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Hydralazine/hydrochlorothiazide Disease Interactions

There are 17 disease interactions with hydralazine / hydrochlorothiazide.

Major

Hydralazine (applies to hydralazine/hydrochlorothiazide) bone marrow suppression

Major Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Hydralazine may rarely cause blood dyscrasias at recommended dosages. Reduction in hemoglobin, red cell count, agranulocytosis, leukopenia, and purpura have been reported. Therapy with hydralazine should be administered cautiously in patients with these preexisting conditions and if such abnormalities develop during the course of therapy, treatment should be discontinued. Monitoring blood counts should be considered for those patients at higher risk.

References

  1. Koch-Weser J "Hydralazine." N Engl J Med 295 (1976): 320-3
  2. Orenstein AA, Yakulis V, Eipe J, Costea N "Immune hemolysis due to hydralazine." Ann Intern Med 86 (1977): 450-1
  3. Widerlov E, Karlman I, Storsater J "Hydralazine-induced neonatal thrombocytopenia." N Engl J Med 303 (1980): 1235
  4. Freestone S, Ramsay LE "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J 285 (1982): 1536-7
  5. Macleod WN "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J 28 (1983): 181-2
  6. Harrison BD, Laidlaw ST, Reilly JT "Fatal aplastic anaemia associated with lisinopril." Lancet 346 (1995): 247-8
  7. "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals (2001):
View all 7 references
Major

Hydralazine (applies to hydralazine/hydrochlorothiazide) coronary artery disease

Major Potential Hazard, High plausibility. Applicable conditions: Ischemic Heart Disease

The use of hydralazine is contraindicated in patients with coronary artery disease. Reflex tachycardia may commonly occur. Palpitations and chest pain have also been reported. Myocardial infarction has been associated with the use of hydralazine.

References

  1. Koch-Weser J "Hydralazine." N Engl J Med 295 (1976): 320-3
  2. Laslett LJ, DeMaria AN, Amsterdam EA, Mason DT "Hydralazine-induced tachycardia and sodium retention in heart failure: hemodynamic and symptomatic correlation by prazosin therapy." Arch Intern Med 138 (1978): 819-20
  3. Packer M, Meller J, Medina N, et al. "Provocation of myocardial ischemic events during initiation of vasodilator therapy for severe chronic heart failure." Am J Cardiol 48 (1981): 939-46
Major

Hydralazine (applies to hydralazine/hydrochlorothiazide) lupus erythematosus

Major Potential Hazard, High plausibility.

The use of hydralazine has been associated with the development of lupus erythematosus and lupus-like syndromes, as well as exacerbation of the disease. Hydralazine therapy should be withdrawn in patients experiencing worsening of preexisting lupus. Monitoring complete blood counts, and antinuclear antibody titers before and during prolonged therapy is recommended.

