Hydrochlorothiazide / Spironolactone Side Effects

Medically reviewed by Drugs.com. Last updated on Apr 23, 2025.

Applies to hydrochlorothiazide / spironolactone: oral tablet.

Precautions

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Do not take other medicines unless they have been discussed with your doctor. This especially includes potassium supplements or salt substitutes containing potassium, certain diuretics (eg, amiloride, triamterene (Dyazide®, Dyrenium®, Maxzide®, Midamor®, Moduretic®), or other products containing spironolactone (Aldactone®).

Check with your doctor immediately if blurred vision, difficulty reading, eye pain, or any other change in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor may want an eye doctor to check your eyes.

This medicine may cause dizziness, drowsiness, lightheadedness, or fainting, especially when you get up suddenly from a lying or sitting position. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous until you know how this medicine affects you. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you become sick while taking this medicine, especially if you have severe or continuing nausea, vomiting, or diarrhea that does not stop. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.

This medicine may affect blood sugar levels. Check with your doctor if you notice a change in the results of your blood or urine sugar tests.

This medicine may cause swelling of the breasts (gynecomastia) and breast pain in some patients. If you have questions about this, talk to your doctor.

This medicine may increase your risk of getting skin cancer (eg, non-melanoma skin cancer). Avoid sun exposure. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.

Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills.

Do not take other medicines unless they have been discussed with your doctor. This especially includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects

Along with its needed effects, hydrochlorothiazide / spironolactone 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 hydrochlorothiazide / spironolactone:

Get emergency help immediately if any of the following symptoms of overdose occur while taking hydrochlorothiazide / spironolactone:

Symptoms of overdose

• difficulty with sleeping
• disorientation
• drowsiness to profound coma
• hallucination
• lethargy
• lightheadedness
• mood or other mental changes
• rash with flat lesions or small raised lesions on the skin

Other side effects

Some side effects of hydrochlorothiazide / spironolactone 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:

For healthcare professionals

Applies to hydrochlorothiazide / spironolactone: oral tablet.

Endocrine adverse events

Spironolactone:

• Frequency not reported: Gynecomastia^[Ref]

Other

Hydrochlorothiazide:

• Frequency not reported: Weakness, fever, vertigo

Spironolactone:

• Frequency not reported: Breast pain, fever^[Ref]

Cardiovascular

Hydrochlorothiazide:

• Frequency not reported: Hypotension, orthostatic hypotension, necrotizing angitis, vasculitis

Spironolactone:

• Frequency not reported: Vasculitis^[Ref]

Hepatic

Hydrochlorothiazide:

• Frequency not reported: Pancreatitis, intrahepatic cholestatic jaundice

Spironolactone:

• Frequency not reported: Mixed cholestatic/hepatocellular toxicity^[Ref]

Gastrointestinal

Hydrochlorothiazide:

• Frequency not reported: Diarrhea, vomiting, sialoadenitis, cramping, constipation, gastric irritation, nausea

Spironolactone:

• Frequency not reported: Gastric bleeding, ulceration, gastritis, diarrhea, cramping, nausea, vomiting^[Ref]

Metabolic

Hydrochlorothiazide:

• Frequency not reported: Anorexia, electrolyte imbalance, hyperglycemia, hyperuricemia

Spironolactone:

• Frequency not reported: Hyperkalemia, electrolyte disturbances^[Ref]

Ocular

Hydrochlorothiazide:

• Frequency not reported: Acute myopia, acute angle closure glaucoma, transient blurred vision, xanthopsia^[Ref]

Hematologic

Hydrochlorothiazide:

• Frequency not reported: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia

Spironolactone:

• Frequency not reported: Leukopenia, agranulocytosis, thrombocytopenia^[Ref]

Immunologic

Hydrochlorothiazide:

• Frequency not reported: Anaphylactic reactions

Spironolactone:

• Frequency not reported: Anaphylactic reactions^[Ref]

Dermatologic

Hydrochlorothiazide:

• Frequency not reported: Cutaneous vasculitis, photosensitivity, urticaria, rash, purpura, erythema multiforme, pruritus

Spironolactone:

• Frequency not reported: Urticaria, maculopapular or erythematous cutaneous eruptions, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, alopecia, pruritus

Postmarketing: Non-melanoma skin cancer^[Ref]

Respiratory

Hydrochlorothiazide:

• Frequency not reported: Pneumonitis, pulmonary edema^[Ref]

Genitourinary

Hydrochlorothiazide:

• Frequency not reported: Glycosuria

Spironolactone:

• Frequency not reported: Inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding^[Ref]

Musculoskeletal

Hydrochlorothiazide:

• Frequency not reported: Muscle spasm

Spironolactone:

• Frequency not reported: Leg cramps^[Ref]

Nervous system

Hydrochlorothiazide:

• Frequency not reported: Paresthesias, dizziness, headache

Spironolactone:

• Frequency not reported: Lethargy, ataxia, dizziness, headache, drowsiness^[Ref]

Psychiatric

Hydrochlorothiazide:

• Frequency not reported: Restlessness

Spironolactone:

• Frequency not reported: Mental confusion^[Ref]

Renal

Hydrochlorothiazide:

• Frequency not reported: Renal failure, renal dysfunction, interstitial nephritis

Spironolactone:

• Frequency not reported: Renal dysfunction, renal failure^[Ref]

Oncologic

Spironolactone:

• Frequency not reported: Carcinoma of the breast^[Ref]

See also:

Further information

Hydrochlorothiazide/spironolactone side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer