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Hydrochlorothiazide/ spironolactone

Generic Name: spironolactone/hydrochlorothiazide (spir-ON-oh-LAK-tone/HYE-droe-KLOR-oh-THYE-a-zide)
Brand Name: Aldactazide

Spironolactone, an ingredient in hydrochlorothiazide/spironolactone, has been shown to cause tumors in laboratory animals. Hydrochlorothiazide/spironolactone should be used for the conditions for which it is indicated. Avoid unnecessary use of hydrochlorothiazide/spironolactone.

Hydrochlorothiazide/spironolactone may not be appropriate for all patients. Tell your doctor if you have never taken any medicine for high blood pressure or for swelling or fluid retention.

Be sure to keep all doctor and lab appointments while you are taking hydrochlorothiazide/spironolactone.


Hydrochlorothiazide/ spironolactone is used for:

Treating swelling and fluid retention in patients who have congestive heart failure, cirrhosis of the liver, or a certain kidney problem (nephrotic syndrome) when other treatments are not effective or appropriate. It is also used to treat high blood pressure in patients for whom other treatments are not effective or appropriate. It may also be used for other conditions as determined by your doctor.

Hydrochlorothiazide/spironolactone is a combination of a potassium-sparing diuretic (spironolactone) and a thiazide diuretic (hydrochlorothiazide). It works by making the kidneys eliminate sodium (salt) and water from the body, which helps to lower blood pressure. The spironolactone component helps minimize potassium loss.

Do NOT use hydrochlorothiazide/ spironolactone if:

  • you are allergic to any ingredient in hydrochlorothiazide/spironolactone, to thiazide diuretics (eg, indapamide), or to any other sulfonamide (eg, sulfamethoxazole)
  • you are unable to urinate, have severe kidney problems, severe liver problems, high blood potassium or calcium levels, or Addison disease
  • you are taking another potassium-sparing diuretic (eg, amiloride, triamterene), another aldosterone-blocker (eg, eplerenone), or dofetilide

Contact your doctor or health care provider right away if any of these apply to you.

Before using hydrochlorothiazide/ spironolactone:

Some medical conditions may interact with hydrochlorothiazide/spironolactone. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have cirrhosis or other liver problems, diabetes, gout, kidney problems (eg, kidney stones), asthma, heart problems (eg, heart failure), menstrual problems, or systemic lupus erythematosus (SLE or lupus)
  • if you have high cholesterol or triglyceride levels, elevated blood acid, low folic acid levels, or electrolyte problems (eg, low blood sodium or magnesium levels), or are dehydrated
  • if you have a history of high blood potassium levels or if your diet has a lot of potassium in it
  • if you have recently had a certain type of nerve surgery (sympathectomy)
  • if you have never taken medicines for high blood pressure or for swelling or fluid retention

Some MEDICINES MAY INTERACT with hydrochlorothiazide/spironolactone. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Cholestyramine because a severe side effect called metabolic acidosis may occur
  • Aliskiren, angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin II receptor antagonists (eg, valsartan), canagliflozin, cyclosporine, heparin or related products (eg, dalteparin, enoxaparin), macrolide immunosuppressives (eg, tacrolimus), other aldosterone-blockers (eg, eplerenone), other potassium-sparing diuretics (eg, amiloride, triamterene), potassium supplements, or salt substitutes containing potassium because the risk of high blood potassium levels may be increased
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin) because they may decrease hydrochlorothiazide/spironolactone's effectiveness, and the risk of high blood potassium or kidney problems may be increased
  • Corticotrophin (ACTH), corticosteroids (eg, prednisone), or loop diuretics (eg, furosemide) because the risk of low blood potassium levels may be increased
  • Barbiturates (eg, phenobarbital), diazoxide, digoxin, dofetilide, lithium, narcotic pain medicines (eg, codeine), or medicines for high blood pressure because the risk of their side effects may be increased by hydrochlorothiazide/spironolactone
  • Insulin or other diabetes medicines (eg, glipizide) because their effectiveness may be decreased by hydrochlorothiazide/spironolactone

This may not be a complete list of all interactions that may occur. Ask your health care provider if hydrochlorothiazide/spironolactone may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use hydrochlorothiazide/ spironolactone:

Use hydrochlorothiazide/spironolactone as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take hydrochlorothiazide/spironolactone by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • Hydrochlorothiazide/spironolactone may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
  • If you take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with hydrochlorothiazide/spironolactone.
  • If you miss a dose of hydrochlorothiazide/spironolactone, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use hydrochlorothiazide/spironolactone.

