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Hydrochlorothiazide

Pronunciation

Class: Thiazide Diuretics
VA Class: CV701
CAS Number: 58-93-5
Brands: Accuretic, Aldactazide, Aldoril, Atacand HCT, Avalide, Benicar HCT, Capozide, Diovan HCT, Dyazide, Hydra-Zide, HydroDIURIL, Hyzaar, Inderide, Lopressor HCT, Lotensin HCT, Maxzide, Micardis HCT, Microzide, Moduretic, Monopril HCT, Prinzide, Teveten HCT, Timolide, Uniretic HCT, Vaseretic, Zestoretic, Ziac

Introduction

Thiazide diuretic and antihypertensive agent.a

Uses for Hydrochlorothiazide

Hypertension

Used alone or in combination with other antihypertensive agents for all stages of hypertension.b f 110

Thiazides have well-established benefits, can be useful in achieving goal BP alone or combined with other antihypertensive drugs, enhance the antihypertensive efficacy of multidrug regimens, and are more affordable than other agents.b f

JNC 7 recommends that thiazides be used as initial therapy for the treatment of uncomplicated hypertension in most patients, either alone or combined with other classes of antihypertensive drugs with demonstrated benefit (e.g., ACE inhibitors, angiotensin II receptor antagonists, β-blockers, calcium-channel blockers).f

Most hypertension outcome studies have involved thiazides, which generally have been unsurpassed in preventing cardiovascular complications of hypertension and are relatively inexpensive and well tolerated.f

The principal goal of preventing and treating hypertension is to reduce the risk of cardiovascular and renal morbidity and mortality, including target organ damage.f The higher the baseline BP, the more likely the development of MI, heart failure, stroke, and renal disease.f

Effective antihypertensive therapy reduces the risk of stroke by about 34–40%, MI by about 20–25%, and heart failure by more than 50%.f

Antihypertensive drug therapy is recommended for all patients with SBP/DBP ≥140/90 mm Hg who fail to respond to lifestyle/behavioral modifications.f

Initial antihypertensive therapy with drugs generally is recommended for anyone with diabetes mellitus, chronic renal impairment, or heart failure having SBP ≥130 mm Hg or DBP≥80 mm Hg.f

Black hypertensive patients generally tend to respond better to monotherapy with diuretics or calcium-channel blockers than to monotherapy with ACE inhibitors, angiotensin II receptor antagonists, or β-blockers.f 100

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Thiazides are preferred in hypertensive patients with osteoporosis. Secondary beneficial effect in hypertensive geriatric patients of reducing the risk of osteoporosis secondary to effect on calcium homeostasis and bone mineralization.

Thiazide diuretics (unlike potassium-sparing diuretics) may be used in patients who are at an increased risk for developing hyperkalemia (e.g., those receiving an ACE inhibitor).112

Although hypertension during pregnancy responds well to thiazides, and the drugs had been used widely in the past for preeclampsia and eclampsia,b g such use no longer is recommended and other antihypertensives (e.g., methyldopa, hydralazine, labetalol) currently are preferred.f

Although rarely induces acute gout, generally avoid or use with caution in hypertensive patients with a history of gout or elevated uric acid concentrations.f

Edema (General)

Management of edema resulting from various causes; diagnose etiology before use.b

Edema caused by renal disease or by corticosteroids or estrogens may be relatively resistant to treatment.b

Ineffective in patients with Scr or BUN concentrations greater than twice normal.b

May be ineffective in patients with a GFR of <15–25 mL/minute; even when GFR is 25–50 mL/minute, more potent (e.g., loop) diuretics may be indicated.b

No substantial difference in clinical effects or toxicity of comparable thiazide or thiazide-like diuretics, except metolazone may be more effective in edema with renal impairment.b

Edema in CHF

Management of edema associated with CHF.b c

Used in conjunction with moderate sodium restriction (≤3 g of sodium daily), an ACE inhibitor, and usually a β-adrenergic blocking agent, with or without a cardiac glycoside.c d

Beneficial effects are additive with those of cardiac glycosides and/or ACE inhibitors.c

Unless contraindicated or not tolerated, all patients with mild to severe CHF secondary to left ventricular systolic dysfunction (ejection fraction less than 35–40%) generally should receive therapy with a diuretic in conjunction with an ACE inhibitor with or without a cardiac glycoside or a β-adrenergic blocking agent.d

Diuretic therapy and sodium restriction are not routinely necessary in patients with left ventricular systolic dysfunction and no or minimal overt signs or symptoms of heart failure (NYHA functional class I heart failure);d d diuretics should be added to ACE inhibitor therapy if volume overload develops or if symptoms of heart failure continue.

Concomitant diuretic therapy usually is indicated in patients with symptomatic heart failure (NYHA class II or greater) because of the likelihood of sodium and fluid retention.d

Do not use diuretics as monotherapy in CHF even if symptoms (e.g., peripheral edema, pulmonary congestion) are well controlled; diuretics alone do not prevent progression of heart failure.

Diuretics produce rapid symptomatic benefits, relieving pulmonary and peripheral edema more rapidly (within hours or days) than cardiac glycosides, ACE inhibitors, or β-blockers (in weeks or months).

Once fluid retention has resolved in CHF, diuretic therapy should be maintained to prevent recurrence of fluid retention. Ideally, diuretic therapy should be adjusted according to changes in body weight (as an indicator of fluid retention) rather than maintained at a fixed dosage.

Diuretics should be continued in CHF and comorbid conditions (e.g., hypertension) where ongoing therapy with the drugs is indicated.