References

  1. Hahn BH, Sharp GC, Irvin WS, et al. "Immune responses to hydralazine and nuclear antigens in hydralazine-induced lupus erythematosus." Ann Intern Med 76 (1972): 365-74
  2. Carey RM, Coleman M, Feder A "Pericardial tamponade: a major presenting manifestation of hydralazine-induced lupus syndrome." Am J Med 54 (1973): 84-7
  3. Perry HM "Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis." Am J Med 54 (1973): 58-72
  4. Blumenkrantz N, Christiansen AH, Ullman S, Asboe-Hansen G "Hydralazine-induced lupoid syndrome." Acta Med Scand 195 (1974): 443-9
  5. Weinstein J "Hypocomplementemia in hydralazine-associated systemic lupus erythematosus." Am J Med 65 (1978): 553-6
  6. Freestone S, Ramsay LE "Transient monoclonal gammopathy in hydralazine-induced lupus erythematosus." Br Med J 285 (1982): 1536-7
  7. Macleod WN "Anaemia in the hydrallazine-induced lupus syndrome." Scott Med J 28 (1983): 181-2
  8. Ihle BU, Whitworth JA, Dowling JP, Kincaid-Smith P "Hydralazine and lupus nephritis." Clin Nephrol 22 (1984): 230-8
  9. Cameron HA, Ramsay LE "The lupus syndrome induced by hydralazine: a common complication with low dose treatment." Br Med J 289 (1984): 410-12
  10. Naparstek Y, Kopolovic J, Tur-Kaspa R, Rubinger D "Focal glumerulonephritis in the course of hydralazine-induced lupus syndrome." Arthritis Rheum 27 (1984): 822-5
  11. Shapiro KS, Pinn VW, Harrington JT, Levey AS "Immune complex glomerulonephritis in hydralazine-induced SLE." Am J Kidney Dis 3 (1984): 270-4
  12. Cush JJ, Goldings EA "Southwestern internal medicine conference: drug-induced lupus: clinical spectrum and pathogenesis." Am J Med Sci 290 (1985): 36-45
  13. Innes A, Rennie JA, Cato GR "Drug-induced lupus caused by very-low-dose hydralazine." Br J Rheumatol 25 (1986): 225-31
  14. Darwaza A, Lamey P-J, Connell JM "Hydrallazine-induced Sjogren's syndrome." Int J Oral Maxillofac Surg 17 (1988): 92-3
  15. Sturman SG, Kumararatne D, Beevers DG "Fatal hydralazine-induced systemic lupus erythematosus." Lancet 12/03/88 (1988): 1304
  16. Fleming MG, Bergfeld WF, Tomecki KJ, et al. "Bullous systemic lupus erythematosus." Int J Dermatol 28 (1989): 321-6
  17. Ramsey-Goldman R, Franz T, Solano FX, Medsger TA "Hydralazine induced lupus and sweet's syndrome: report and review of the literature." J Rheumatol 17 (1990): 682-4
  18. Lunde PK, Frislid K, Hansteen V "Disease and acetylation polymorphism." Clin Pharmacokinet 2 (1977): 182-97
  19. Timbrell JA, Facchini V, Harland SJ, Mansilla-Tinoco R "Hydralazine-induced lupus: is there a toxic metabolic pathway?" Eur J Clin Pharmacol 27 (1984): 555-9
  20. "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals (2001):
  21. Pirmohamed M "Hydralazine-induced lupus: yet another autoantibody! triplex-DNA stabilization by hydralazine and the presence of anti-(triplex DNA) antibodies in patients treated with hydralazine - comment." Hum Exp Toxicol 15 (1996): 361-2
View all 21 references
Major

Hydralazine (applies to hydralazine/hydrochlorothiazide) valvular heart disease

Major Potential Hazard, High plausibility.

The use of hydralazine is contraindicated in patients with mitral valvular rheumatic heart disease.

References

  1. "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals (2001):
Major

Thiazides (applies to hydralazine/hydrochlorothiazide) anuria

Major Potential Hazard, High plausibility.

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

References

  1. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  2. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  4. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  5. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  6. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  7. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  8. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 9 references
Major

