Chlorothiazide prevents sodium and water from being reabsorbed in the distal tubules, which causes the body to lose salt and water. Thus, it is applied to the following ailments:
- Edematous and fluid overloaded states
- It may be used to treat Hypertension as monotherapy (or in combination with other medicines ) in the absence of other comorbid conditions like diabetes, kidney disease, ischemic heart disease, and cerebrovascular disease.
Chlorothiazide Dose in Adults
- Dose in Hypertension:
- 500 to 2,000 mg per day once or twice daily.
- Dose in patients with Edema:
- A daily dose cap of 1,000 mg is reached by taking 250 to 500 mg orally once or twice per day.
- 500 to 1,000 mg administered intravenously once daily along with a loop diuretic
Chlorothiazide Dose in Children
- For diuresis, heart failure, and hypertension:
- Infants, Children, and Adolescents:
- 10 to 40 mg/kg/day orally once or twice daily to a maximum daily dose of
- 375 mg/day in infants and children less than 2 years of age,
- 1000 mg in children older than 2 years of age, and
- 2000 mg daily in adolescents
- 5 to 10 mg/kg/day intravenous in one or two daily divided doses to a maximum dose of 500 mg/dose.
- 10 to 40 mg/kg/day orally once or twice daily to a maximum daily dose of
- Infants, Children, and Adolescents:
- Dose in central Diabetes insipidus:
- Infants:
- 10 mg/kg/day in two divided doses. The dose may be incrementally increased to a target urine osmolality of 100 to 150 mOsm/L.
- Infants:
Pregnancy Risk Factor C
- The placental barrier is crossed by chlorothiazide and can cause neonatal jaundice or thrombocytopenia.
- Women with hypertension may need thiazide diuretics during pregnancy. It should not be used to treat edema caused by pregnancy
Chlorothiazide use during breastfeeding:
- Breastmilk contains chlorothiazide, which can be excreted in this substance.
- This could lead to serious adverse drug reactions in the child.
- You should stop using it while you are breastfeeding.
- Nursing mothers should avoid diuretics as they can reduce milk production.
Chlorothiazide Dose in Kidney Disease:
- It is usually not effective in patients with a CrCl of less than 30 mL/minute and is, therefore, combined with a loop diuretic.
- Patients with a CrCl of less the 10 mL/minute should avoid the drug.
Chlorothiazide Dose in Liver Disease:
Although the manufacturer has not advised changing the dosage for people with liver disease, advanced liver disease should be treated cautiously.
Side Effects of Chlorothiazide:
- Cardiovascular:
- Hypotension
- Necrotizing angiitis
- Orthostatic hypotension
- Central nervous system:
- Dizziness
- Headache
- Paresthesia
- Restlessness
- Vertigo
- Dermatologic:
- Alopecia
- Erythema multiforme
- Exfoliative dermatitis
- Skin photosensitivity
- Skin rash
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Urticaria
- Endocrine & metabolic:
- Glycosuria
- Hypercalcemia
- Hyperglycemia
- Hyperuricemia
- Hypochloremic alkalosis
- Hypokalemia
- Hypomagnesemia
- Hyponatremia
- Increased serum cholesterol
- Increased serum triglycerides
- Gastrointestinal:
- Abdominal cramps
- Anorexia
- Constipation
- Diarrhea
- Gastric irritation
- Nausea
- Pancreatitis
- Sialadenitis
- Vomiting
- Genitourinary:
- Hematuria
- Impotence
- Hematologic & oncologic:
- Agranulocytosis
- Aplastic anemia
- Hemolytic anemia
- Leukopenia
- Purpura
- Thrombocytopenia
- Hepatic:
- Jaundice
- Hypersensitivity:
- Anaphylaxis
- Neuromuscular & skeletal:
- Muscle spasm
- Systemic lupus erythematosus
- Weakness
- Ophthalmic:
- Blurred vision
- Xanthopsia
- Renal:
- Interstitial nephritis
- Renal failure
- Renal insufficiency
- Respiratory:
- Pneumonitis
- Pulmonary edema
- Respiratory distress
- Miscellaneous:
- Fever
Contraindication to chlorothiazide include:
- Chlorothiazide, any medication produced from a sulfonamide, or any ingredient in the formulation allergy or sensitivity
- Anuria is a urine volume of less than 100ml within the last 24 hours.
Warnings and Precautions
- Electrolyte disturbances:
- It alters blood electrolytes, causing hypercalcemia and hyponatremia as well as hypokalemia, hypochloremic acidosis, hypokalemia, and hypomagnesemia.