Edema Secondary to Nephrotic Syndrome

May be useful if the patient fails to respond to corticosteroid therapy.b

More likely to become refractory to thiazides than edema associated with CHF, and more potent diuretics may be required.b

Edema in Pregnancy

Generally responds well to thiazides except when caused by renal disease.b

Thiazides should not be used for routine therapy in pregnant women with mild edema who are otherwise healthy.b

Diabetes Insipidus

Has been used widely in the treatment of diabetes insipidus.b

Effective in both the neurohypophyseal and nephrogenic forms of the disease, decreasing urine volume by up to 50%.b

Particularly useful in nephrogenic diabetes insipidus, since this form of the disease is unresponsive to vasopressin or lypressin and chlorpropamide.b

Useful in patients who are allergic or refractory to vasopressin or lypressin and has been used in combination with one of these hormones and a low-salt diet in patients who excrete an exceptionally large volume of urine.b

Renal Tubular Acidosis

Has been used with success in the treatment of electrolyte disturbances associated with renal tubular acidosis.b

Renal Calculus Formation

Has been used with success in the prophylaxis of renal calculus formation associated with hypercalciuria.b

Hydrochlorothiazide Dosage and Administration

Administration

Administer orally.a

Dosage

Individualize according to requirements and response.a Use lowest dosage necessary to produce desired clinical effect.109

If added to potent hypotensive agent regimen, initially reduce hypotensive dosage to avoid the possibility of severe hypotension.a

Pediatric Patients

Usual Dosage
Oral

Infants <6 months of age: Up to 3 mg/kg daily, in 2 divided doses; up to 37.5 mg daily.109

Infants 6 months to 2 years of age: Usually, 1–2 mg/kg daily, in a single or 2 divided doses, up to 37.5 mg daily.109

Children 2–12 years of age: 1–2 mg/kg daily, in a single or 2 divided doses, up to 100 mg daily.a

Hypertension
Oral

Initially, 1 mg/kg once daily.111 Increase dosage as necessary up to a maximum of 3 mg/kg (up to 50 mg) once daily.111

Adults

Hypertension
BP Monitoring and Treatment Goals

Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.d

Avoid large or abrupt reductions in BP.d

Adjust dosage at approximately monthly intervals (more aggressively in high-risk patients [stage 2 hypertension, comorbid conditions]) if BP control is inadequate at a given dosage; it may take months to control hypertension adequately while avoiding adverse effects of therapy.d

SBP is the principal clinical end point, especially in middle-aged and geriatric patients.d Once the goal SBP is attained, the goal DBP usually is achieved.

The goal is to achieve and maintain a lifelong SBP <140 mm Hg and a DBP <90 mm Hg if tolerated.d

The goal in hypertensive patients with diabetes mellitus or renal impairment is to achieve and maintain a SBP <130 mm Hg and a DBP <80 mm Hg.d

Monotherapy
Oral

Initially, 12.5–25 mg daily.101 102 110 112

Gradually increase until the desired therapeutic response is achieved or adverse effects become intolerable, up to 50 mg daily.101 102 109

If adequate response is not achieved at maximum dosage, add or substitute another hypotensive agent.101 102 109 110

Maintenance

Usually, 12.5–50 mg once daily.102 109 110

Combination Therapy
Oral

Initially, administer each drug separately to adjust dosage.a

May use fixed combination if optimum maintenance dosage corresponds to drug ratio in combination preparation.a

Administer each drug separately whenever dosage adjustment is necessary.a

Alternatively, may initially use certain (low-dose hydrochlorothiazide/other antihypertensive) fixed combinations for potentiation of antihypertensive effect and minimization of potential dose-related adverse effects of each drug.102

Edema
Oral

Usually, 25–100 mg daily in 1–3 divided doses.109

Many patients also may respond to intermittent therapy (e.g., alternate days, 3–5 days weekly); decreased risk of excessive diuretic response and resulting electrolyte imbalance.109

Prescribing Limits

Pediatric Patients

Usual Dosage
Oral

Infants <2 years of age: Maximum 37.5 mg daily.109

Children 2–12 years of age: Maximum 100 daily.109

Hypertension
Oral

Maximum 3 mg/kg (up to 50 mg) once daily.111

Adults

Hypertension
Oral

Maximum before switching/adding alternative drug is 50 mg daily.101 102 109

Higher dosages had been used in the past (up to 200 mg daily)e but no longer are recommended because of the risk of adverse effects (e.g., markedly decreased serum potassium).101 Instead, switch to or add alternative drug.

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment; caution because of risk of precipitating hepatic coma.a 109

Renal Impairment

No specific dosage recommendations for renal impairment; caution because of risk of precipitating azotemia.a 109

Geriatric Patients

Initiate therapy at the lowest dosage (12.5 mg daily); may adjust dosage in increments of 12.5 mg if needed.112

Cautions for Hydrochlorothiazide

Contraindications

  • Anuria.b 109

  • Known hypersensitivity to hydrochlorothiazide, other thiazides, or any ingredient in the formulation.b

  • Although manufacturers state allergy to other sulfonamide derivatives is a contraindication,109 evidence to support cross-sensitivity is limited, and history of sensitivity to sulfonamide anti-infectives (“sulfa sensitivity”) should not be considered an absolute contraindication.

Warnings/Precautions

Warnings

Severe Renal Impairment

Use with caution; thiazides decrease GFR and may precipitate azotemia.b 109

Effects may be cumulative in impaired renal function.b 109

Hepatic Impairment

Use with caution in hepatic impairment or progressive liver disease (particularly with associated potassium deficiency); electrolyte imbalance may precipitate hepatic coma.b 109

Discontinue immediately if signs of impending hepatic coma appear.b

Hypotensive Agents

May potentiate effects of other hypotensive agents.109 Although additive or potentiated antihypertensive effects usually are used to therapeutic advantage,f hypotension could occur.109 b (See Interactions.)