Thiazides (applies to hydralazine/hydrochlorothiazide) electrolyte losses

Major Potential Hazard, High plausibility. Applicable conditions: 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. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  2. Leigh H "Letter: Factitious hypokalemia." Ann Intern Med 80 (1974): 111-2
  3. Moore TD, Bechtel TP "Hyponatremia secondary to tolbutamide and chlorothiazide." Am J Hosp Pharm 36 (1979): 1107-10
  4. Falch DK, Schreiner AM "Changes in urinary electrolytes versus serum electrolytes during treatment of primary hypertension with chlorthalidone alone and in combination with spironolactone." Acta Med Scand 209 (1981): 111-4
  5. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  6. Kuller L, Farrier N, Caggiula A, Borhani N, Dunkle S "Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial." Am J Epidemiol 122 (1985): 1045-59
  7. Remenchik AP, Johnston LC "Potassium depletion produced by administration of chlorthalidone to nonedematous patients with arterial hypertensin." Am J Med Sci 252 (1966): 171-6
  8. Katz FH, Eckert RC, Gebott MD "Hypokalemia caused by surreptitious self-administration of diuretics." Ann Intern Med 76 (1972): 85-90
  9. Fichman MP, Vorherr H, Kleeman CR, Telfer N "Diuretic-induced hyponatremia." Ann Intern Med 75 (1971): 853-63
  10. Stewart DE, Ikram H, Espiner EA, Nicholls MG "Arrhythmogenic potential of diuretic induced hypokalaemia in patients with mild hypertension and ischaemic heart disease." Br Heart J 54 (1985): 290-7
  11. Kuller LH, Hulley SB, Cohen JD, Neaton J "Unexpected effects of treating hypertension in men with electrocardiographic abnormalities: a critical analysis." Circulation 73 (1986): 114-23
  12. Landmann-Suter R, Struyvenberg A "Initial potassium loss and hypokalaemia during chlorthalidone administration in patients with essential hypertension: the influence of dietary sodium restriction." Eur J Clin Invest 8 (1978): 155-64
  13. Navarro RP, O'Brien DK, Nuffort P, Spencer DL "Diuretic induced hypokalemia in the elderly." J Fam Pract 14 (1982): 685-9
  14. Oh SJ, Douglas JE, Brown RA "Hypokalemic vacuolar myopathy associated with chlorthalidone treatment." JAMA 216 (1971): 1858-9
  15. Mozes B, Pines A, Werner D, Olchovsky D, Lieberman P, Frankl O "Thiazide-induced hyponatremia: an unusual neurologic course." South Med J 79 (1986): 629-31
  16. Jensen OB, Mosdal C, Reske-Nielsen E "Hypokalemic myopathy during treatment with diuretics." Acta Neurol Scand 55 (1977): 465-82
  17. Cembrowski GS, Huntington RW, 3d "Probable fatal cardiac dysrhythmia secondary to diuretic-induced hypokalemia." Am J Forensic Med Pathol 2 (1981): 243-8
  18. Sumiye L, Vivian AS, Frisof KB, Podany EC "Potassium loss associated with hydrochlorothiazide versus chlorthalidone." Clin Ther 4 (1981): 308-20
  19. Berg KJ, Gisholt K, Wideroe TE "Potassium deficiency in hypertensives treated with diuretics. Analysis of three alternative treatments by an oral test for potassium deficiency." Eur J Clin Pharmacol 7 (1974): 401-5
  20. Chowdhury FR, Bleicher SJ "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  21. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
  22. Ragnarsson J, Hardarson T, Snorrason SP "Ventricular dysrhythmias in middle-aged hypertensive men treated either with a diuretic agent or a beta-blocker." Acta Med Scand 221 (1987): 143-8
  23. Hollifield JW, Slaton PE "Thiazide diuretics, hypokalemia and cardiac arrhythmias." Acta Med Scand Suppl 647 (1981): 67-73
  24. Papademetriou V, Price M, Notargiacomo A, Gottdiener J, Fletcher RD, Freis ED "Effect of diuretic therapy on ventricular arrhythmias in hypertensive patients with or without left ventricular hypertrophy." Am Heart J 110 (1985): 595-9
  25. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  26. Krishna GG, Narins RG "Hemodynamic consequences of diuretic-induced hypokalemia." Am J Kidney Dis 12 (1988): 329-31
  27. Polanska AI, Baron DN "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 175-6
  28. Pinnock CA "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 48
  29. Itescu S, Haskell LP, Tannenberg AM "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  30. Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  31. Bain PG, Egner W, Walker PR "Thiazide-induced dilutional hyponatraemia masquerading as subarachnoid haemorrhage ." Lancet 2 (1986): 634
  32. Benfield GF, Haffner C, Harris P, Stableforth DE "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Lancet 2 (1986): 341