Important safety information:

  • Hydrochlorothiazide/spironolactone may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use hydrochlorothiazide/spironolactone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Hydrochlorothiazide/spironolactone may cause dizziness, light-headedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
  • Check with your doctor before you drink alcohol while you are using hydrochlorothiazide/spironolactone.
  • Hydrochlorothiazide/spironolactone can raise your blood potassium level. The risk may be increased in people with kidney or liver problems, or in the elderly. High blood potassium levels may lead to serious and possibly fatal irregular heartbeat. Discuss any questions or concerns with your doctor.
  • Hydrochlorothiazide/spironolactone contains a sulfonamide called hydrochlorothiazide, which can cause certain eye problems (eg, myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting hydrochlorothiazide/spironolactone. Contact your doctor right away if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain.
  • Hydrochlorothiazide/spironolactone may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to hydrochlorothiazide/spironolactone. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
  • Hydrochlorothiazide/spironolactone may cause enlarged breasts in some men who take it. This effect is normally reversible after hydrochlorothiazide/spironolactone is stopped, but may rarely persist after stopping it. Contact your doctor if you experience enlarged breasts.
  • Tell your doctor or dentist that you take hydrochlorothiazide/spironolactone before you receive any medical or dental care, emergency care, or surgery.
  • Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.
  • Check with your doctor before you use a salt substitute or a product that has potassium in it.
  • Hydrochlorothiazide/spironolactone may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away.
  • Diabetes patients - Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • Hydrochlorothiazide/spironolactone may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking hydrochlorothiazide/spironolactone.
  • Lab tests, including liver function, kidney function, lung function, blood pressure, blood electrolytes, and fasting blood glucose, may be performed while you use hydrochlorothiazide/spironolactone. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use hydrochlorothiazide/spironolactone with caution in the ELDERLY; they may be more sensitive to its effects, especially high blood potassium levels.
  • Hydrochlorothiazide/spironolactone should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using hydrochlorothiazide/spironolactone while you are pregnant. Hydrochlorothiazide/spironolactone is found in breast milk. Do not breast-feed while taking hydrochlorothiazide/spironolactone.

Possible side effects of hydrochlorothiazide/ spironolactone:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; headache; loss of appetite; nausea; stomach upset or cramping; tiredness; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody, black, or tarry stools; breast pain; burning, numbness, or tingling; confusion; dark urine; decreased coordination; decreased sexual ability; decreased urination or change in the amount of urine produced; dry mouth; excessive thirst; eye pain; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; leg or muscle cramps, pain, or weakness; menstrual changes; mental or mood changes; red, swollen, blistered, or peeling skin; restlessness; severe or persistent dizziness, weakness, or tiredness; severe or persistent nausea or vomiting; sluggishness; stomach pain; unusual bruising or bleeding; unusual drowsiness; unusual weight loss; vision changes (eg, blurred vision, decreased vision clearness); vomit that looks like coffee grounds; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include diarrhea; light-headedness, especially upon standing; nausea; symptoms of blood electrolyte problems (eg, confusion; dizziness; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness; trouble breathing); unusual drowsiness; vomiting; weakness.

Proper storage of hydrochlorothiazide/spironolactone:

Store hydrochlorothiazide/spironolactone at room temperature, below 77 degrees F (25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep hydrochlorothiazide/spironolactone out of the reach of children and away from pets.

General information:

  • If you have any questions about hydrochlorothiazide/spironolactone, please talk with your doctor, pharmacist, or other health care provider.
  • Hydrochlorothiazide/spironolactone is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take hydrochlorothiazide/spironolactone or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about hydrochlorothiazide/spironolactone. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to hydrochlorothiazide/spironolactone. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using hydrochlorothiazide/spironolactone.

Issue Date: July 2, 2014
Database Edition 14.3.1.001
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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