Lupus Erythematosus

Possible exacerbation or activation of systemic lupus erythematosus.109

Lithium

Generally, do not use with lithium salts.109 (See Interactions.)

Sensitivity Reactions

Hypersensitivity

May occur with or without history of allergy or bronchial asthma.109

Sulfonamide cross-sensitivity unlikely. (See Contraindications under Cautions.)

General Precautions

Electrolyte Imbalance

Monitor for fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia).b 109

Observe for signs of electrolyte imbalance (e.g., dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains, cramps, muscular fatigue, hypotension, tachycardia, nausea, vomiting).109

Perform periodic serum electrolyte determinations (particularly of potassium, sodium, chloride, and bicarbonate); institute measures to maintain normal serum concentrations if necessary.b

Serum and urinary electrolyte measurements are especially important with diabetes mellitus, vomiting, diarrhea, parenteral fluid therapy, or expectations of excessive diuresis.b

Weekly (or more frequent) electrolyte measurement recommended early in treatment; possible to extend interval between measurements to ≥3 months when electrolyte response has stabilized.b

Hypokalemia

May occur after brisk diuresis, when cirrhosis is present, or with prolonged therapy; inadequate oral electrolyte intake may contribute.109

May cause cardiac arrhythmias, exaggerate cardiac response to cardiac glycoside toxicity (increase ventricular irritability).109

Use potassium-sparing diuretics and/or potassium supplementation to avoid or treat hypokalemia.109

Hypochloremia

Generally mild, usually does not require specific treatment except in renal or hepatic impairment.109

Chloride replacement may be required for metabolic acidosis.109

Hyponatremia

Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate treatment usually is water restriction rather than salt administration except when hyponatremia is life-threatening.109

In actual salt depletion, appropriate replacement is treatment of choice.109

Gout

Hyperuricemia or precipitation of gout may occur.109

Hyperglycemia

In diabetic patients, dosage adjustment of insulin or oral hypoglycemics may be required; hyperglycemia may occur and latent diabetes mellitus may become evident.109

Sympathectomy

Antihypertensive effect may be enhanced after sympathectomy.109

Hypomagnesemia

May increase magnesium urinary excretion, resulting in hypomagnesemia.109

Hypercalcemia

May decrease calcium urinary excretion, cause slight intermittent serum calcium increase in absence of known calcium metabolism disorder; marked hypercalcemia may indicate hyperparathyroidism.109

Discontinue prior to performing parathyroid tests.109

Hyperlipidemia

May increase cholesterol and triglyceride concentrations.109

Clinical importance of these changes is unknown.b Diet low in saturated fat and cholesterol usually compensates.b

Hypotensive Effects

Orthostatic hypotension rarely occurs.b

Specific Populations

Pregnancy

Category B.109

Although hypertension during pregnancy responds well to thiazides, and the drugs had been used widely in the past for preeclampsia and eclampsia,b g such use no longer is recommended and other antihypertensives (e.g., methyldopa, hydralazine, labetalol) currently are preferred.f Diuretics are not recommended for pregnancy-induced hypertension because of the maternal hypovolemia associated with this form of hypertension; decreased placental perfusion is possible.g Diuretics are considered second-line agents for control of chronic hypertension in pregnant women.f

Thiazides should not be used as routine therapy in pregnant women with mild edema who are otherwise healthy.b

Edema associated with pregnancy generally responds well to thiazides except when caused by renal disease.b

Lactation

Distributed into milk.g h 109 Discontinue nursing or the drug.109

Although hydrochlorothiazide use generally is considered compatible with breast-feeding,g h thiazides can reduce milk volume and thus suppress lactation.f g

Pediatric Use

No controlled studies in children; use is supported by experience and published literature about hypertension treatment in children.109 111

Geriatric Use

Elderly may be at increased risk of dilutional hyponatremia, especially underweight females with poor oral fluid and electrolyte intake or excessive low-sodium nutritional supplement intake.b (See Hyponatremia under Warnings/Precautions.)

Increased incidence of adverse effects and excessive reduction in BP in those >65 years of age.112 (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use caution.b (See Hepatic Impairment under Warnings.)

Renal Impairment

Use caution.b (See Severe Renal Impairment under Warnings.)

Consider interruption or discontinuance if progressive renal impairment (rising nonprotein nitrogen, BUN, or serum creatinine) occurs.109

Common Adverse Effects

Potassium depletion, hyperuricemia (usually asymptomatic rarely leading to gout).b Hypochloremic alkalosis in patients at risk (e.g., hypokalemic patients).b Hyperglycemia and glycosuria in diabetics.b

Interactions for Hydrochlorothiazide

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Alcohol

Increased risk of postural hypotension with thiazidesb

Amphetamine

Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., amphetamine) with concurrent useb

Urine pH change is not great during thiazide use and, toxic blood concentrations of amines usually do not occurb

Monitor for signs of toxicity after initiation of thiazides in patients receiving amphetamineb

Amphotericin B

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Anticoagulants, oral

Postulated that may antagonize oral anticoagulant effectsb

Confirmatory evidence is lackingb

Antidiabetic agents (sulfonylureas)

Thiazide hyperglycemic effect may exacerbate diabetes mellitus, increase antidiabetic agent requirements, and/or cause temporary loss of diabetic control or secondary failure to antidiabetic agentb

Barbiturates

Increased risk of postural hypotension with thiazidesb

Cholestyramine or colestipol resin

May bind thiazides, reduce their GI absorption, with cholestyramine reportedly producing greater binding in vitrob

Administer thiazides at least 2 hours before cholestyramine or colestipol when used concomitantlyb

Corticosteroids

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Corticotropin

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Diazoxide

May potentiate diazoxide hyperglycemic, hypotensive, and hyperuricemic effectsb

Use concomitantly with cautionb

Digitalis glycosides

Thiazide-induced electrolyte disturbances (principally hypokalemia, but also hypomagnesemia and hypercalcemia) may increase digitalis toxicity riskb