- Orthostatic hypotension
- This can lead to postural hypotension, especially when combined with concomitant alcohol.
- Photosensitivity
- Allergy to sulfonamide ("sulfa drug")
- Although, the FDA recommends avoiding chlorothiazide in patients allergic to sulfa drugs, however, studies do not indicate any cross-reactivity.
- Patients with severe reactions should avoid it.
- Insufficiency of the adrenals:
- Patients suffering from primary adrenal insufficiency need to avoid chlorothiazide. It may be necessary to adjust the dose of steroid.
- Diabetes:
- In people with diabetes mellitus, it may alter glucose metabolism and should be administered with caution.
- Gout
- In patients with hyperuricemia, it should be administered cautiously because it may cause gout to flare up.
- Hepatic impairment
- Patients with liver disease should not take it. Hypokalemia due to excessive chlorothiazide may lead to hepaticencephalopathy.
- Hypercalcemia:
- Chlorothiazide should not be used in patients with hypercalcemia.
- Hypercholesterolemia:
- This could lead to elevated blood levels, especially of triglyceride.
- Hypokalemia
- Before using hypokalemia, it must be corrected
- Renal impairment
- Patients with impaired renal function should be cautious.
- Systemic lupus, erythematosus
- It could cause SLE due to drug-induced side effects
Chlorothiazide: Drug Interaction
Note: Drug Interaction Categories:
- Risk Factor C: Monitor When Using Combination
- Risk Factor D: Consider Treatment Modification
- Risk Factor X: Avoid Concomitant Use
Risk Factor C (Monitor therapy). |
|
| Ajmaline | Sulfonamides can increase the toxic/adverse effects of Ajmaline. Particularly, there may be an increase in the risk of cholestasis. |
| Alcohol (Ethyl) | May intensify the effects of thiazide or thiazide-like diuretics on orthostatic hypotension. |
| Alfuzosin | May intensify blood pressure lowering medications' hypotensive effects. |
| Allopurinol | Thiazide or Thiazide-Like Deuretics may enhance the possibility of Allopurinol hypersensitivity reactions. The serum concentration of allopurinol can be raised by thiazide and thiazide-like diuretics. Particularly Thiazide Diuretics may raise Oxypurinol concentrations, an active metabolite of Allopurinol. |
| Aminolevulinic Acid Topical | Aminolevulinic Acid Topical's photosensitizing effects may be exacerbated by photosensitizing substances. |
| Amphetamines | May lessen the effects of antihypertensive medications in treating hypertension. |
| Angiotensin-Converting Enzyme Inhibitors | Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics. |
| Anticholinergic Agents | Thiazide or Thiazide-Like Diuretics may rise in serum. |
| Antidiabetic Agents | Thiazide or Thiazide-Like Diauretics may reduce the effectiveness of anti-diabetic medications. |
| Antidiabetic Agents | The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents. |
| Antipsychotic Agents, Second Generation (Atypical) | Antipsychotic drugs can have a greater hypotensive effect when blood pressure-lowering medications are used (Second Gen [Atypical]). |
| Barbiturates | May intensify the effects of thiazide or thiazide-like diuretics on orthostatic hypotension. |
| Barbiturates | May intensify blood pressure lowering medications' hypotensive effects. |
| Benperidol | May intensify blood pressure lowering medications' hypotensive effects. |
| Beta2-Agonists | May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia. |
| Brigatinib | May lessen the effects of antihypertensive medications in treating hypertension. The bradycardic effects of antihypertensive medications may be exacerbated by brutinib. |
| Brimonidine (Topical) | May intensify blood pressure lowering medications' hypotensive effects. |
| Calcium Salts | Calcium salt excretion can be decreased by thiazide or thiazide-like diuretics. |
| CarBAMazepine | Metabolic alkalosis may also result from concurrent usage. |
| Cardiac Glycosides | Thiazide or Thiazide-Like Dehydrators may make CarBAMazepine more toxic or harmful. Perhaps more people have hyponatremia. |
| Corticosteroids (Orally inhaled) | When taken with diuretics that are similar to or identical to thiazides, cardiac glycosides may become more toxic. Thiazide diuretics' hypokalemic or hypomagnesemic adverse effects may worsen cardiac glycoside toxicity. |
| Corticosteroids (Systemic) | May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia. |
| Cyclophosphamide | Thiazide or Thiazide-Like Dehydrators may increase Cyclophosphamide's toxic/adverse effects. In particular, granulocytopenia could be increased. |