  33. Gould L, Reddy CV, Zen B, Singh BK "Life-threatening reaction to thiazides." N Y State J Med 80 (1980): 1975-6
  34. Seelig CB "Magnesium deficiency in two hypertensive patient groups." South Med J 83 (1990): 739-42
  35. 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,
  36. Kone B, Gimenez L, Watson AJ "Thiazide-induced hyponatremia." South Med J 79 (1986): 1456-7
  37. Holland OB, Kuhnert L, Pollard J, Padia M, Anderson RJ, Blomqvist G "Ventricular ectopic activity with diuretic therapy." Am J Hypertens 1 (1988): 380-5
  38. Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z "Cardiac conduction defects associated with hyponatremia." Clin Cardiol 14 (1991): 165-8
  39. Kaur J, Wahi PL "Polythiazide as a diuretic. A clinical trial." J Indian Med Assoc 48 (1967): 13-7
  40. Mroczek WJ "Indapamide: clinical pharmacology, therapeutic efficacy in hypertension, and adverse effects." Pharmacotherapy 3 (1983): 61-7
  41. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  42. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  43. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  44. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  45. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  46. Stern A "Metolazone, a diuretic agent." Am Heart J 91 (1976): 262-3
  47. Black W, Shiner P, Roman J "Severe electrolyte disturbances associated with metolazone and furosemide." South Med J 71 (1978): 381
  48. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  49. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  50. Ghose RR "Letter: Hyponatraemia and diuretics." Lancet 1 (1975): 578-9
  51. Brors O, Enger E, Jacobsen S, Aakvaag A, Foss OP "Effects of hydroflumethiazide in congestive heart failure: renal electrolyte excretion related to urinary thiazide excretion and aldosterone." Acta Pharmacol Toxicol (Copenh) 49 (1981): 399-406
  52. Brors O, Jacobsen S, Foss OP, Aakvaag A "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  53. el-Meheiry MM, Nabih AE, Soliman MD "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  54. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  55. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  56. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  57. Husby S, Marthedal NJ "Hyponatraemia due to a thiazide diuretic. A case report." Acta Med Scand 210 (1981): 523-4
  58. Berglund G, Andersson O, Larsson O, Wilhelmsen L "Antihypertensive effect and side-effects of bendroflumethiazide and propranolol." Acta Med Scand 199 (1976): 499-506
  59. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  60. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  61. Condon JR, Nassim R "Hypophosphataemia and hypokalaemia." Br Med J 1 (1970): 110
  62. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  63. Lee MR, Morgan DB "Familial hyperkalaemia responsive to benzothiadiazine diuretic." Lancet 1 (1980): 879
  64. Hesp R, Wilkinson PR "Potassium supplementation of thiazide therapy." Lancet 2 (1976): 1144
  65. Struthers AD, Whitesmith R, Reid JL "Prior thiazide diuretic treatment increases adrenaline-induced hypokalaemia." Lancet 1 (1983): 1358-61
  66. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  67. Starr JM, Whalley LJ "Hypertensive Old People in Edinburgh (HOPE) Study: electrocardiographic changes after captopril or bendrofluazide treatment." Age Ageing 22 (1993): 343-8
  68. Toner JM, Ramsay LE "Thiazide-induced hypokalaemia; prevalence higher in women." Br J Clin Pharmacol 18 (1984): 449-52
  69. 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
  70. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Wikstrom B "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  71. 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
  72. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  73. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  74. Read SJ, Trenerry HM, Whiting GF "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  75. Chan TY "Indapamide-induced severe hyponatremia and hypokalemia." Ann Pharmacother 29 (1995): 1124-8
  76. Simunic M, Rumboldt Z, Ljutic D, Sardelic S "Ramipril decreases chlorthalidone-induced loss of magnesium and potassium in hypertensive patients." J Clin Pharmacol 35 (1995): 1150-5
  77. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
  78. Palmer BF, Gates JR, Lader M "Causes and management of hyponatremia." Ann Pharmacother 37 (2003): 1694-702
View all 78 references
Major