Perform periodic electrolyte determinations with concomitant use; correct hypokalemia if warrantedb

Hypotensive agents

Increased hypotensive effects of most other hypotensive agents b

Addition of thiazide to stabilized regimen with potent hypotensive agent (e.g., guanethidine sulfate, methyldopa, ganglionic blocking agent) may cause severe postural hypotensionb

Usually used to therapeutic advantageb

Insulin

May exacerbate diabetes mellitus, increase insulin requirements, cause temporary loss of diabetic control, or secondary failure to insulinb

Lithium

Thiazides (sometimes used with lithium to reduce lithium-induced polyuria) reduced renal lithium clearance within several daysb

Can increase serum lithium concentrations and the risk of lithium intoxicationb

Occasionally used to therapeutic advantage to reduce lithium-induced polyuria, but reduce lithium dosage by about 50% and monitor serum lithium carefully.b Generally, avoid concomitant use because of increased lithium toxicity risk.b

Methenamine

Urinary alkalinization may decrease the effectiveness of methenamine compounds which require a urinary pH of ≤5.5 for optimal activityb

Monitor urine pH during concurrent therapyb

Neuromuscular blocking agents (e.g., tubocurarine chloride or gallamine triethiodide [both no longer commercially available in the US])

May cause prolonged neuromuscular blockadeb

Confirmatory evidence lackingb

NSAIAs

Increased risk of NSAIA-induced renal failure secondary to prostaglandin inhibition and decreased renal blood flowb

NSAIAs may interfere with the natriuretic, diuretic, and antihypertensive response to diuretics b

Monitor closely for possible adverse effects and/or attenuation of diuretic-induced therapeutic effects during concomitant useb

Opiates

Increased risk of postural hypotension with thiazidesb

Probenecid

Blocks thiazide-induced uric acid retentionb

Also blocks renal tubular secretion of thiazide, but effect on thiazide duration of action apparently not studiedb

Apparently enhances excretion of calcium, magnesium, and citrate during thiazide therapy, but urinary calcium concentrations remain below normalb

Sodium, potassium, ammonia, chloride, bicarbonate, phosphate, and titratable acid excretion apparently not affected by concomitant probenecid and thiazide therapyb

Used to therapeutic advantageb

Quinidine

Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., quinidine) with concurrent useb

Urine pH change is not great during thiazide use, and toxic blood concentrations of amines usually do not occurb

Monitor for signs of toxicity after initiation of thiazideb

Test, Amylase (serum)

Values may be increased substantially in both asymptomatic patients and in patients developing acute pancreatitis who are receiving thiazidesb

Test, Corticosteroids (urinary) (Glenn-Nelson technique)

Decreased values by interfering in vitro with the absorbance in the modified Glenn-Nelson technique for urinary 17-hydroxycorticosteroids; may also decrease urinary cortisol excretionb

Importance of effect on urinary corticosteroids is unclearb

Test, Estrogens (spectrophotometric assay of total urinary estrogen; assay of estradiol)

Hydrochlorothiazide causes falsely decreased values by interfering with formation of the Kober chromogen, and with the assay of estriol by degrading estriol at the acid hydrolytic stage of the assay; does not occur with chlorothiazideb

Test, Histamine for pheochromocytoma

False-negative resultsb

Test, Parathyroid function tests

May elevate serum calcium in the absence of known disorders of calcium metabolismb

Discontinue thiazides prior to performing parathyroid function testsb

Test, Phenolsulfonphthalein (PSP)

Thiazides compete with phenolsulfonphthalein (PSP) for secretion by the proximal renal tubulesb

Importance unknownb

Test, Phentolamine

False-negative resultsb

Test, Protein-bound iodine (PBI)

Values may be decreased, although usually not to subnormalb

Test, Triiodothyronine resin uptake

Decreased slightly, but 24-hour I 131 uptake is not affectedb

Test, Tyramine

False-negative resultsb

Vasopressors (e.g., norepinephrine)

Possible decreased arterial responsiveness to vasopressor amines b

Clinical importance not established;b decrease in pressor response not sufficient to preclude vasopressor use109

Hydrochlorothiazide Pharmacokinetics

Absorption

Bioavailability

Variable absorption from GI tract.b

Onset

Diuretic effect: Within 2 hours; peak effect in 3–6 hours.b 109

Hypotensive effect: Generally 3–4 days.b

Duration

Diuretic effect: 6–12 hours.b 109

Food

Food decreases rate and extent of absorption of Microzide capsules.112

Distribution

Extent

Distributed in the extracellular space.a b

Does not cross blood-brain barrier.a

Readily crosses the placenta.a b g

Distributed into breast milk.a g h

Elimination

Metabolism

Not metabolized.a

Elimination Route

Excreted unchanged in urine;a ≥61% eliminated in 24 hours.a

Half-life

5.6–15 hours.a

Special Populations

In patients with uncompensated CHF or impaired renal function, excretion may be delayed.b Effect of hemodialysis on elimination of the drug has not been determined.112

Stability

Storage

Oral

Capsules

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.112

Oral Solution

Tight containers at <40°C, preferably at 15–30°C.a Avoid freezing.a

Tablets

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.109 a

Actions

  • Exact mechanism of diuretic action is unclear; may act by altering metabolism of the tubular cells.b

  • Enhances excretion of sodium, chloride, and water by interfering with the transport of sodium ions across the renal tubular epithelium.b

  • Primary site of diuretic action appears to be the cortical diluting segment of the nephron.b

  • GFR decreases, but unclear whether secondary to a direct effect on renal vasculature or to the decrease in intravascular fluid volume or an increase in tubular pressure caused by the inhibition of sodium and water reabsorption.b The fall in GFR is not important in the mechanism of action.b

