Trade Names:Chlorothiazide- Tablets 250 mg- Tablets 500 mg
Trade Names:Diuril- Oral suspension 250 mg per 5 mL- Injection, lyophilized powder for solution 500 mg
Enhances excretion of sodium, chloride, and water by interfering with transport of sodium ions across renal tubular epithelium.
Chlorothiazide crosses the placenta but not the blood-brain barrier.
Chlorothiazide is not metabolized.
Excreted by the kidney. Plasma t ½ 45 to 120 min. Following IV administration, 96% is excreted unchanged in the urine within 23 h.
Within 2 h after oral administration; within 15 min after IV administration.
Approximately 4 h after oral administration; approximately 30 min after IV administration.
Approximately 6 to 12 h after oral administration.
Adjunctive treatment in edema associated with CHF, hepatic cirrhosis, and corticosteroid and estrogen therapy; edema caused by various forms of renal function impairment such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure (oral and IV); management of hypertension (oral).
Calcium nephrolithiasis; diabetes insipidus; osteoporosis.
Anuria, hypersensitivity to sulfonamide-derived drugs or any component of this product.
PO 30 mg/kg in 2 divided doses may be required.Children 6 mo to 2 yr of age (see Precautions)
PO 10 to 20 mg/kg/day in single or 2 divided doses (max, 375 mg/day).Children 2 to 12 yr of age (see Precautions)
PO 1 g/day.EdemaAdults
PO 500 to 1,000 mg once or twice daily. Many patients respond to intermittent therapy (alternate day therapy or administration on 3 to 5 days each wk). IV 500 to 1,000 mg once or twice daily. Should be reserved for patients unable to take oral medication or for emergency situations. Individualize dosage according to patient response, using the smallest dosage necessary.HypertensionAdults
PO 500 to 1,000 mg as a single or divided dose. Increase or decrease dose according to BP response. Rarely, some patients may require up to 2 g/day in divided doses.
Store oral suspension at controlled room temperature (59° to 86°F). Protect from freezing. Store powder for injection between 36° and 77°F. Store tablets at 68° to 77°F. Dispense in light-resistant container.
May potentiate orthostatic hypotension.Antihypertensive agents
Coadministration may result in additive antihypertensive effects, or the effects may be potentiated.Bile acid sequestrants
May reduce thiazide absorption; give thiazide at least 2 h before bile acid sequestrants.Cisapride
Cisapride is contraindicated in patients who experience rapid reduction in plasma potassium, including patients receiving chlorothiazide.Corticosteroids
Increased electrolyte depletion, especially hypokalemia.Diazoxide
May cause hyperglycemia.Digitalis glycosides
Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.Dofetilide
Dofetilide is contraindicated in patients receiving chlorothiazide because hypokalemia may occur, increasing the risk of torsades de pointes.Insulin, sulfonylureas
May decrease hypoglycemic effect of sulfonylureas. Because chlorothiazide may elevate blood glucose levels, may need to increase dosage of sulfonylureas or insulin.Lithium
May decrease renal excretion of lithium.Loop diuretics
Synergistic effects may result in profound diuresis and serious electrolyte abnormalities.Nondepolarizing muscle relaxants (eg, tubocurarine), skeletal muscle relaxants
Response to muscle relaxants may be increased.NSAIDs
Pharmacologic effects of chlorothiazide may be reduced.Pressor amines (eg, norepinephrine)
Effect of pressor amines may be reduced.
May produce false-negative results with the phentolamine and tyramine tests; may interfere with the phenolsulfonphthalein test because of decreased excretion; may cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, and a decrease in serum protein-bound iodine levels without signs of thyroid disturbance.
Hypotension; orthostatic hypotension.
Dizziness; headache; paresthesia; restlessness; vertigo.
Alopecia; erythema multiforme; exfoliative dermatitis; Stevens-Johnson syndrome; toxic epidermal necrolysis.
Transient blurred vision; xanthopsia.
Anorexia; constipation; cramping; diarrhea; gastric irritation; nausea; pancreatitis; sialadenitis; vomiting.
Hematuria (IV use); impotence; interstitial nephritis; renal failure; renal function impairment.
Agranulocytosis; aplastic anemia; hemolytic anemia; leukemia; thrombocytopenia.
Jaundice (intrahepatic cholestasis).
Anaphylactic reactions; fever; necrotizing angiitis (vasculitis and cutaneous vasculitis); photosensitivity; purpura; rash; respiratory distress, including pneumonitis and pulmonary edema; urticaria.
Electrolyte imbalance; glycosuria; hyperglycemia; hyperuricemia.
Muscle spasm; weakness.
Monitor blood sugar in diabetic patients when drug is started or dose is changed. Advise patient to report significant changes to health care provider.BP/Pulse
Monitor and record BP and pulse. Should hypotension result, advise patient to hold medication and notify health care provider.Chloride deficit
Generally mild except in certain circumstances (eg, liver or renal disease), which may require treatment including chloride replacement for the treatment of metabolic alkalosis.Orthostatic hypotension
Take safety precautions if orthostatic hypotension occurs.Routine tests
Ensure that serum electrolytes, BUN, creatinine, and uric acid are monitored periodically.
Category C .
Excreted in breast milk.
Safety and efficacy not established. Oral dosing recommendation is supported by empiric use in children and published literature regarding the treatment of hypertension.
Use with caution, usually starting at the low end of the dosage range, because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides also may occur.
Drug may precipitate azotemia; use drug with caution.
Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use with caution.
May become manifest.
May occur in edematous patients in hot weather.
Increased urinary excretion of sodium, potassium, or magnesium may occur; decreased urinary excretion of calcium may occur.
May occur or frank gout may be precipitated.
Increased cholesterol and triglycerides may occur.
Exacerbation or activation may occur.
Antihypertensive effects may be enhanced.
Electrolyte depletion (hypochloremia, hypokalemia, hyponatremia); dehydration; hypokalemia may accentuate cardiac arrhythmias if digitalis is being administered.
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