Thiazides (applies to hydralazine/hydrochlorothiazide) liver disease

Major Potential Hazard, High plausibility.

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. Aneckstein AG, Weingold AB "Chlorothiazide-induced hepatic coma in pregnancy." Am J Obstet Gynecol 95 (1966): 136-7
  2. Sherlock S, Senewiratne B, Scott A, Walker JG "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52
  3. 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
  4. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  5. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  6. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  8. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  9. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  10. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  11. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 12 references
Major

Thiazides (applies to hydralazine/hydrochlorothiazide) lupus erythematosus

Major Potential Hazard, Moderate plausibility.

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. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Ann Intern Med 103 (1985): 49-51
  2. Parodi A, Romagnoli M, Rebora A "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Photodermatol 6 (1989): 100-2
  3. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  4. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  5. Goodrich AL, Kohn SR "Hydrochlorothiazide-induced lupus erythematosus: a new variant?" J Am Acad Dermatol 28 (1993): 1001-2
  6. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  8. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  9. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  10. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  11. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  13. Rich MW, Eckman JM "Can hydrochlorothiazide cause lupus?" J Rheumatol 22 (1995): 1001
  14. Brown CW, Deng JS "Thiazide diuretics induce cutaneous lupus-like adverse reaction." J Toxicol Clin Toxicol 33 (1995): 729-33
View all 14 references
Major

Thiazides (applies to hydralazine/hydrochlorothiazide) renal function disorders

Major Potential Hazard, High plausibility. Applicable conditions: 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. Fleuren HLJ, Verwey-van Wissen C, van Rossum JM "Dose-dependent urinary excretion of chlorthalidone." Clin Pharmacol Ther 25 (1979): 806-12
  2. Beermann B, Groschinsky-Grind M, Rosen A "Absorption, metabolism, and excretion of hydrochlorothiazide." Clin Pharmacol Ther 19 (1975): 531-7
  3. Niemeyer C, Hasenfub G, Wais U, et al. "Pharmacokinetics of hydrochlorothiazide in relation to renal function." Eur J Clin Pharmacol 24 (1983): 661-5
  4. Gehr TW, Sica DA, Brater DC, et al. "Metolazone pharmacokinetics and pharmacodynamics in renal transplantation." Int J Clin Pharmacol Ther Toxicol 29 (1991): 116-23
  5. Jones B, Nanra RS "Double-blind trial of antihypertensive effect of chlorothiazide in severe renal failure." Lancet 2 (1979): 1258-60
  6. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
  7. Magil AB, Ballon HS, Cameron EC, Rae A "Acute interstitial nephritis associated with thiazide diuretics. Clinical and pathologic observations in three cases." Am J Med 69 (1980): 939-43
  8. Magil AB "Drug-induced acute interstitial nephritis with granulomas." Hum Pathol 14 (1983): 36-41
  9. Delevett AF, Recalde M "Diuretic-induced renal colic." JAMA 225 (1973): 992
  10. 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
  11. Tilstone WJ, Dargie H, Dargie EN, Morgan HG, Kennedy AC "Pharmacokinetics of metolazone in normal subjects and in patients with cardiac or renal failure." Clin Pharmacol Ther 16 (1974): 322-9
  12. Bennett WM, Porter GA "Efficacy and safety of metolazone in renal failure and the nephrotic syndrome." J Clin Pharmacol 13 (1973): 357-64
  13. Craswell PW, Ezzat E, Kopstein J, Varghese Z, Moorhead JF "Use of metolazone, a new diuretic, in patients with renal disease." Nephron 12 (1974): 63-73
  14. Acchiardo SR, Skoutakis VA "Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment." Am Heart J 106 (1983): 237-44
  15. Brennan L, Wu MJ, Laquer UJ "A multicenter study of indapamide in hypertensive patients with impaired renal function." Clin Ther 5 (1982): 121-8
  16. Klunk LJ, Ringel S, Neiss ES "The disposition of 14C-indapamide in man." J Clin Pharmacol 23 (1983): 377-84
  17. Newstead CG, Moore RH, Barnes AJ "Interstitial nephritis associated with indapamide." BMJ 300 (1990): 1344
  18. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  19. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  20. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  21. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  22. Seyffart, G "Drug Dosage in Renal Insufficiency." Dordrecht, The Netherlands: Kluwer Academic Publishers 1 (1991): 227-8
  23. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  24. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  25. Hobbs DC, Twomey TM "Kinetics of polythiazide." Clin Pharmacol Ther 23 (1978): 241-6
  26. Lant AF, Baba WI, Wilson GM "Localization of the site of action of oral diuretics in the human kidney." Clin Sci 33 (1967): 11-27
  27. Brors O, Jacobsen S "Distribution of elimination of hydroflumethiazide in man." Eur J Clin Pharmacol 16 (1979): 125-31
  28. Brors O, Haffner JF, Jacobsen S "Excretion of hydroflumethiazide in bile and urine of man." Eur J Clin Pharmacol 15 (1979): 287-9
  29. Yakatan GJ, Smith RB, Frome EL, Doluisio JT "Pharmacokinetics of orally administered hydroflumethiazide in man." J Clin Pharmacol 17 (1977): 37-47
  30. el-Meheiry MM, Nabih AE, Soliman MD "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  31. Sketris IS, Skoutakis VA, Acchiardo SR, Meyer MC "The pharmacokinetics of trichlormethiazide in hypertensive patients with normal and compromised renal function." Eur J Clin Pharmacol 20 (1981): 453-7
  32. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  33. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  34. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  35. Larsson GB, Langer L, Nassberger L "Thiazide-induced kidney damage with circulating antibodies against myeloperoxidase and cardiolipin." J Intern Med 233 (1993): 493-4
  36. Beermann B, Groschinsky-Grind M, Lindstrom B "Pharmacokinetics of bendroflumethiazide." Clin Pharmacol Ther 22 (1977): 385-8
  37. Beermann B, Groschinsky-Grind M, Lindstrom B, Wikland B "Pharmacokinetics of bendroflumenthiazide in hypertensive patients." Eur J Clin Pharmacol 13 (1978): 119-24
  38. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  39. Read SJ, Trenerry HM, Whiting GF "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  40. Madkour H, Gadallah M, Plante GE, Massry SG "Comparison between the effects of indapamide and hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension." Am J Nephrol 15 (1995): 251-5
  41. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
View all 41 references
Moderate

