Chlorthalidone Side Effects
Some side effects of chlorthalidone may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to chlorthalidone: oral tablet
Along with its needed effects, chlorthalidone may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking chlorthalidone:Incidence not known
- Abdominal or stomach pain
- black, tarry stools
- bleeding gums
- blistering, peeling, or loosening of skin
- blood in urine or stools
- blurred vision
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- chest pain
- clay-colored stools
- cold sweats
- cough or hoarseness
- coughing up blood
- darkened urine
- dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
- dry mouth
- fast heartbeat
- flushed, dry skin
- fruit-like breath odor
- general feeling of tiredness or weakness
- increased hunger
- increased thirst
- increased urination
- joint pain, stiffness, or swelling
- loss of appetite
- lower back or side pain
- pain in joints or muscles
- painful or difficult urination
- pains in stomach, side, or abdomen, possibly radiating to the back
- pinpoint red spots on skin
- red irritated eyes
- red skin lesions, often with a purple center
- redness, soreness or itching skin
- shortness of breath
- skin rash
- sore throat
- sores, ulcers, or white spots on lips or in mouth
- sores, welting, or blisters
- sugar in the urine
- swelling of feet or lower legs
- swollen glands
- tightness in chest
- troubled breathing
- unpleasant breath odor
- unusual bleeding or bruising
- unusual tiredness or weakness
- unusual weight loss
- vomiting of blood
- weight loss
- yellow eyes or skin
Some side effects of chlorthalidone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Incidence not known
- decreased interest in sexual intercourse
- difficulty having a bowel movement (stool)
- feeling of constant movement of self or surroundings
- inability to have or keep an erection
- increased sensitivity of skin to sunlight
- loss in sexual ability, desire, drive, or performance
- muscle spasm
- redness or other discoloration of skin
- sensation of spinning
- severe sunburn
For Healthcare Professionals
Applies to chlorthalidone: oral tablet
In a prospective study of 83 patients who were taking daily doses of chlorthalidone 200 mg, 23 (28%) developed a decrease in their serum potassium (K+) concentration by at least 0.6 mEq/L. Keeping the serum K+ replenished during therapy decreases the risk of arrhythmias, myopathy, hyponatremia and abnormal glucose metabolism. Concomitant administration of an angiotensin converting enzyme (ACE) inhibitor can decrease the risk of hypokalemia. (ACE inhibitors decrease serum aldosterone.)
There may be significant metabolic side effects of chlorthalidone, as with other thiazide diuretics. Approximately 14% of patients develop hypokalemia during therapy. The risk of hypokalemia, hypomagnesemia, hyponatremia, and hypochloremia appears to be dose-related. Hypercalcemia and an increased serum bicarbonate may result from chlorthalidone diuresis.
Cardiovascular side effects are related to decreased intravascular volume and hypokalemia. Hypokalemia may induce or provoke arrhythmias in some patients. Orthostatic hypotension and syncope have been reported in rare cases.
The initial report from the Multiple Risk Factor Intervention Trial (MRFIT) raised the possibility that the increased coronary heart disease (CHD) mortality observed in a subset of men with hypertension who were taking diuretics may be misleading. Subsequent analysis of the data reveals no consistent relationship between CHD mortality and the dose of chlorthalidone, the most recent serum potassium concentration, or the presence of premature ventricular depolarizations (PVDs). It is probable that these men had left ventricular hypertrophy, which is associated with a greater incidence of PVDs, even in the absence of diuretic therapy.
Chlorthalidone-induced hypokalemia can rarely cause serious arrhythmias in otherwise healthy patients. It is recommended that the serum potassium concentration be kept within normal limits during chlorthalidone therapy, especially in patients who are predisposed to arrhythmias.
Hypersensitivity reactions to thiazide diuretics usually involve the skin. Thiazides and chlorthalidone have been implicated as the cause of necrotizing vasculitis, psoriasiform eruptions, and pseudoporphyria (bullous photosensitive lesions) in rare cases.
New or worsened renal insufficiency may develop if patients become too dehydrated. The use of chlorthalidone has been associated with mild decreases in urine concentrating ability and renal plasma flow, suggestive of interference with renal tubular function.
