Diuril Sodium Side Effects

Generic Name: chlorothiazide

Note: This page contains information about the side effects of chlorothiazide. Some of the dosage forms included on this document may not apply to the brand name Diuril Sodium.

Not all side effects for Diuril Sodium may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to chlorothiazide: oral suspension, oral tablet

In addition to its needed effects, some unwanted effects may be caused by chlorothiazide (the active ingredient contained in Diuril Sodium). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking chlorothiazide:

Incidence not known
  • Abdominal or stomach pain
  • back, leg, or stomach pains
  • black, tarry stools
  • bleeding gums
  • blistering, peeling, or loosening of skin
  • bloating
  • blood in urine or stools
  • bloody urine
  • blue lips and fingernails
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain
  • chills
  • clay-colored stools
  • cloudy urine
  • cold sweats
  • confusion
  • constipation
  • cough or hoarseness
  • coughing that sometimes produces a pink frothy sputum
  • coughing up blood
  • cracks in the skin
  • darkened urine
  • decrease in urine output or decrease in urine-concentrating ability
  • decreased frequency or amount of urine
  • diarrhea
  • difficult, fast, or noisy breathing, sometimes with wheezing
  • difficulty swallowing
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • dry mouth
  • fast or irregular heartbeat
  • fever
  • flushed, dry skin
  • fruit-like breath odor
  • general body swelling
  • general feeling of discomfort or illness
  • general feeling of tiredness or weakness
  • greatly decreased frequency of urination or amount of urine
  • headache
  • hives
  • increased blood pressure
  • increased hunger
  • increased sweating
  • increased thirst
  • increased urination
  • indigestion
  • itching
  • joint pain, stiffness, or swelling
  • loss of appetite
  • loss of heat from the body
  • lower back or side pain
  • muscle cramps or pain
  • nausea or vomiting
  • nosebleeds
  • numbness, tingling, pain, or weakness in hands or feet
  • pain in joints or muscles
  • painful or difficult urination
  • pains in stomach, side, or abdomen, possibly radiating to the back
  • pale skin
  • pinpoint red spots on skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rash
  • red, irritated eyes
  • red skin lesions, often with a purple center
  • red, swollen skin
  • redness, soreness, or itching skin
  • scaly skin
  • seizures
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on lips or in mouth
  • sores, welting, or blisters
  • sugar in the urine
  • swelling of face, fingers, legs, ankles, feet, or lower legs
  • swollen or painful glands
  • tenderness of salivary glands
  • thickening of bronchial secretions
  • tightness in chest
  • trembling
  • troubled breathing
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight loss
  • vomiting of blood
  • weakness and heaviness of legs
  • weight gain
  • wheezing
  • yellow eyes or skin

Some of the side effects that can occur with chlorothiazide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Incidence not known
  • Cramping
  • decreased interest in sexual intercourse
  • difficulty having a bowel movement (stool)
  • feeling of constant movement of self or surroundings
  • hair loss, thinning of hair
  • inability to have or keep an erection
  • increased sensitivity of skin to sunlight
  • loss in sexual ability, desire, drive, or performance
  • muscle spasm
  • pinpoint red or purple spots on skin
  • redness or other discoloration of skin
  • restlessness
  • sensation of spinning
  • severe sunburn
  • weakness

For Healthcare Professionals

Applies to chlorothiazide: intravenous powder for injection, oral suspension, oral tablet

Metabolic

Hyperuricemia may be an important consideration in patients with a history of gout. Hypophosphatemia and low serum magnesium concentrations may occur, but are usually clinically insignificant except in malnourished patients.

Rare cases of the milk-alkali syndrome (hypercalcemia, metabolic alkalosis, and renal insufficiency) have been associated with chlorothiazide (the active ingredient contained in Diuril Sodium)

Chlorothiazide-induced hypercalcemia appears to depend on circulating parathyroid hormone.[Ref]

Metabolic changes associated with chlorothiazide, as with other thiazide diuretics, are relatively common, especially when daily doses greater than 500 mg are used. Mild hypokalemia (decrease of 0.5 mEq/L) occurs in up to 50%, and may predispose patients to cardiac arrhythmias. Metabolic alkalosis, hyponatremia, hypomagnesemia, hypophosphatemia, hypercalcemia, hyperglycemia, hypercholesterolemia, and hyperuricemia are also relatively common.[Ref]

Cardiovascular

Cardiovascular complications of diuretic therapy include orthostatic hypotension secondary to intravascular volume depletion. This has resulted in syncope and, in some patients with glaucoma, temporary loss of vision. Rare cases of cerebrovascular accident associated with thiazide-induced diuresis have been reported.[Ref]

Hypersensitivity

Thiazides may induce allergic reactions in patients who are allergic to sulfonamides.[Ref]

Hypersensitivity reactions usually involve the skin (cutaneous vasculitis, urticaria, rash, purpura), but may involve the gastrointestinal system (nausea, vomiting, or diarrhea), the genitourinary system (interstitial nephritis), and the respiratory system (acute noncardiogenic pulmonary edema, pneumonitis). Thiazide diuretics may induce phototoxic dermatitis.[Ref]

Dermatologic

Dermatologic reactions may indicate hypersensitivity to the drug. Erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis (including toxic epidermal necrolysis), and alopecia have been reported in rare cases.[Ref]

