Class: Thiazide diuretic
- Tablets 250 mg
- Tablets 500 mg
- Oral suspension 250 mg per 5 mL
- Injection, lyophilized powder for solution 500 mg
Enhances excretion of sodium, chloride, and water by interfering with transport of sodium ions across renal tubular epithelium.
Chlorothiazide crosses the placenta but not the blood-brain barrier.
Chlorothiazide is not metabolized.
Excreted by the kidney. Plasma t ½ 45 to 120 min. Following IV administration, 96% is excreted unchanged in the urine within 23 h.
Within 2 h after oral administration; within 15 min after IV administration.
Approximately 4 h after oral administration; approximately 30 min after IV administration.
Approximately 6 to 12 h after oral administration.
Indications and Usage
Adjunctive treatment in edema associated with CHF, hepatic cirrhosis, and corticosteroid and estrogen therapy; edema caused by various forms of renal function impairment such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure (oral and IV); management of hypertension (oral).
Calcium nephrolithiasis; diabetes insipidus; osteoporosis.
Anuria, hypersensitivity to sulfonamide-derived drugs or any component of this product.
Dosage and AdministrationDiuresis and Control of Hypertension
Children younger than 6 mo of age (see Precautions)
PO 30 mg/kg in 2 divided doses may be required.Children 6 mo to 2 yr of age (see Precautions)
PO 10 to 20 mg/kg/day in single or 2 divided doses (max, 375 mg/day).Children 2 to 12 yr of age (see Precautions)
PO 1 g/day.Edema
PO 500 to 1,000 mg once or twice daily. Many patients respond to intermittent therapy (alternate day therapy or administration on 3 to 5 days each wk). IV 500 to 1,000 mg once or twice daily. Should be reserved for patients unable to take oral medication or for emergency situations. Individualize dosage according to patient response, using the smallest dosage necessary.Hypertension
PO 500 to 1,000 mg as a single or divided dose. Increase or decrease dose according to BP response. Rarely, some patients may require up to 2 g/day in divided doses.
- Tablets and suspension
- Administer without regard to meals. Administer with food if GI upset occurs.
- Shake suspension well before measuring dose. Use dosing syringe, spoon, or cup to measure prescribed dose of suspension.
- Reconstitute powder for injection following manufacturer's recommendations using sterile water for injection.
- Do not administer if particulate matter, cloudiness, or discoloration is noted.
- Administer by slow IV injection or IV infusion as ordered. Take special precautions to avoid extravasation. Do not give subcutaneously or IM.
- Discard any unused portion of vial. Do not save for future use. For single dose only.
Store oral suspension at controlled room temperature (59° to 86°F). Protect from freezing. Store powder for injection between 36° and 77°F. Store tablets at 68° to 77°F. Dispense in light-resistant container.
Drug InteractionsAlcohol, barbiturates, narcotics
May potentiate orthostatic hypotension.Antihypertensive agents
Coadministration may result in additive antihypertensive effects, or the effects may be potentiated.Bile acid sequestrants
May reduce thiazide absorption; give thiazide at least 2 h before bile acid sequestrants.Cisapride
Cisapride is contraindicated in patients who experience rapid reduction in plasma potassium, including patients receiving chlorothiazide.Corticosteroids
Increased electrolyte depletion, especially hypokalemia.Diazoxide
May cause hyperglycemia.Digitalis glycosides
Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.Dofetilide
Dofetilide is contraindicated in patients receiving chlorothiazide because hypokalemia may occur, increasing the risk of torsades de pointes.Insulin, sulfonylureas
May decrease hypoglycemic effect of sulfonylureas. Because chlorothiazide may elevate blood glucose levels, may need to increase dosage of sulfonylureas or insulin.Lithium
May decrease renal excretion of lithium.Loop diuretics
Synergistic effects may result in profound diuresis and serious electrolyte abnormalities.Nondepolarizing muscle relaxants (eg, tubocurarine), skeletal muscle relaxants
Response to muscle relaxants may be increased.NSAIDs
Pharmacologic effects of chlorothiazide may be reduced.Pressor amines (eg, norepinephrine)
Effect of pressor amines may be reduced.
