Chlorthalidone - Dose, indications, side effects, brands ...

Chlorthalidone is a week thiazide diuretic that is used (along with other appropriate drugs) in the treatment of the following conditions:

  • Edema brought on by kidney illness, cirrhosis, heart failure, or corticosteroid and oestrogen medication.
  • Management of hypertension especially in patients who require monotherapy in the absence of other comorbid conditions like diabetes, ischemic heart disease, and cerebrovascular diseases.
  • Hypercalciuria and patients predisposed to develop calcium stones.

Chlorthalidone Dose in Adults

  • Edema:
    • Every 24 hours, 50 to 100 mg, or 100 mg every other day, up to a daily maximum of 200 mg.
  • Patients with Heart failure:
    • 100 mg per day is the maximum dosage, or 12.5 to 25 mg once every 24 hours.
  • Hypertension:
    • 12.5 to 25 mg once every 24 hours, tapered by 25 mg daily, up to a daily maximum of 100 mg.
  • Off-label use in patients with hypercalciuria and calcium stones:
    • 25 mg once daily

Chlorthalidone Dose in Children

Dose of chlorthalidone in children & adolescents with Hypertension:

  • To a maximum dose of 2 mg/kg/day or 50 mg/day, administer 0.3 mg/kg/dose once every 24 hours, preferably in the morning.

Pregnancy Risk Factor C

  • The palcenta is crossed by chlorthalidone and could be associated with the adverse events listed below:
    • Neonatal or fetal jaundice
    • Thrombocytopenia and
    • It can also cause other adverse reactions similar to those experienced by adults.
  • Women who were treated with thiazide diuretics before conception can continue to use the drug during pregnancy.(Hypertension in Pregnancy ACOG 2007(

Use of chlorthalidone during breastfeeding  

  • The breastmilk may contain thiazide diuretics, which can cause severe neonatal side effects. 
  • Breastfeeding and thiazide diuretics should not be done during breastfeeding.
  • Milk production is also affected by diuretics.

Chlorthalidone Dose in Renal Disease:

  • Chlorthalidone is contraindicated in patients with anuria.
  • In individuals with ESRD and advanced renal impairment (CrCl of less than 10 ml/min), it is ineffective.
  • Patients with a CrCl of 10 ml/min or higher do not require a dosage change.

Chlorthalidone Dose in Liver Disease:

  • It should be used with caution in patients with liver disease.

Chlorthalidone Side effects:

  • Cardiovascular:
    • Necrotizing angiitis
    • Orthostatic hypotension
    • Vasculitis
  • Central nervous system:
    • Dizziness
    • Headache
    • Paresthesia
    • Restlessness
    • Vertigo
  • Dermatologic:
    • Skin photosensitivity
    • Skin rash
    • Toxic epidermal necrolysis
    • Urticaria
  • Endocrine & metabolic:
    • Glycosuria
    • Hyperglycemia
    • Hyperuricemia
    • Hypochloremic alkalosis
    • Hypokalemia
    • Hyponatremia
  • Gastrointestinal:
    • Abdominal cramps
    • Anorexia
    • Constipation
    • Diarrhea
    • Gastric irritation
    • Nausea
    • Pancreatitis
    • Vomiting
  • Genitourinary:
    • Impotence
  • Hematologic & oncologic:
    • Agranulocytosis
    • Aplastic anemia
    • Hypersensitivity angiitis
    • Leukopenia
    • Nonthrombocytopenic purpura
    • Thrombocytopenia
  • Hepatic:
    • Intrahepatic cholestatic jaundice
  • Neuromuscular & skeletal:
    • Asthenia
    • Muscle spasm
  • Ophthalmic:
    • Xanthopsia

Contraindication to Chlorthalidone include:

  • Hypersenstivity
  • Anuria is a low urine output of less than 100ml within the last 24 hours.

Warnings and Precautions

  • Electrolyte imbalance:
    • Chlorthalidone therapy patients may experience any of these electrolyte imbalances.
      • Hypokalemia
      • Hypochloremic alkalosis
      • Hypomagnesemia is a condition in which there is hypomagnesemia.
      • Hyponatremia
      • Combining chlorthalidone and other drugs, such as ACE inhibitors or ARBs, can help to prevent electrolyte imbalances.
  • Gout:
    • It can precipitate gout in patients with:
      • a history of gout
      • a familial predisposition to gout
      • chronic renal failure
      • Patients at higher risk of hyperuricemia are those whose daily intake exceeds 50 mg/day.
  • Hypersensitivity reactions:
    • Patients with asthma and atopy are at-risk of developing allergic reactions to chlorthalidone.
  • PhotosensitivityPossible side effects of the drug
  • Allergy to sulfonamide ("sulfa")
    • Patients who have a history of severe reactions to sulfa drugs, especially those with severe allergies, should be screened.Steven-Johnson syndrome, TENAvoid chlorthalidone
  • Insufficiency of the adrenals:
    • Patients suffering from adrenal insufficiency should avoid this drug. Patients with adrenal insufficiency should avoid the drug.
  • Diabetes:
    • It can cause glucose problems in patients who are already diabetic or have pre-diabetic.
  • Hepatic impairment
    • This could lead to hepatic and/or metabolic encephalopathy in patients with advanced liver disease.
  • Hypercalcemia:
    • Patients suffering from hypercalcemia should stay away from thiazide diuretics, as they can inhibit calcium excretion from the renal tubules.
  • Hypercholesterolemia:
    • Patients with dyslipidemias, particularly those with high triglyceride levels should be cautious when using thiazide diuretics.
  • Parathyroid disease
    • Before testing for parathyroid hormone, you should stop taking thiazide Diuretics.
    • In individuals getting treatment with thiazide diuretics, pathological alterations brought on by hypophosphatemia and hypercalcemia have been seen.
  • Renal impairment
    • Patients with extensive renal illness, anuria, or rapidly fluctuating renal functions shouldn't undergo this procedure.
  • Systemic lupus erythematosus (SLE):
    • The drug-induced SLE caused by chlorthalidone could be accompanied by positive anti-histoen antibody.

