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hydrochlorothiazide
Apo-Hydro†, Dichlotride‡, Diuchlor H†, Esidrix, Ezide, Hydro-D, HydroDIURIL, Hydro-Par, HydroSaluric§, Mictrin, Neo-Codema†, Novo-Hydrazide†, Oretic, Urozide†

Pregnancy Risk Category B

How supplied
Tablets:
25 mg, 50 mg, 100 mg
Oral solution:
50 mg/5 ml, 100 mg/ml

Action
A thiazide diuretic that increases sodium and water excretion by inhibiting sodium and chloride reabsorption in the nephron's distal segment.

Indications & dosage
Edema
--
Adults:
25 to 100 mg P.O. daily or intermittently; up to 200 mg initially for several days until dry weight is attained.
Children ages 2 to 12:
1 to 2 mg/kg once daily or b.i.d., not to exceed 37.5 to 100 mg daily.
Children ages 6 months to 2 years:
1 to 2 mg/kg once daily or b.i.d. within range of 12.5 to 37.5 mg daily.
Infants under age 6 months:
up to 3 mg/kg P.O. daily in two divided doses. Total daily dose may range from 12.5 to 37.5 mg.
Hypertension--

Adults:
25 to 50 mg P.O. daily as a single dose or divided b.i.d. Daily dose increased or decreased according to blood pressure.
Doses exceeding 50 mg/day aren't needed when combined with other antihypertensives.

Adverse reactions
CNS:
dizziness, vertigo, headache, paresthesia, weakness, restlessness.
CV:
orthostatic hypotension, allergic myocarditis, vasculitis.
GI:
anorexia, nausea, pancreatitis, epigastric distress, vomiting, abdominal pain, diarrhea, constipation.
GU:
polyuria, frequent urination, renal failure, interstitial nephritis.
Hematologic:
aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia, hemolytic anemia.
Hepatic:
jaundice.
Metabolic:
hypokalemia, hyperglycemia and impaired glucose tolerance; fluid and electrolyte imbalances, including dilutional hyponatremia and hypochloremia, metabolic alkalosis; increased serum glucose, cholesterol, and triglyceride levels; hypercalcemia, volume depletion and dehydration.
Musculoskeletal:
muscle cramps.
Respiratory:
respiratory distress, pneumonitis.
Skin:
dermatitis, photosensitivity, rash, purpura, alopecia.
Other:
hypersensitivity reactions, asymptomatic hyperuricemia, gout, anaphylactic reactions.

Interactions
Drug-drug.
Amphotericin B, corticosteroids: increased risk of hypokalemia. Monitor closely.
Antidiabetics:
decreased effectiveness of hypoglycemics; dosage adjustments may be needed. Monitor blood glucose levels.
Antihypertensives:
additive antihypertensive effect. Use together cautiously.
Barbiturates, opiates:
increased orthostatic hypotensive effect. Monitor closely.
Cardiac glycosides:
increased risk of digitalis toxicity from hydrochlorothiazide-induced hypokalemia. Monitor potassium and digitalis levels.
Cholestyramine, colestipol:
decreased intestinal absorption of thiazides. Separate doses.
Diazoxide:
increased antihypertensive, hyperglycemic, and hyperuricemic effects. Use together cautiously.
Lithium:
decreased lithium excretion, increasing risk of lithium toxicity. Monitor lithium level.
NSAIDs:
increased risk of NSAID-induced renal failure. Monitor closely.
Drug-lifestyle.
Alcohol use: increased orthostatic hypotensive effect. Monitor closely.

Effects on diagnostic tests
Drug may interfere with tests for parathyroid function.

Contraindications
Contraindicated in patients with hypersensitivity to other thiazides or other sulfonamide derivatives and in those with anuria.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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