Gastrointestinal

Gastrointestinal problems include diarrhea, vomiting, constipation or abdominal pain in approximately 5% of patients. Thiazide diuretics have been associated with acute cholecystitis and rare cases of pancreatitis.[Ref]

A retrospective case-control drug surveillance study has revealed the relative risk of acute cholecystitis associated with the use of a thiazide diuretic is 2.0. The suspected explanation for this association is the potentially deleterious effect thiazides have on the serum lipid profile. Chlorothiazide-induced hypercholesterolemia or hypertriglyceridemia may enhance the formation of some types of gallstones.[Ref]

Renal

Renal side effects including new or worsened renal insufficiency associated with chlorothiazide (the active ingredient contained in Diuril Sodium) therapy is a probable sign of intravascular volume depletion, and serves as a signal to reduce or withhold therapy. Rare cases of allergic interstitial nephritis have been associated with chlorothiazide.[Ref]

Endocrine

Endocrinologic changes associated with chlorothiazide (the active ingredient contained in Diuril Sodium) as with other thiazide diuretic agents, include decreased glucose tolerance and a potentially deleterious effect on the lipid profile. This may be important in some patients with or who are at risk for diabetes or coronary artery disease.[Ref]

Hematologic

Hematologic side effects are rare. Rare cases of immune-complex hemolytic anemia, aplastic anemia, and thrombocytopenia have been associated with thiazide diuretics.[Ref]

Musculoskeletal

Musculoskeletal cramping or spasms have occasionally been reported during chlorothiazide (the active ingredient contained in Diuril Sodium) diuresis.[Ref]

Genitourinary

Genitourinary problems have been limited to rare complaints of impotence among male patients.[Ref]

References

1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.

2. Aneckstein AG, Weingold AB "Chlorothiazide-induced hepatic coma in pregnancy." Am J Obstet Gynecol 95 (1966): 136-7

3. Leigh H "Letter: Factitious hypokalemia." Ann Intern Med 80 (1974): 111-2

4. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5

5. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22

6. Popovtzer MM, Subryan VL, Alfrey AC, Reeve EB, Schrier RW "The acute effect of chlorothiazide on serum-ionized calcium. Evidence for a parathyroid hormone-dependent mechanism." J Clin Invest 55 (1975): 1295-302

7. Parfitt AM "Chlorothiazide-induced hypercalcemia in juvenile osteoporosis and hyperparathyroidism." N Engl J Med 281 (1969): 55-9

8. Sherlock S, Senewiratne B, Scott A, Walker JG "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52

9. Moore TD, Bechtel TP "Hyponatremia secondary to tolbutamide and chlorothiazide." Am J Hosp Pharm 36 (1979): 1107-10

10. Parfitt AM "Thiazide-induced hypercalcemia in vitamin D-treated hypoparathyroidism." Ann Intern Med 77 (1972): 557-63

11. Lapidus PW, Guidotti FP "Gout in orthopaedic practice: review of 232 cases." Clin Orthop 28 (1963): 97-110

12. Jackson WP, Nellen M "Effect of frusemide on carbohydrate metabolism, blood-pressure, and other modalities. A comparison with chlorothiazide." Br Med J 2 (1966): 333-6

13. Gammon GD, Docherty JP "Thiazide-induced hypercalcemia in a manic-depressive patient." Am J Psychiatry 137 (1980): 1453-5

14. Sherlock S, Walker JG, Senewiratne B, Scott A "The complications of diuretic therapy in patients with cirrhosis." Ann N Y Acad Sci 139 (1966): 497-505

15. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia 39 (1996): 861-4

16. Gora ML, Seth SK, Bay WH, Visconti JA "Milk-alkali syndrome associated with use of chlorothiazide and calcium carbonate." Clin Pharm 8 (1989): 227-9

17. Bullock JD "Antihypertensive drugs and danger to vision ." JAMA 237 (1977): 2186

18. Bowden FJ "Non-cardiogenic pulmonary edema after ingestion of chlorothiazide." BMJ 298 (1989): 605

19. Lyons H, Pinn VW, Cortell S, Cohen JJ, Harrington JT "Allergic interstitial nephritis causing reversible renal failure in four patients with idiopathic nephrotic syndrome." N Engl J Med 288 (1973): 124-8

20. Chan HL "Fixed drug eruptions. A study of 20 occurrences in Singapore." Int J Dermatol 23 (1984): 607-9

21. Stern RS, Kleinerman RA, Parrish JA, et al "Phototoxic reactions to photoactive drugs in patients treated with PUVA." Arch Dermatol 116 (1980): 1269-71

22. Rosenberg L, Shapiro S, Slone D, Kaufman DW, Miettinen OS, Stolley PD "Thiazides and acute cholecystitis." N Engl J Med 303 (1980): 546-8

23. Goldman JA, Neri A, Ovadia J, Eckerling B, Vries A, de "Effect of chlorothiazide on intravenous glucose tolerance in pregnancy." Am J Obstet Gynecol 105 (1969): 556-60

24. Miller NR, Moses H "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA 240 (1978): 1887-8

25. Bird CC, Reeves BD "Effect of diuretic administration on urinary estriol levels in late pregnancy." Am J Obstet Gynecol 105 (1969): 552-5

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