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Chlorthalidone / clonidine Disease Interactions

There are 16 disease interactions with chlorthalidone / clonidine:

Major

Thiazides (Includes Chlorthalidone/clonidine) ↔ Anuria

Severe Potential Hazard, High plausibility

Applies to: Anuria

The use of thiazide diuretics is contraindicated in patients with anuria.

References

  1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
View all 9 references
Major

Thiazides (Includes Chlorthalidone/clonidine) ↔ Electrolyte Losses

Severe Potential Hazard, High plausibility

Applies to: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration

The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic.

References

  1. Peters RW, Hamilton J, Hamilton BP "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J 82 (1989): 966-9,
  2. Jorgensen FS, Brunner S "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  3. Medical Research Council Working Party on Mild to Moderate Hypertension. "Ventricular extrasystoles during thiazide treatment: substudy of MRC mild hypertension trial." Br Med J (Clin Res Ed) 287 (1983): 1249-53
View all 77 references
Major

Thiazides (Includes Chlorthalidone/clonidine) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Patients with severe liver disease or cirrhosis are very susceptible to thiazide-induced hypokalemic hypochloremic alkalosis. Blood ammonia concentrations may be further increased in patients with previously elevated concentrations. Hepatic encephalopathy and death have occurred secondary to the electrolyte alterations accompanying diuretic use. Therapy with thiazide diuretics should be administered cautiously in patients with impaired hepatic function or progressive liver disease, and discontinued promptly if signs of impending hepatic coma appear (e.g., tremors, confusion, and increased jaundice).

References

  1. Sherlock S, Senewiratne B, Scott A, Walker JG "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52
  2. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 12 references
Major

Thiazides (Includes Chlorthalidone/clonidine) ↔ Lupus Erythematosus

Severe Potential Hazard, Low plausibility

Applies to: Lupus Erythematosus

The use of thiazide diuretics has been reported to possibly exacerbate or activate systemic lupus erythematosus. Reported cases have generally been associated with chlorothiazide and hydrochlorothiazide. Therapy with thiazide diuretics should be administered cautiously in patients with a history or risk of SLE.

References

  1. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  2. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 14 references
Major

Thiazides (Includes Chlorthalidone/clonidine) ↔ Renal Function Disorders

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Thiazide diuretics may be ineffective when the glomerular filtration rate is low (GFR < 25 mL/min) because they are not expected to be filtered into the renal tubule, their site of action. In addition, thiazide diuretics decrease the GFR and may precipitate azotemia in renal disease. Cumulative effects may also develop because most of these drugs are excreted unchanged in the urine by glomerular filtration and active tubular secretion. Therapy with thiazide diuretics should be administered cautiously at reduced dosages in patients with renal impairment. If renal function becomes progressively worse, as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of thiazide therapy should be considered.

References

  1. Klunk LJ, Ringel S, Neiss ES "The disposition of 14C-indapamide in man." J Clin Pharmacol 23 (1983): 377-84
  2. Riess W, Dubach UC, Burckhardt D, Theobald W, Vuillard P, Zimmerli M "Pharmacokinetic studies with chlorthalidone (Hygroton) in man." Eur J Clin Pharmacol 12 (1977): 375-82
  3. Brennan L, Wu MJ, Laquer UJ "A multicenter study of indapamide in hypertensive patients with impaired renal function." Clin Ther 5 (1982): 121-8
View all 41 references
Moderate

Alpha-2 Agonists (Central) (Includes Chlorthalidone/clonidine) ↔ Bradyarrhythmia

Moderate Potential Hazard, High plausibility

Applies to: Heart Block, Sinus Node Dysfunction

Central alpha-2 adrenoreceptor agonists reduce sympathetic outflow from the central nervous system. Heart rate is decreased, which may lead to or exacerbate sinus bradycardia and atrioventricular block. Therapy with central alpha-2 adrenoreceptor agonists should be administered cautiously in patients with conduction disturbances such as sinus node dysfunction or AV nodal disease.

References

  1. van Zwieten PA, Thoolen MJ, Timmermans PB "The hypotensive activity and side effects of methyldopa, clonidine, and guanfacine." Hypertension 6 (1984): 28-33
  2. "Product Information. Catapres (clonidine)." Boehringer-Ingelheim, Ridgefield, CT.
  3. Golusinski LL, Blount BW "Clonidine-induced bradycardia." J Fam Pract 41 (1995): 399-401
View all 7 references
Moderate

Alpha-2 Agonists (Central) (Includes Chlorthalidone/clonidine) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression

Central alpha-2 adrenoreceptor agonists may occasionally cause mental depression and should be used cautiously in patients with a history of depression.

References

  1. Kostis JB, Rosen RC, Holzer BC, et al "CNS side effects of centrally-active antihypertensive agents: a prospective, placebo-controlled study of sleep, mood state, and cognitive and sexual function in hypertensive males." Psychopharmacology (Berl) 102 (1990): 163-70
  2. Prasad A, Shotliff K "Depression and chronic clonidine therapy." Postgrad Med J 69 (1993): 327-8
  3. "Product Information. Catapres (clonidine)." Boehringer-Ingelheim, Ridgefield, CT.
View all 5 references
Moderate

Alpha-2 Agonists (Central) (Includes Chlorthalidone/clonidine) ↔ Hypotension

Moderate Potential Hazard, High plausibility

Applies to: Hypotension, Ischemic Heart Disease, Peripheral Arterial Disease, Cerebrovascular Insufficiency

Central alpha-2 adrenoreceptor agonists reduce sympathetic outflow from the central nervous system, resulting in decreases in heart rate, peripheral and renovascular resistance, and blood pressure. Therapy with these agents should be administered cautiously in patients with hypotension or conditions that may be exacerbated by decreased blood pressure and perfusion, such as coronary insufficiency, peripheral vascular disease (e.g., Raynaud's syndrome), cerebrovascular disease, or recent myocardial infarction.