  • Enhances urinary excretion of potassium secondary to increased amount of sodium at distal tubular site of sodium-potassium exchange.b

  • Increases urinary bicarbonate excretion (although to a lesser extent than chloride excretion) but change in urinary pH is usually minimal; diuretic efficacy is not affected by the acid-base balance of the patient.b

  • Hypocalciuric effect is thought to result from a decrease in extracellular fluid (ECF) volume, although calcium reabsorption in the nephron may be increased; also, slight or intermittent elevations in serum calcium concentration.b

  • Rate of uric acid excretion is decreased, probably because of competitive inhibition of uric acid secretion or a decrease in ECF volume and a secondary increase in uric acid reabsorption.b

  • Hypotensive activity in hypertensive patients; also augments the action of other hypotensive agents.b Precise mechanism of hypotensive action has not been determined, but postulated that part of this effect is caused by direct arteriolar dilation.b

Advice to Patients

  • Advise patient of signs of electrolyte imbalance (e.g., dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains or cramps, muscular fatigue, hypotension, tachycardia, GI disturbances such as nausea and vomiting).b

  • Advise patients of importance of compliance with scheduled determinations of serum electrolyte concentrations (particularly potassium, sodium, chloride, and bicarbonate).b

  • Advise hypertensive patients of importance of continuing lifestyle/behavioral modifications that include weight reduction (for those who are overweight or obese), dietary changes to include foods that are rich in potassium and calcium and moderately restricted in sodium (adoption of the Dietary Approaches to Stop Hypertension [DASH] eating plan), increased physical activity, smoking cessation, and moderation of alcohol intake.

    Advise that lifestyle/behavioral modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk and remain an indispensable part of the management of hypertension.

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

12.5 mg*

Hydrochlorothiazide Capsules

Microzide

Watson

Solution

50 mg/5 mL*

Hydrochlorothiazide Solution

Tablets

25 mg*

Hydrochlorothiazide Tablets

HydroDIURIL (scored)

Merck

50 mg*

Hydrochlorothiazide Tablets

HydroDIURIL (scored)

Merck

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Amiloride Hydrochloride and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg of Anhydrous Amiloride Hydrochloride and Hydrochlorothiazide 50 mg*

Amiloride Hydrochloride and Hydrochlorothiazide Tablets

Moduretic (scored)

Merck

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Captopril and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

25 mg Captopril and Hydrochlorothiazide 15 mg*

Capozide (scored)

Par

Captopril and Hydrochlorothiazide Tablets

25 mg Captopril and Hydrochlorothiazide 25 mg*

Capozide (scored)

Par

Captopril and Hydrochlorothiazide Tablets

50 mg Captopril and Hydrochlorothiazide 15 mg*

Capozide (scored)

Par

Captopril and Hydrochlorothiazide Tablets

50 mg Captopril and Hydrochlorothiazide 25 mg*

Capozide (scored)

Par

Captopril and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Enalapril Maleate and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg Enalapril Maleate and Hydrochlorothiazide 12.5 mg*

Enalapril Maleate and Hydrochlorothiazide Tablets

Vaseretic

Biovail

10 mg Enalapril Maleate and Hydrochlorothiazide 25 mg*

Enalapril Maleate and Hydrochlorothiazide Tablets

Vaseretic

Biovail

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Methyldopa and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

250 mg Methyldopa and Hydrochlorothiazide 15 mg*

Methyldopa and Hydrochlorothiazide Tablets

250 mg Methyldopa and Hydrochlorothiazide 25 mg*

Aldoril

Merck

Methyldopa and Hydrochlorothiazide Tablets

Metoprolol Tartrate and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

50 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg

Lopressor HCT (scored)

Novartis

100 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg

Lopressor HCT (scored)

Novartis

100 mg Metoprolol Tartrate and Hydrochlorothiazide 50 mg

Lopressor HCT (scored)

Novartis

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Propranolol Hydrochloride and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

40 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg*

Inderide (scored)

Wyeth

Propranolol Hydrochloride and Hydrochlorothiazide Tablets

80 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg*

Inderide (scored)

Wyeth

Propranolol Hydrochloride and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Spironolactone and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

25 mg Spironolactone and Hydrochlorothiazide 25 mg*

Aldactazide

Pfizer

Spironolactone and Hydrochlorothiazide Tablets

50 mg Spironolactone and Hydrochlorothiazide 50 mg*

Aldactazide (scored)

Pfizer

Timolol Maleate and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

10 mg Timolol Maleate and Hydrochlorothiazide 25 mg

Timolide

Merck

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Triamterene and Hydrochlorothiazide (Co-triamterzide)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Dyazide

GlaxoSmithKline

Triameterene and Hydrochlorothiazide Capsules

50 mg Triamterene and Hydrochlorothiazide 25 mg*

Triamterene and Hydrochlorothiazide Capsules

Tablets

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Maxzide (scored)

Mylan Bertek

Triameterene and Hydrochlorothiazide Tablets

75 mg Triamterene and Hydrochlorothiazide 50 mg*

Maxzide (scored)

Mylan Bertek

Triameterene and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Other Hydrochlorothiazide Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

25 mg with Hydralazine Hydrochloride 25 mg

Hydra-Zide

Par

50 mg with Hydralazine Hydrochloride 50 mg

Hydra-Zide

Par

50 mg with Hydralazine Hydrochloride 100 mg

Hydra-Zide

Par

Tablets

12.5 mg with Candesartan 16 mg

Atacand HCT

AstraZeneca

12.5 mg with Candesartan 32 mg

Atacand HCT

AstraZeneca

12.5 mg with Fosinopril Sodium 10 mg

Fosinopril Sodium and Hydrochlorothiazide Tablets

Monopril HCT

Bristol-Myers Squibb

12.5 mg with Fosinopril Sodium 20 mg

Fosinopril Sodium and Hydrochlorothiazide Tablets

Monopril HCT (scored)