| Dexketoprofen | May increase the toxic/adverse effects of Sulfonamides. |
| Dexmethylphenidate | Antihypertensive agents may have a less therapeutic effect. |
| Diacerein | Might increase the therapeutic effects of Diuretics. Particularly, there may be an increase in the risk of hypokalemia or dehydration. |
| Diazoxide | Thiazide or Thiazide-Like Diauretics can increase the toxic/adverse effects of Diazoxide. |
| Diazoxide | May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia. |
| DULoxetine | By reducing blood pressure, DULoxetine may exacerbate hypotension. |
| Herbs (Hypertensive Properties) | May lessen the effects of antihypertensive medications in treating hypertension. |
| Herbs (Hypotensive properties) | May lessen the effects of antihypertensive medications in treating hypertension. |
| Hypotension-Associated Agents | The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications. |
| Ipragliflozin | Diuretics that act like thiazides and thiazide-like thiazides may be harmful or poisonous. There may be a greater chance of intravascular volume loss in particular. |
| Ivabradine | Ivabradine's arrhythmogenic effects can be increased by Thiazide or Thiazide-Like diuretics. |
| Levodopa-Containing Products | Levodopa-Containing Products' hypotensive effects may be amplified by blood pressure-lowering medications. |
| Licorice | May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia. |
| Lormetazepam | May intensify blood pressure lowering medications' hypotensive effects. |
| Methylphenidate | May lessen the effects of antihypertensive medications in treating hypertension. |
| Molsidomine | May intensify blood pressure lowering medications' hypotensive effects. |
| Multivitamins/Fluoride (with ADE) | May intensify the effects of thiazide or thiazide-like diuretics on hypercalcemia. |
| Multivitamins/Minerals (with ADEK, Folate, Iron) | The effect of multivitamins and minerals on hypercalcemia may be enhanced by thiazide and thiazide-like diuretics (with ADEK, Folate, Iron). |
| Multivitamins/Minerals (with AE, No Iron) | The serum concentration of multiple vitamins and minerals may rise after taking thiazide and thiazide-like diuretics (with AE, No Iron). Thiazide diuretics may reduce the excretion of calcium, and long-term concurrent use may result in metabolic alkalosis. |
| Naftopidil | May intensify blood pressure lowering medications' hypotensive effects. |
| Neuromuscular-Blocking Agents (Nondepolarizing) | The neuromuscular-blocking action of neuromuscular-blocking agents may be enhanced by thiazide and thiazide-like diuretics (Nondepolarizing). |
| Nicergoline | May intensify blood pressure lowering medications' hypotensive effects. |
| Nicorandil | May intensify blood pressure lowering medications' hypotensive effects. |
| Nitroprusside | Blood pressure lowering medications may intensify Nitroprusside's hypotensive effects. |
| Nonsteroidal Anti-Inflammatory Drugs | Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) can have more nephrotoxic effects when taken with thiazide-Like and thiazide-Like diuretics. Thiazide and Thiazide-Like Diuretics may have less of a therapeutic impact when used with nonsteroidal anti-inflammatory drugs. |
| Opioid Agonists | Could worsen diuretics' toxic/unfavorable effects. Opioid Agonists may lessen the therapeutic effects of diuretics. |
| Oxcarbazepine | Thiazide or Thiazide-Like Dehydrators may make OXcarbazepine more toxic or harmful. Perhaps more people have hyponatremia. |
| Pentoxifylline | May intensify blood pressure lowering medications' hypotensive effects. |
| Pholcodine | Pholcodine's ability to reduce blood pressure may help to increase hypotensive effects. |
| Phosphodiesterase 5 Inhibitors | May intensify blood pressure lowering medications' hypotensive effects. |
| Porfimer | The photosensitizing effects of Porfimer may be enhanced by photosensitizing substances. |
| Prostacyclin Analogues | May intensify blood pressure lowering medications' hypotensive effects. |
| Quinagolide | May intensify blood pressure lowering medications' hypotensive effects. |
| Reboxetine | May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia. |
| Selective Serotonin Reuptake inhibitors | May intensify the effects of thiazide or thiazide-like diuretics that cause hyponatraemia. |
| Toremifene | Thiazide or Thiazide-Like Diauretics may increase toremifene's hypercalcemic effects. |
| Verteporfin | Verteporfin's photosensitizing effects may be exacerbated by photosensitizing substances. |
| Vitamin D Analogs | The effects of vitamin D analogues on hypercalcemia can be exacerbated by thiazide or Thiazide-Like diuretics. |