Hydralazine (applies to hydralazine/hydrochlorothiazide) cerebral vasculopathy

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Cerebral Vascular Disorder

The vasodilatory effects of hydralazine may aggravate cerebral vasculopathy. Therapy with hydralazine should be administered cautiously in patients with cerebral vasculopathy.

References

  1. Koch-Weser J "Hydralazine." N Engl J Med 295 (1976): 320-3
  2. "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals (2001):
Moderate

Hydralazine (applies to hydralazine/hydrochlorothiazide) renal dysfunction

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glomerulonephritis

The use of hydralazine has been associated with the development of glomerulonephritis. Hydralazine should be used with caution in patients with advanced renal damage and these patients may require a lower dose. Renal function should be monitored and supported as required.

References

  1. "Product Information. Apresoline (hydralazine)." Ciba-Geigy Pharmaceuticals (2001):
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) asthma

Moderate Potential Hazard, Moderate plausibility.

Thiazide diuretics should be used with caution in patients with history of bronchial asthma as sensitivity reactions may occur.

References

  1. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  2. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  4. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  5. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  6. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  7. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  8. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 9 references
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  2. 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
  3. Miller NR, Moses H "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA 240 (1978): 1887-8
  4. Kansal PC, Buse J, Buse MG "Thiazide diuretics and control of diabetes mellitus." South Med J 62 (1969): 1372-9
  5. Andersen OO, Persson I "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J 2 (1968): 798-801
  6. Curtis J, Horrigan F, Ahearn D, Varney R, Sandler SG "Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma." JAMA 220 (1972): 1592-3
  7. Chowdhury FR, Bleicher SJ "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  8. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2
  9. Jones IG, Pickens PT "Diabetes mellitus following oral diuretics." Practitioner 199 (1967): 209-10
  10. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  11. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  12. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet 2 (1982): 1293-5
  13. Seltzer HS, Allen EW "Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man." Diabetes 18 (1969): 19-28
  14. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  15. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  16. Bell DS "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med 93 (1993): 99-103,
  17. Berlin I "Prazosin, diuretics, and glucose intolerance." Ann Intern Med 119 (1993): 860
  18. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  19. Rowe P, Mather H "Hyperosmolar non-ketotic diabetes mellitus associated with metolazone." Br Med J 291 (1985): 25-6
  20. Domenet JG "Diabetogenic effect of oral diuretics." Br Med J 3 (1968): 188
  21. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  22. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  23. Schmitz O, Hermansen K, Nielsen OH, Christensen CK, Arnfred J, Hansen HE, Mogensen CE, Orskov H, Beck-Nielsen H "Insulin action in insulin-dependent diabetics after short-term thiazide therapy." Diabetes Care 9 (1986): 631-6
  24. Blayac JP, Ribes G, Buys D, Puech R, Loubatieres-Mariani MM "Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion." Arch Int Pharmacodyn Ther 253 (1981): 154-63
  25. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  26. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  27. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  28. Berglund G, Andersson O, Widgren B "Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide." Acta Med Scand 220 (1986): 419-24
  29. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  30. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  31. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  32. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  33. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  34. 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
  35. Harper R, Ennis CN, Heaney AP, Sheridan B, Gormley M, Atkinson AB, Johnston GD, Bell PM "A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM." Diabetologia 38 (1995): 853-9
  36. 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
View all 36 references
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