Bristol-Myers Squibb

12.5 mg with Irbesartan 150 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Aventis)

12.5 mg with Irbesartan 300 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Aventis)

12.5 mg with Lisinopril 10 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

12.5 mg with Lisinopril 20 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

12.5 mg with Telmisartan 40 mg

Micardis HCT

Boehringer Ingelheim

12.5 mg with Telmisartan 80 mg

Micardis HCT

Boehringer Ingelheim

12.5 mg with Valsartan 80 mg

Diovan HCT

Novartis

12.5 mg with Valsartan 160 mg

Diovan HCT

Novartis

12.5 mg with Valsartan 320 mg

Diovan HCT

Novartis

25 mg with Irbesartan 300 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)

25 mg with Lisinopril 20 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

25 mg with Telmisartan 80 mg

Micardis HCT

Boehringer Ingelheim

25 mg with Valsartan 160 mg

Diovan HCT

Novartis

25 mg with Valsartan 320 mg

Diovan HCT

Novartis

Tablets, film-coated

6.25 mg with Benazepril Hydrochloride 5 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

6.25 mg with Bisoprolol Fumarate 2.5 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

6.25 mg with Bisoprolol Fumarate 5 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

6.25 mg with Bisoprolol Fumarate 10 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

12.5 mg with Benazepril Hydrochloride 10 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

12.5 mg with Benazepril Hydrochloride 20 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

12.5 mg with Eprosartan Mesylate 600 mg (of eprosartan)

Teveten HCT

Abbott

12.5 mg with Losartan Potassium 50 mg

Hyzaar

Merck

12.5 mg with Losartan Potassium 100 mg

Hyzaar

Merck

12.5 mg with Moexipril Hydrochloride 7.5 mg

Uniretic (scored)

Schwarz

12.5 mg with Moexipril 15 mg

Uniretic HCT (scored)

Schwarz

12.5 mg with Olmesartan Medoxomil 20 mg

Benicar HCT

Daiichi-Sankyo

12.5 mg with Olmesartan Medoxomil 40 mg

Benicar HCT

Daiichi-Sankyo

12.5 mg with Quinapril Hydrochloride 10 mg (of quinapril)

Accuretic (scored)

Pfizer

12.5 mg with Quinapril Hydrochloride 20 mg (of quinapril)

Accuretic (scored)

Pfizer

15 mg with Hydrochlorothiazide 250 mg*

Methyldopa and Hydrochlorothiazide Tablets

25 mg with Benazepril Hydrochloride 20 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

25 mg with Eprosartan Mesylate 600 mg (of eprosartan)

Teveten HCT

Abbott

25 mg with Losartan Potassium 100 mg

Hyzaar

Merck

25 mg with Hydrochlorothiazide 250mg*

Aldoril

Merck

Methyldopa and Hydrochlorothiazide Tablets

25 mg with Moexipril Hydrochloride 15 mg

Uniretic (scored)

Schwarz

25 mg with Olmesartan Medoxomil 40 mg

Benicar HCT

Daiichi-Sankyo

25 mg with Quinapril Hydrochloride 20 mg (of quinapril)

Accuretic (scored)

Pfizer

25 mg with Spironolactone 25 mg*

Aldactazide ()

Pfizer

Spironolactone and Hydrochlorothiazide Tablets

50 mg with Spironolactone 50 mg

Aldactazide (scored)

Pfizer

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Accuretic 10-12.5MG Tablets (PFIZER U.S.): 30/$66.99 or 90/$200.98

Accuretic 20-12.5MG Tablets (PFIZER U.S.): 30/$67.41 or 90/$174.54

Accuretic 20-25MG Tablets (PFIZER U.S.): 30/$64.04 or 90/$192.12

Aldactazide 25-25MG Tablets (PFIZER U.S.): 30/$41.99 or 90/$103.97

Aldactazide 50-50MG Tablets (PFIZER U.S.): 30/$67.99 or 90/$187.97

Amiloride-Hydrochlorothiazide 5-50MG Tablets (MYLAN): 90/$31.99 or 180/$51.97

Amturnide 300-10-25MG Tablets (NOVARTIS): 30/$109.99 or 90/$305.96

Atacand HCT 16-12.5MG Tablets (ASTRAZENECA LP): 30/$110.99 or 90/$315.97

Atacand HCT 32-12.5MG Tablets (ASTRAZENECA LP): 30/$115.99 or 90/$325.97

Atacand HCT 32-25MG Tablets (ASTRAZENECA LP): 30/$121.99 or 90/$340.98

Avalide 150-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$117.99 or 90/$336.99

Avalide 300-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$131.99 or 90/$378.98

Avalide 300-25MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 30/$122.95 or 90/$345.09

Benazepril-Hydrochlorothiazide 10-12.5MG Tablets (SANDOZ): 30/$22.99 or 90/$56.96

Benazepril-Hydrochlorothiazide 20-12.5MG Tablets (SANDOZ): 30/$26.99 or 90/$69.96

Benazepril-Hydrochlorothiazide 20-25MG Tablets (SANDOZ): 30/$27.99 or 90/$71.97

Benazepril-Hydrochlorothiazide 5-6.25MG Tablets (SANDOZ): 30/$25.91 or 90/$67.18

Benicar HCT 20-12.5MG Tablets (SANKYO): 30/$96.99 or 90/$275.96

Benicar HCT 40-12.5MG Tablets (SANKYO): 30/$135.99 or 90/$391.96

Benicar HCT 40-25MG Tablets (SANKYO): 30/$135.99 or 90/$376.98

Bisoprolol-Hydrochlorothiazide 10-6.25MG Tablets (SANDOZ): 30/$22.99 or 90/$59.97

