hydrochlorothiazide

BEERS REMS

Hypertension.
Edema associated with:
- HF,
- Renal impairment,
- Cirrhosis,
- Glucocorticoid therapy,

Contraindicated in:

Hypersensitivity (cross-sensitivity with other thiazides or sulfonamides may exist);
Some products contain tartrazine and should be avoided in patients with known intolerance;
Anuria;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
OB: Safety not established in pregnancy;
Geri: Appears on Beers list. May worsen or cause hyponatremia in older adults. Use with caution in older adults and monitor sodium concentrations closely when initiating therapy or ↑ the dose.

CV: hypotension

Derm: photosensitivity, rash, SKIN CANCER (NONMELANOMA), STEVENS JOHNSON SYNDROME

EENT: acute angle-closure glaucoma, acute myopia

Endo: hyperglycemia

F and E: hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia

GI: anorexia, cramping, hepatitis, nausea, PANCREATITIS, vomiting

Hemat: blood dyscrasias

Metab: hyperuricemia, hypercholesterolemia

MS: muscle cramps

Neuro: dizziness, drowsiness, lethargy, weakness

Drug-drug:

Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates..
Additive hypokalemia with corticosteroids, amphotericin B, or piperacillin/tazobactam.
May ↑ lithium levels.
Cholestyramine orcolestipol↓ absorption.
Hypokalemia ↑ risk of digoxin toxicity.
NSAIDs may ↓ effectiveness..

(Generic available)

Capsules: 12.5 mg
Tablets: 12.5 mg; 25 mg; 50 mg
In combination with: numerous antihypertensives. See Appendix [not included in this PDA edition].

PO (Adults ): 12.5–100 mg/day in 1–2 doses (up to 200 mg/day; not to exceed 50 mg/day for hypertension; doses above 25 mg are associated with greater likelihood of electrolyte abnormalities).
PO (Children >6 mo): 2 mg/kg in 2 divided doses (not to exceed 200 mg/day).
PO (Children <6 mo): Up to 2–4 mg/kg/day in 2 divided doses (not to exceed 37.5 mg/day).

Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule.
Promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium and bicarbonate.
May produce arteriolar dilation.

Therapeutic effects:

Lowering of BP in hypertensive patients and diuresis with mobilization of edema.

Therapeutic Classification: antihypertensives, diuretics

Pharmacologic Classification: thiazide diuretics

Absorption: Rapidly absorbed after oral administration.

Distribution: Distributed into extracellular space.

Metabolism/Excretion: Excreted mainly unchanged by the kidneys.

Half-Life: 6–15 hr.

(diuretic effect)

ROUTE	ONSET	PEAK	DURATION
PO‡	2 hr	3–6 hr	6–12 hr

‡Onset of antihypertensive effect is 3–4 days and does not become maximal for 7–14 days of dosing.

Instruct patient to take this medication at the same time each day. Take missed doses as soon as remembered but not just before next dose is due. Do not double doses.
- Instruct patient to monitor weight biweekly and notify health care professional of significant changes.
- Caution patient to change positions slowly to minimize orthostatic hypotension. This may be potentiated by alcohol.
- Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient of the need to undergo skin cancer screenings at least yearly during therapy.
- Instruct patient to discuss dietary potassium requirements with health care professional (see Food Sources for Specific Nutrients).
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Advise patient to notify health care professional if signs and symptoms of hyperglycemia (confusion, fatigue, more thirst, hunger, passing a lot of urine, flushing, fast breathing, breath that smells like fruit), fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness or passing out, fast heartbeat, more thirst, seizures, loss of strength and energy, lack of appetite, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or nausea or vomiting), allergic reaction (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), weight gain, chest pain or shortness of breath, swelling in the arms or legs, bleeding, bruising, skin lump, skin growth, mole changes, rash, or diarrhea occur.
- May cause fetal or neonatal jaundice and thrombocytopenia. Advise patient to notify health care professional if pregnancy if planned or suspected and to avoid breastfeeding during therapy.
- Emphasize the importance of routine follow-up exams.
Hypertension: Advise patients to continue taking the medication even if feeling better. Medication controls but does not cure hypertension.
- Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, regular exercise, smoking cessation, moderation of alcohol consumption, and stress management).
- Instruct patient and family in correct technique for monitoring weekly BP.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products, especially cough or cold preparations.

hye-droe-klor-oh-THYE-a-zide

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆ ⬇

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