Chlorthalidone: 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. Thiazide-Like and Thiazide Diuretics can raise the serum levels of allopurinol. 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' hypotensive effects may be enhanced by thiazide and thiazide-like diuretics. 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.
Brimonidine (Topical) The bradycardic effects of antihypertensive medications may be exacerbated by brutinib.
Calcium Salts May intensify blood pressure lowering medications' hypotensive effects.
CarBAMazepine Calcium salt excretion can be decreased by thiazide or thiazide-like diuretics.
Cardiac Glycosides 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 (Orally inhaled) May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia.
Corticosteroids (Systemic) May intensify the effects of thiazide or thiazide-like diuretics on hypokalemia.
Cyclophosphamide Cyclophosphamide's hazardous or deleterious effects may be exacerbated by thiazide or thiazide-like dehydrators. Granulocytopenia in particular could become more severe.
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 blood pressure lowering medications' hypotensive effects.
DULoxetine By reducing blood pressure, DULoxetine may intensify the hypotensive effects.
Herbs (Hypertensive Properties) May lessen the effects of antihypertensive medications in treating hypertension.
Herbs (Hypotensive properties) May intensify blood pressure lowering medications' hypotensive effects.
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. Compared to nonsteroidal anti-inflammatory drugs, thiazide-like diuretics and thiazide-like diuretics may have a less potent therapeutic impact.
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 By reducing blood pressure, pholocdine may exacerbate hypotension.
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 on hypokalemia.
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 (Regard therapy modification)

 
Amifostine The hypotensive effects of amifostine may be strengthened by blood pressure reducing medications. Treatment: Patients receiving chemotherapy should stop taking blood pressure medications at least 24 hours before receiving 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 and Thiazide-Like Diuretics Thiazide may raise the serum levels of dofetilide. Management: Despite the fact that hydrochlorothiazide is clearly listed as being contraindicated, the risk certainly applies to all thiazide and thiazide-like diuretics and may even be larger when using chlorthalidone or bendroflumethiazide. Always keep alternate possibilities in mind.
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 a thiazide-like diuretic, keep an eye out for high topiramate levels and any negative 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 Bromperidol's hypotensive effects may be enhanced by Blood Pressure Lowering agents. Bromperidol could decrease the hypotensive effects of Blood Pressure Lowering agents.
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:

While on chlorthalidone therapy, Monitor:

  • Weight (an indirect evidence of body fluid balance)
  • intake and output records daily to determine fluid status
  • Blood pressure (The target blood pressure in a patient with ASCVD risk of more than 10% is less than 130/80 mmHg.
  • serum electrolytes, and
  • renal functions

How to administer Chlorthalidone?

  • Take the tablet orally after breakfast (after the morning meal).

Mechanism of action of Chlorthalidone:

  • Chlorthalidone, a diuretic produced from sulfonamides, prevents salt and chloride from being reabsorbed in the ascending loops of Henle.

Peak effects appear between two and six hours after the beginning of activity, on average.

After a single dose, the duration of effect ranges from 24 to 48 hours. The liver metabolises the medication, which is attached to proteins in 75% of its composition.

The drug's half-life ranges from 40 to 60 hours, however it can be extended in individuals with renal impairment.

It is priamrily excreted via the kidneys

International brands of Chlorthalidone:

  • C-Done
  • Chotalin
  • Clortalil
  • Dichlor
  • Dinorik
  • Higroton
  • Hygroton
  • Hythalton
  • Igroton
  • Metorene
  • Nefrofil
  • Oxodoline
  • Saluretin
  • Thalin
  • Tonorma
  • Unichlor

Chlorthalidone Brands in pakistan:

Chlorthalidone tablets in Pakistan

Chlorthalidone [Tabs 25 mg]

BLOKIUM-DIU HIGHNOON LABORATORIES LTD.

 

Chlorthalidone [Tabs 12.5 mg]

ATLIN PLUS BOSCH PHARMACEUTICALS (PVT) LTD.
BLOKIUM-DIU HIGHNOON LABORATORIES LTD.
CARDIOLITE PLUS ASIAN CONTINENTAL (PVT) COMPANY
CO-PULSE WERRICK PHARMACEUTICALS
CO-PULSE WERRICK PHARMACEUTICALS
NORMITAB PLUS NABIQASIM INDUSTRIES (PVT) LTD.
TENORET-50 ICI PAKISTAN LTD.