Bisoprolol-Hydrochlorothiazide 2.5-6.25MG Tablets (UNICHEM PHARMACEUTICALS): 90/$59.99 or 180/$105.97

Bisoprolol-Hydrochlorothiazide 5-6.25MG Tablets (UNICHEM PHARMACEUTICALS): 90/$19.96 or 180/$39.92

Captopril-Hydrochlorothiazide 25-15MG Tablets (MYLAN): 90/$47.99 or 270/$114.97

Captopril-Hydrochlorothiazide 25-25MG Tablets (MYLAN): 90/$44.99 or 270/$125.99

Captopril-Hydrochlorothiazide 50-15MG Tablets (TEVA PHARMACEUTICALS USA): 60/$53.99 or 180/$154.98

Captopril-Hydrochlorothiazide 50-25MG Tablets (MYLAN): 60/$54.99 or 180/$155.97

Dyazide 37.5-25MG Capsules (GLAXO SMITH KLINE): 30/$45.99 or 90/$110.97

Enalapril-Hydrochlorothiazide 10-25MG Tablets (TARO): 30/$27.99 or 90/$72.97

Enalapril-Hydrochlorothiazide 5-12.5MG Tablets (APOTEX): 30/$23.99 or 90/$64.99

Exforge HCT 10-160-12.5MG Tablets (NOVARTIS): 30/$128.99 or 90/$372.95

Exforge HCT 5-160-12.5MG Tablets (NOVARTIS): 30/$117.99 or 90/$341.97

Exforge HCT 5-160-25MG Tablets (NOVARTIS): 30/$119.99 or 90/$339.99

Fosinopril Sodium-HCTZ 10-12.5MG Tablets (GLENMARK PHARMACEUTICALS): 60/$99.99 or 180/$279.96

Fosinopril Sodium-HCTZ 20-12.5MG Tablets (GLENMARK PHARMACEUTICALS): 60/$89.99 or 180/$249.97

Hydrochlorothiazide 12.5MG Capsules (WATSON LABS): 30/$14.99 or 60/$22.98

Hydrochlorothiazide 12.5MG Tablets (ACTAVIS ELIZABETH): 100/$27.99 or 200/$43.97

Hydrochlorothiazide 25MG Tablets (QUALITEST): 100/$12.99 or 200/$15.96

Hydrochlorothiazide 50MG Tablets (IVAX PHARMACEUTICALS): 100/$15.99 or 200/$23.97

Hyzaar 100-12.5MG Tablets (MERCK SHARP &amp; DOHME): 30/$130.66 or 90/$373.29

Hyzaar 100-25MG Tablets (MERCK SHARP &amp; DOHME): 30/$130.00 or 90/$385.98

Hyzaar 50-12.5MG Tablets (MERCK SHARP &amp; DOHME): 90/$279.99 or 180/$536.00

Irbesartan-Hydrochlorothiazide 300-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$115.99 or 90/$325.97

Lisinopril-Hydrochlorothiazide 10-12.5MG Tablets (LUPIN PHARMACEUTICALS): 30/$23.99 or 60/$39.98

Lisinopril-Hydrochlorothiazide 20-12.5MG Tablets (LUPIN PHARMACEUTICALS): 30/$21.99 or 90/$59.97

Lisinopril-Hydrochlorothiazide 20-25MG Tablets (LUPIN PHARMACEUTICALS): 30/$21.99 or 90/$59.97

Lopressor HCT 100-50MG Tablets (NOVARTIS): 30/$81.99 or 90/$224.97

Lopressor HCT 50-25MG Tablets (NOVARTIS): 60/$120.99 or 180/$349.96

Losartan Potassium-HCTZ 100-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$95.99 or 90/$265.96

Losartan Potassium-HCTZ 100-25MG Tablets (SANDOZ): 30/$97.99 or 90/$268.98

Losartan Potassium-HCTZ 50-12.5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$69.99 or 90/$193.97

Lotensin HCT 10-12.5MG Tablets (NOVARTIS): 30/$62.99 or 90/$175.98

Lotensin HCT 20-12.5MG Tablets (NOVARTIS): 30/$63.99 or 90/$168.97

Lotensin HCT 20-25MG Tablets (NOVARTIS): 30/$65.99 or 90/$179.97

Maxzide 75-50MG Tablets (MYLAN): 30/$87.99 or 90/$241.96

Maxzide-25 37.5-25MG Tablets (MYLAN): 30/$43.99 or 90/$109.97

Methyldopa-Hydrochlorothiazide 250-25MG Tablets (MYLAN): 60/$22.99 or 180/$46.97

Metoprolol-Hydrochlorothiazide 100-25MG Tablets (MYLAN): 30/$50.99 or 90/$132.96

Metoprolol-Hydrochlorothiazide 100-50MG Tablets (MYLAN): 30/$55.99 or 90/$149.97

Metoprolol-Hydrochlorothiazide 50-25MG Tablets (MYLAN): 60/$63.99 or 180/$168.97

Micardis HCT 40-12.5MG Tablets (BOEHRINGER INGELHEIM): 30/$123.99 or 90/$339.96

Micardis HCT 80-12.5MG Tablets (BOEHRINGER INGELHEIM): 30/$122.00 or 90/$335.97

Micardis HCT 80-25MG Tablets (BOEHRINGER INGELHEIM): 30/$123.99 or 90/$349.97

Microzide 12.5MG Capsules (WATSON LABS): 30/$42.02 or 90/$107.51

Moexipril-Hydrochlorothiazide 15-12.5MG Tablets (WATSON LABS): 100/$109.98 or 300/$315.96