Nervous system side effects include sleep disturbances in 18% of patients, which may be made worse with a sodium-restricted diet. Headache or fatigue have been reported in approximately 7% of patients.
Use of chlorthalidone has been associated with increases in total serum cholesterol, triglycerides, and LDL cholesterol.
At least one case of severe glucose intolerance, resulting in hyperosmolar hyperglycemic nonketotic coma, has been associated with chlorthalidone. The patient did not have diabetes, had a normal fasting blood glucose prior to chlorthalidone therapy, and did well on no antidiabetic medications after resolution of the acute episode of hyperglycemia. Infection and myocardial infarction were ruled out.
Endocrinologic abnormalities related to chlorthalidone, as with other thiazide diuretics, include decreased glucose tolerance and an adverse effect on the lipid profile. This may be important in some patients with a history of diabetes or coronary artery disease.
Genitourinary complaints of decreased sexual libido and erections have been reported in up to 42% of male patients. Decreased sexual arousal and orgasm have rarely been reported among female patients.
The etiology of sexual dysfunction associated with chlorthalidone is not known. One study of 19 middle-aged hypertensive men showed no significant decrease in serum zinc or testosterone relative to a control group of 31 unmedicated middle-aged normotensive men. While sexual dysfunction was reported in 42% of treated men (compared to 16% in the control group), serum testosterone and zinc levels were actually higher in the treated group, and were highest in the men on the highest dose of chlorthalidone.
One study revealed that sexual dysfunction associated with chlorthalidone may be worsened by a low sodium diet and ameliorated by a diet designed to help lose weight. The influence of diet alone or the associated nutritional counseling and sense of well-being on sexual function was not measured.
The Treatment of Mild Hypertension Study (TOMHS), a randomized, placebo-controlled, double-blind study has shown that there is a significantly higher incidence of sexual dysfunction (obtaining and maintaining erections) among male patients who were taking chlorthalidone at 24 and 48 months compared with placebo.
Cases of progressive generalized paralysis associated with chlorthalidone-induced hypokalemia have been reported. In some of these cases, muscle histology is remarkable for vacuolar degeneration.
Musculoskeletal weakness or cramps have been reported in approximately 7% of patients. Chlorthalidone-induced hypokalemia has resulted in hypokalemic myopathy in rare cases.
Gastrointestinal complaints are unusual. Approximately 5% to 10% of patients complain of nausea, vomiting, abdominal cramping, diarrhea, or constipation. A case of acute bacterial pancreatitis and rare cases of intrahepatic cholestasis have been associated with chlorthalidone.
Hematologic side effects that have been rarely associated with chlorthalidone include neutropenia, agranulocytosis, thrombocytopenia, and aplastic anemia.
A 63-year-old man with hypertension, ischemic heart disease, chronic bronchitis, and type II diabetes mellitus was stable on multiple medications until chlorthalidone was substituted for hydrochlorothiazide. Within three weeks after beginning chlorthalidone, the patient developed a diffuse, upper extremity pruritic rash, fever, dyspnea, malaise, and fatigue associated with a peripheral leukocyte count of 2,000/mm3. Bone marrow aspiration revealed hypocellularity of the myeloid line only. Within nine days after stopping chlorthalidone, the patient's leukocyte count returned to normal. No other cause of neutropenia was discovered; the presence of an antineutrophil antibody was not proven.
The mechanism of myopia is unknown. There is evidence of an allergic reaction, where the ciliary body may become edematous, and of a direct disturbance of the normal salinity of the lens. Either may alter the refractive index. In some cases, ultrasonography of affected eyes has shown a difference both in the anterior chamber depth and in the lens thickness during chlorthalidone therapy.
Transient myopia is a rarely reported ocular side effect.
More chlorthalidone resources
- chlorthalidone MedFacts Consumer Leaflet (Wolters Kluwer)
- chlorthalidone Concise Consumer Information (Cerner Multum)
- chlorthalidone Advanced Consumer (Micromedex) - Includes Dosage Information
- Chlorthalidone Prescribing Information (FDA)
- Chlorthalidone Professional Patient Advice (Wolters Kluwer)
- Chlorthalidone Monograph (AHFS DI)
- Thalitone Prescribing Information (FDA)
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