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. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  2. Ames RP, Hill P "Increase in serum-lipids during treatment of hypertension with chlorthalidone." Lancet 1 (1976): 721-3
  3. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  4. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery 11 (1983): 283-96
  5. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  6. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  7. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  8. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  9. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC "The effects of terazosin and methyclothiazide on blood pressure and serum lipids." Am Heart J 117 (1989): 842-7
  10. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  11. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  12. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  13. Smith WM "Diuretics and cholesterol elevation." JAMA 242 (1979): 1612
  14. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  15. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  16. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  18. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  19. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  20. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  21. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  22. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  23. 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
View all 23 references
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) hyperparathyroidism

Moderate Potential Hazard, Moderate plausibility.

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. Anderson PE, Ellis GG, Austin SM "Case report: metolazone-associated hypercalcemia and acute pancreatitis." Am J Med Sci 302 (1991): 235-7
  2. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  3. Gammon GD, Docherty JP "Thiazide-induced hypercalcemia in a manic-depressive patient." Am J Psychiatry 137 (1980): 1453-5
  4. Parfitt AM "Thiazide-induced hypercalcemia in vitamin D-treated hypoparathyroidism." Ann Intern Med 77 (1972): 557-63
  5. 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
  6. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  7. Parfitt AM "Chlorothiazide-induced hypercalcemia in juvenile osteoporosis and hyperparathyroidism." N Engl J Med 281 (1969): 55-9
  8. Palmer FJ "Letter: Chlorthalidone-induced hypercalcemia." JAMA 229 (1974): 267
  9. Hakim R, Tolis G, Goltzman D, Meltzer S, Friedman R "Severe hypercalcemia associated with hydrochlorothiazide and calcium carbonate therapy." Can Med Assoc J 121 (1979): 591-4
  10. Itescu S, Haskell LP, Tannenberg AM "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  11. Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  12. Balizet L "Recurrent parathyroid adenoma. Association with prolonged thiazide administration." JAMA 225 (1973): 1238-9
  13. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  14. Duarte CG, Winnacker JL, Becker KL, Pace A "Thiazide-induced hypercalcemia." N Engl J Med 284 (1971): 828-30
  15. Klimiuk PS, Davies M, Adams PH "Primary hyperparathyroidism and thiazide diuretics." Postgrad Med J 57 (1981): 80-3
  16. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  17. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  18. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  19. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  20. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  21. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  22. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  23. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  24. Hilker RR "Reversible hypercalcemia associated with prolonged thiazide administration to control hypertension." J Occup Med 12 (1970): 444-5
  25. 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
  26. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Wikstrom B "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  27. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 27 references
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) hyperuricemia

Moderate Potential Hazard, High plausibility. Applicable conditions: 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. Lapidus PW, Guidotti FP "Gout in orthopaedic practice: review of 232 cases." Clin Orthop 28 (1963): 97-110
  2. Labeeuw M, Pozet N, Aissa AH, Zech PY, Sassard J, Laville M "Uric acid renal handling: spontaneous changes and influence of a thiazide alone or associated with triamterene." Int J Clin Pharmacol Ther Toxicol 26 (1988): 79-83
  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
  4. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  5. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  6. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  7. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  8. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  9. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  10. Brors O, Jacobsen S, Foss OP, Aakvaag A "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  11. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  12. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  13. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  14. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  15. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  16. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  17. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  18. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Odlind B, Wikstrom B "Effects of bendroflumethiazide on urate metabolism during treatment of patients with renal stones." J Urol 127 (1982): 1207-10
  19. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  20. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
View all 20 references
Moderate

Thiazides (applies to hydralazine/hydrochlorothiazide) thyroid function tests

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  3. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  4. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  5. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  6. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  7. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  8. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  9. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 10 references

Hydralazine/hydrochlorothiazide drug interactions

There are 586 drug interactions with hydralazine / hydrochlorothiazide.

Hydralazine/hydrochlorothiazide alcohol/food interactions

There are 2 alcohol/food interactions with hydralazine / hydrochlorothiazide.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.