Moexipril-Hydrochlorothiazide 15-25MG Tablets (WATSON LABS): 30/$36.99 or 90/$89.97

Moexipril-Hydrochlorothiazide 7.5-12.5MG Tablets (WATSON LABS): 30/$37.99 or 90/$95.97

Monopril HCT 10-12.5MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 60/$94.99 or 180/$259.49

Prinzide 10-12.5MG Tablets (MERCK SHARP &amp; DOHME): 30/$46.99 or 90/$125.96

Propranolol-HCTZ 40-25MG Tablets (MYLAN): 30/$30.79 or 60/$50.57

Propranolol-HCTZ 80-25MG Tablets (MYLAN): 60/$67.99 or 180/$197.97

Quinapril-Hydrochlorothiazide 10-12.5MG Tablets (MYLAN): 30/$35.99 or 90/$89.97

Quinapril-Hydrochlorothiazide 20-12.5MG Tablets (GREENSTONE): 90/$86.99 or 100/$94.96

Quinapril-Hydrochlorothiazide 20-25MG Tablets (MYLAN): 90/$90.99 or 100/$100.97

Spironolactone-HCTZ 25-25MG Tablets (MYLAN): 30/$16.99 or 60/$23.97

Tekturna HCT 300-25MG Tablets (NOVARTIS): 30/$123.41 or 90/$341.66

Teveten HCT 600-12.5MG Tablets (ABBOTT): 30/$120.99 or 90/$335.97

Teveten HCT 600-25MG Tablets (ABBOTT): 30/$109.98 or 90/$309.98

Triamterene-HCTZ 37.5-25MG Capsules (MYLAN): 100/$41.99 or 200/$68.98

Triamterene-HCTZ 37.5-25MG Tablets (MYLAN): 100/$29.99 or 200/$45.96

Triamterene-HCTZ 50-25MG Capsules (SANDOZ): 100/$169.99 or 300/$489.96

Triamterene-HCTZ 75-50MG Tablets (SANDOZ): 100/$27.99 or 300/$67.98

Tribenzor 20-5-12.5MG Tablets (SANKYO): 30/$119.99 or 90/$335.95

Tribenzor 40-10-25MG Tablets (SANKYO): 30/$152.14 or 90/$433.29

Tribenzor 40-5-12.5MG Tablets (SANKYO): 30/$152.14 or 60/$304.27

Tribenzor 40-5-25MG Tablets (SANKYO): 30/$154.49 or 90/$444.01

Uniretic 15-12.5MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$228.98

Uniretic 15-25MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$228.98

Uniretic 7.5-12.5MG Tablets (SCHWARZ PHARMA): 30/$84.99 or 90/$231.97

Vaseretic 10-25MG Tablets (VALEANT): 30/$110.23 or 90/$297.41

Vaseretic 5-12.5MG Tablets (BTA PHARMACEUTICALS): 30/$41.99 or 90/$125.97

Zestoretic 10-12.5MG Tablets (ASTRAZENECA): 30/$56.78 or 90/$147.40

Zestoretic 20-12.5MG Tablets (ASTRAZENECA): 30/$60.05 or 90/$163.77

Ziac 10-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$113.99 or 90/$322.99

Ziac 2.5-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$114.63 or 90/$319.88

Ziac 5-6.25MG Tablets (TEVA/WOMENS HEALTH): 30/$115.00 or 90/$318.98

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions June 1, 2012. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1984; 144:1045-57. [IDIS 184763] [PubMed 6143542]

101. 1988 Joint National Committee. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1988; 148:1023-38. [IDIS 242588] [PubMed 3365073]

102. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health. (NIH publication No. 98-4080.)

103. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000; 35:1021-4. [PubMed 10818056]

104. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. 2000; 35:1019-20. [PubMed 10818055]

105. Bakris GL, Williams M, Dworkin L et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000; 36:646-61. [IDIS 452007] [PubMed 10977801]

106. Associated Press (American Diabetes Association). Diabetics urged: drop blood pressure. Chicago, IL; 2000 Aug 29. Press Release from web site.

107. Appel LJ. The verdict from ALLHAT—thiazide diuretics are the preferred initial therapy for hypertension. JAMA. 2002; 288:3039-42. [IDIS 490723] [PubMed 12479770]

108. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97. [IDIS 490721] [PubMed 12479763]

109. Merck & Co., Inc. HydroDiuril (hydrochlorothiazide) tablets prescribing information. West Point, PA; 1998 Jun.

110. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Express. Bethesda, MD: May 14 2003. From NIH website. (Also published in JAMA. 2003; 289.

111. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76. [PubMed 15286277]

112. Microzide capsules (hydrocholorothiazide 12.5 mg) prescribing information. Watson Pharmaceuticals, Inc. Corona, CA; 2003 Apr.

a. AHFS drug information 2004. McEvoy GK, ed. Hydrochlorothiazide. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 2544-6.

b. AHFS drug information 2004. McEvoy GK, ed. Thiazides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 2534-42.

c. AHFS drug information 2004. McEvoy GK, ed. Cardiac glycosides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 1584-91.

d. AHFS drug information 2004. McEvoy GK, ed. Captopril. Bethesda, MD: American Society of Health-System Pharmacists; 2004: 1835-45.

e. American Hospital Formulary Service drug information 84. McEvoy GK, ed. Hydrochlorothiazide. Bethesda, MD: American Society of Health-System Pharmacists; 1984: 984-5.

f. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Complete Version. Bethesda, MD: 2003 Nov 5. Hypertension. 2003; 42:1206-52. [PubMed 14656957]

g. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 6th ed. 242-245.

h. American Academy of Pediatrics. The Transfer of Drugs and Other Chemical into Human Milk. Pediatrics. 2001; 108:776-789. [IDIS 468574] [PubMed 11533352]

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