
• Child 6 mo - 2 yrs: 10-20 mg/kg/day PO divided daily-bid. Max: 375 mg/day
• Child 2-12 yrs: 10-20 mg/kg/day PO divided daily-bid. Max: 1000 mg/day

[Outline]

• Adult Dosing
• Pediatric Dosing

• Edema associated with CHF, hepatic cirrhosis, corticosteroid and estrogen therapy, nephrotic syndrome, acute glomerulonephritis, and chronic renal failure
• Hypertension (either alone or in combination with other antihypertensive drugs)

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to sulfonamide-derived drugs
• Anuria

• N/A

Renal Dose Adjustment

• Severe impairment: Caution advised; dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment/progressive hepatic disease: Caution advised; dose adjustments not defined

• Use with caution in severe renal disease due to risk of azotemia
• Use with caution in hepatic impairment or progressive liver disease as minor alterations in electrolyte and fluid balance can precipitate hepatic coma
• Monitor for signs of fluid or electrolyte imbalance such as hyponatremia, hypochloremic alkalosis, and hypokalemia.
• Hypokalemia caused by thaizide diuretics may cause cardiac arrhythmias and may also sensitize/exaggerate the response of the heart to the toxic effects of digitalis. Use potassium sparing diuretics or administer supplemental potassium
• Dilutional hyponatremia may occur in edematous patients in hot weather; water restriction is recommended rather than salt administration, except in rare instances when hyponatremia is considered life-threatening
• Chloride deficit caused by thiazide diuretics is generally mild except in certain circumstances (hepatic or renal disease), which may require treatment including chloride replacement

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Progressive liver disease
• Hx of bronchial asthma
• Diabetes mellitus (monitor blood sugar levels)
• Post sympathectomy (may enhance antihypertensive effects)
• Volume depletion
• Electrolyte imbalances
• Pregnancy near-term
• Systemic Lupus Erythematosus (may aggravate symptoms)
• Hx of gout
• Hx of pancreatitis
• Geriatric Population
• Concomitant use of lithium

Diuril interacts with :

	Eskalith
	Lithium
	Lithobid

Pregnancy Category:C

Breastfeeding: Low dose chlorothiazide is acceptable with breastfeeding. Large doses may cause intense diuresis resulting in decrease breast milk production. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT).This drug is considered compatible with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 11 October 2010). Manufacturer recommends discontinuation of breastfeeding, or postponing of treatment (taking into account the importance of the drug to the mother).

• CV: Hypotension, orthostatic hypotension, arrhythmias
• CNS: Vertigo, dizziness, headache, restlessness
• NEURO: Paresthesias
• GI: Pancreatitis, nausea, anorexia, vomiting, diarrhea, jaundice (intrahepatic cholestatic jaundice), sialadenitis, cramping, constipation, gastric irritation
• HEMA: Blood dyscrasias (rare), thrombocytopenia, aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia
• ENDOCRINE: Hyperglycemia
• HYPERSENSITIVITY: Photosensitivity, fever, urticaria, rash, purpura, anaphylactic reactions, necrotizing angitis, respiratory distress including pneumonitis, pulmonary, edema
• METABOLIC: Hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypercholesterolemia, hyponatremia, hypophosphatemia, hypovolemia
• MUSC: Muscle cramps
• DERM: Erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, alopecia, photosensitivity, rashes
• EENT: Transient blurred vision, xanthopsia
• GU: Renal dysfunction, renal failure, interstitial nephritis, impotence
• MISC: Weakness, SLE exacerbation, hepatotoxicity (rare)

• Thiazide diuretic; increases excretion of sodium, chloride, water, potassium and bicarbonate by affecting distal renal tubule
• Not metabolized
• Renally excreted: primarily unchanged
• Half Life: 45-120 mins

US Trade Name(s)

• Diuril

US Availability

chlorothiazide (generic)

• TABS: 250, 500 mg

Diuril

• SUSP: 250 mg/5 mL

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Cardiovascular

Diuretics

Thiazide Diuretics

Pricing data from www.DrugStore.com in U.S.A.

• Chlorothiazide 500 MG TABS [Bottle] (MYLAN)
  30 mg = $14.99
  60 mg = $20.97
• Chlorothiazide 250 MG TABS [Bottle] (MYLAN)
  30 mg = $14.99
  90 mg = $25.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• Chlorothiazide 250 MG Oral Tablet (Mylan Pharmaceuticals Inc.)
• Chlorothiazide 250 MG Oral Tablet (West-ward Pharmaceutical Corp)
• Chlorothiazide 500 MG Oral Tablet (Mylan Pharmaceuticals Inc.)
• Chlorothiazide 500 MG Oral Tablet (West-ward Pharmaceutical Corp)