References

  1. "Product Information. Wytensin (guanabenz)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Given BD, Taylor T, Lilly LS, Dzau VJ "Symptomatic hypotension following the clonidine suppression test for pheochromocytoma." Arch Intern Med 143 (1983): 2195-6
  3. Greene CS, Gretler DD, Cervenka K, et al "Cerebral blood flow during the acute therapy of severe hypertension with oral clonidine." Am J Emerg Med 8 (1990): 293-6
View all 12 references
Moderate

Clonidine (Includes Chlorthalidone/clonidine) ↔ Arrhythmias

Moderate Potential Hazard, Moderate plausibility

Applies to: Sinus Node Dysfunction, Arrhythmias

The sympatholytic action of clonidine may worsen sinus node dysfunction and atrioventricular (AV) block, especially in patients taking other sympatholytic drugs. There are postmarketing reports of patients with conduction abnormalities and/or taking other sympatholytic drugs who developed severe bradycardia that required pharmacological IV treatment. Caution is advised if using clonidine in patients with conduction abnormalities.

Moderate

Clonidine (Includes Chlorthalidone/clonidine) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Clonidine is primarily eliminated unchanged by the kidney. The serum concentrations and half-life of clonidine may be increased in patients with impaired renal function, so patients may benefit from a lower initial dose. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment. Only a minimal amount of clonidine is removed during routine hemodialysis, and there is no need to give supplemental clonidine following dialysis.

References

  1. Hulter HN, Licht JH, Ilnicki LP, Singh S "Clinical efficacy and pharmacokinetics of clonidine in hemodialysis and renal insufficiency." J Lab Clin Med 94 (1979): 223-31
  2. Lowenthal DT, Affrime MB, Meyer A, et al "Pharmacokinetics and pharmacodynamics of clonidine in varying states of renal function." Chest 83 (1983): 386-90
  3. "Product Information. Catapres (clonidine)." Boehringer-Ingelheim, Ridgefield, CT.
Moderate

Clonidine (Includes Chlorthalidone/clonidine) ↔ Sedatives/Alcohol

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Acute Alcohol Intoxication

Patients may experience a sedative effect, dizziness, or accommodation disorder with the use of clonidine. Patients should be cautioned about engaging in activities such as driving a vehicle or operating machinery. The sedative effect may be increased with the concomitant use of alcohol or other sedating drugs.

Moderate

Thiazides (Includes Chlorthalidone/clonidine) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Abnormal Glucose Tolerance

Thiazide diuretics may cause hyperglycemia and glycosuria in patients with diabetes. They may also precipitate diabetes in prediabetic patients. These effects are usually reversible following discontinuation of the drugs. Therapy with thiazide diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during thiazide therapy, and their antidiabetic regimen adjusted accordingly.

References

  1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. Nielsen S, Schmitz A, Knudsen RE, Dollerup J, Mogensen CE "Enalapril versus bendroflumethiazide in type 2 diabetes complicated by hypertension." Q J Med 87 (1994): 747-54
  3. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2
View all 36 references
Moderate

Thiazides (Includes Chlorthalidone/clonidine) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

  1. Ames RP "A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides." Am J Cardiol 77 (1996): b12-6
  2. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  3. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
View all 23 references
Moderate

Thiazides (Includes Chlorthalidone/clonidine) ↔ Hyperparathyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperparathyroidism

Urinary calcium excretion is decreased by thiazide diuretics during chronic administration. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported during prolonged therapy. However, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen. Clinicians should be cognizant of these effects when prescribing or administering thiazide therapy to patients with hyperparathyroidism. These drugs should be discontinued before carrying out tests for parathyroid function.

References

  1. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  2. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
View all 27 references
Moderate

Thiazides (Includes Chlorthalidone/clonidine) ↔ Hyperuricemia

Moderate Potential Hazard, High plausibility

Applies to: Gout

Thiazide diuretics decrease the rate of uric acid excretion. Hyperuricemia occurs frequently but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with thiazide diuretics should be administered cautiously in such patients.

References

  1. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  2. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  3. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
View all 20 references
Moderate

Thiazides (Includes Chlorthalidone/clonidine) ↔ Thyroid Function Tests

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

Thiazide diuretics may decrease serum PBI (protein-bound iodine) levels without associated thyroid disturbance. Clinicians should be cognizant of this effect when prescribing or administering thiazide therapy to patients with thyroid disorders.

References

  1. Bech K, Skovsted L, Siersbaek-Nielsen K, Hansen JM "Influence of thiazides on thyroid parameters in man." Acta Endocrinol (Copenh) 89 (1978): 673-8
  2. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  3. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 10 references

chlorthalidone / clonidine drug Interactions

There are 1003 drug interactions with chlorthalidone / clonidine

chlorthalidone / clonidine alcohol/food Interactions

There are 2 alcohol/food interactions with chlorthalidone / clonidine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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