| Yohimbine | May lessen the effects of antihypertensive medications in treating hypertension. |
Risk Factor D (Keep in mind therapy modification) |
|
| Amifostine | The hypotensive effects of amifostine may be strengthened by blood pressure reducing medications. Treatment: Stop taking blood pressure medications at least 24 hours before taking amifostine. If taking blood pressure medicine cannot be stopped, amifostine should be avoided. |
| Bile Acid Sequestrants | This could reduce the absorption of thiazide and thiazide-like diuretics. Additionally, the diuretic reaction is reduced. |
| Dofetilide | The effects of dofetilide that prolong QTc may be increased by thiazide or thiazide-like dehydrators. Thiazide-Like Diuretics and Thiazide may raise the serum levels of Dofetilide. Specifically listed as a contraindication is hydrochlorothiazide. But the danger probably applies to all thiazide- or thiazide-like-diuretics. Chlorthalidone and bendroflumethiazide may make it much riskier. Think about alternatives whenever possible. |
| Lithium | Lithium excretion can be reduced by diuretics that are thiazide- and thiazide-like. |
| Obinutuzumab | The effects of blood pressure lowering medications may become more hypotensive as a result. Treatment: Starting 12 hours before the obinutuzumab injection and continuing for 1 hour after the infusion, you may temporarily stop taking blood pressure-lowering medications. |
| Sodium Phosphates | Diuretics may intensify the nephrotoxic effects of sodium phosphates. Acute phosphate nephropathy (APN) may become more prevalent. Treatment: You can avoid taking these medications together by temporarily ceasing your diuretic therapy or by finding an alternative to the oral sodium-phosphate bowel preparation. If the combination is not possible, drink plenty of water and keep an eye on your fluid and renal status. |
| Topiramate | Topiramate's effects on hypokalemia can be exacerbated by Thiazide or Thiazide-Like Deuretics. The amounts of topiramate in the serum can be raised by thiazide-Like and thiazide diuretics. Monitoring: When starting or increasing the dosage of a thiazide-like diuretic, keep an eye out for raised topiramate levels and adverse effects (such as hypokalemia). When receiving concurrent therapy, closely monitor the serum potassium levels. It could be essential to lower the topiramate dosage. |
Risk Factor X (Avoid Combination) |
|
| Aminolevulinic Acid Systemic | The photosensitizing effects of Aminolevulinic Acid Systemic may be enhanced by the use of photosensitizing agents. |
| Bromperidol | The hypotensive effects of bromperidol may be strengthened by blood pressure-lowering medications. The hypotensive effects of blood pressure-lowering medications may be lessened by bromperidol. |
| Levosulpiride | Levosulpiride's toxic/unfavorable effects can be increased by Thiazide or Thiazide-Like diuretics. |
| Mecamylamine | Sulfonamides may make mecamylamine more poisonous or harmful. |
| Promazine | Promazine's ability to prolong QTc can be increased by Thiazide or Thiazide-Like diuretics. |
Monitoring Parameters:
- Serum electrolytes,
- renal function,
- blood pressure;
- assess weight,
- intake and output reports daily to determine fluid loss
How to Administer Chlorothiazide?
- Administer the drug as an intravenous infusion.
- It should not be administered via intramuscular or SubQ route.
- Extravasation of the drug must be avoided.
Mechanism of action of Chlorothiazide:
- It acts by blocking the reabsorption sodium and chloride from the distal tubules, resulting in their expulsion along with water.
- It is possible to also lose potassium, hydrogen ions and magnesium.
TheStart of action The oral tablet takes approximately 2 hours, while the intravenous formulation takes about 15 minutes.
For the oral drug to reach its peak, it can take up to 4 hours while for the IV drug, it can take just 15 minutes.
The oral drug's duration of action isIt can take between 6 and 12 hours for intraveneous forms, while it takes about 3 hours.
It is not metabolized and poorly absorbed.
Its bioavailability ranges from 9% to 56%.
Half-life is the time it takes to get rid of the drug.
It is excreted mostly via urine.
International Brands of Chlorothiazide:
- Azide
- Chlorosal
- Chlotride
- Disalunil
- Diurilix
- Diurone
- Diurosulfona
- Hydrochlorothiazidum
- Niagar
- Saluretil
- Saluric
- Salutrid
- Urinex
Chlorothiazide Brands in Pakistan:
No brands available in Pakistan
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