Laboratory Test Interactions
May produce false-negative results with the phentolamine and tyramine tests; may interfere with the phenolsulfonphthalein test because of decreased excretion; may cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, and a decrease in serum protein-bound iodine levels without signs of thyroid disturbance.
Hypotension; orthostatic hypotension.
Dizziness; headache; paresthesia; restlessness; vertigo.
Alopecia; erythema multiforme; exfoliative dermatitis; Stevens-Johnson syndrome; toxic epidermal necrolysis.
Transient blurred vision; xanthopsia.
Anorexia; constipation; cramping; diarrhea; gastric irritation; nausea; pancreatitis; sialadenitis; vomiting.
Hematuria (IV use); impotence; interstitial nephritis; renal failure; renal function impairment.
Agranulocytosis; aplastic anemia; hemolytic anemia; leukemia; thrombocytopenia.
Jaundice (intrahepatic cholestasis).
Anaphylactic reactions; fever; necrotizing angiitis (vasculitis and cutaneous vasculitis); photosensitivity; purpura; rash; respiratory distress, including pneumonitis and pulmonary edema; urticaria.
Electrolyte imbalance; glycosuria; hyperglycemia; hyperuricemia.
Muscle spasm; weakness.
Monitor blood sugar in diabetic patients when drug is started or dose is changed. Advise patient to report significant changes to health care provider.BP/Pulse
Monitor and record BP and pulse. Should hypotension result, advise patient to hold medication and notify health care provider.Chloride deficit
Generally mild except in certain circumstances (eg, liver or renal disease), which may require treatment including chloride replacement for the treatment of metabolic alkalosis.Orthostatic hypotension
Take safety precautions if orthostatic hypotension occurs.Routine tests
Ensure that serum electrolytes, BUN, creatinine, and uric acid are monitored periodically.
Category C .
Excreted in breast milk.
Safety and efficacy not established. Oral dosing recommendation is supported by empiric use in children and published literature regarding the treatment of hypertension.
Use with caution, usually starting at the low end of the dosage range, because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides also may occur.
Drug may precipitate azotemia; use drug with caution.
Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use with caution.
May become manifest.
May occur in edematous patients in hot weather.
Increased urinary excretion of sodium, potassium, or magnesium may occur; decreased urinary excretion of calcium may occur.
May occur or frank gout may be precipitated.
Increased cholesterol and triglycerides may occur.
Exacerbation or activation may occur.
Antihypertensive effects may be enhanced.
Electrolyte depletion (hypochloremia, hypokalemia, hyponatremia); dehydration; hypokalemia may accentuate cardiac arrhythmias if digitalis is being administered.
- Tablets and Suspension
- Advise patient to take prescribed dose once or twice daily without regard to meals, but to take with food if stomach upset occurs.
- Advise patient or caregiver using suspension to shake well before measuring dose and to use dosing spoon, syringe, or cup to measure prescribed dose.
- Advise patient that medication will initially increase urination, but that this should go away after a few weeks of treatment.
- Advise patient if a dose is missed to skip that dose and take the next dose at the regularly scheduled time. Caution patient not to double the dose to catch up.
- Inform patient that drug controls but does not cure hypertension and to continue taking medication as prescribed even when BP is not elevated.
- Instruct patient to continue taking other BP medications as prescribed by health care provider.
- Instruct patient in BP and pulse measurement skills.
- Advise patient to monitor and record BP and pulse at home, and to inform health care provider if abnormal measurements be noted. Also advise patient to take record of BP and pulse to each follow-up visit.
- Instruct patient to lie or sit down if experiencing dizziness or light-headedness when standing.
- Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP, resulting in light-headedness or fainting.
- Instruct patients with diabetes to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
- Caution patient to avoid unnecessary exposure to UV light (eg, sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light until tolerance is determined.
- Emphasize to hypertensive patient importance of the following modalities on BP: weight control, regular exercise, smoking cessation, moderate intake of alcohol and salt.
- Instruct patient to inform health care provider if any of the following occur: abnormal skin sensations; drowsiness; excessive thirst; increased heart rate; muscle pain, weakness, or cramps; persistent nausea or vomiting; unexplained joint pain; unexplained tiredness.
- Advise patient that medication will be prepared by a health care provider and administered in a health care setting.
Copyright © 2009 Wolters Kluwer Health.
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