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Hydrochlorothiazide

Hydrochlorothiazide

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Published by: api-3797941 on Oct 17, 2008
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hydrochlorothiazide
(hye droe klor oht hye' a zide)
Apo-Hydro (CAN), Esidrix, Ezide, HydroDIURIL, Microzide Capsules, Novo-
Hydrazide (CAN), Oretic, Urozide (CAN)
Pregnancy Category B
Drug class
Thiazide diuretic
Therapeutic actions
Inhibits reabsorption of sodium and chloride in distal renal tubule, increasing the
excretion of sodium, chloride, and water by the kidney.
Indications
\u2022
Adjunctive therapy in edema associated with CHF, cirrhosis, corticosteroid, and
estrogen therapy; renal dysfunction
\u2022
Hypertension as sole therapy or in combination with other antihypertensives
\u2022

Unlabeled uses: Calcium nephrolithiasis alone or with amiloride or allopurinol to
prevent recurrences in hypercalciuric or normal calciuric patients; diabetes
insipidus, especially nephrogenic diabetes insipidus; osteoporosis

Contraindications and cautions
\u2022

Contraindicated with allergy to thiazides, sulfonamides; fluid or electrolyte
imbalance; renal disease (can lead to azotemia); liver disease (risk of hepatic
coma); anuria.

\u2022

Use cautiously with gout (risk of attack); SLE; glucose tolerance abnormalities,
diabetes mellitus; hyperparathyroidism; manic-depressive disorder (aggravated by
hypercalcemia); pregnancy; lactation.

Available forms
Tablets\u201425, 50, 100 mg; solution\u201450 mg/5 mL; capsules\u201412.5 mg
Dosages
ADULTS
\u2022
Edema: 25\u2013200 mg daily PO until dry weight is attained. Then, 25\u2013100 mg daily
PO or intermittently, up to 200 mg/day.
\u2022
Hypertension: Starting dose, 12.5\u201350 mg PO. For maintenance, 25\u2013100 mg daily.
\u2022
Calcium nephrolithiasis: 50 mg daily or bid PO.
PEDIATRIC PATIENTS

General guidelines: 2.2 mg/kg/day PO in 2 doses.
< 6 mo: Up to 3.3 mg/kg/day in 2 doses.
6 mo\u20132 yr: 12.5\u201337.5 mg/day in 2 doses.
2\u201312 yr: 37.5\u2013100.0 mg/day in 2 doses.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
2 hr
4\u20136 hr
6\u201312 hr

Metabolism: Hepatic; T1/2: 5.6\u201314.8 hr
Distribution: Crosses placenta; enters breast milk
Excretion:Urin e

Adverse effects
\u2022
CNS: Dizziness, vertigo, paresthesias, weakness, headache, drowsiness, fatigue,
leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, neutropenia
\u2022
C V:Orthostatic hypotension, venous thrombosis, volume depletion, cardiac
arrhythmias, chest pain
\u2022
Dermatologic: Photosensitivity, rash, purpura, exfoliative dermatitis, hives,
alopecia
\u2022
GI: Nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, jaundice,
hepatitis, pancreatitis
\u2022
GU: Polyuria, nocturia, impotence, loss of libido
\u2022
Other: Muscle cramps and muscle spasms, fever, gouty attacks, flushing, weight
loss, rhinorrhea
Interactions
Drug-drug
\u2022
Altered electrolytes with loop diueretics, amphotericin B, corticosteroids
\u2022
Increased neuromuscular blocking effects and respiratory depression with
nondepolarizing muscle relaxants
\u2022
Decreased absorption with cholestyramine, colestipol
\u2022
Increased risk of cardiac glycoside toxicity if hypokalemia occurs
\u2022
Increased risk of lithium toxicity
\u2022
Decreased effectiveness of antidiabetic agents
Drug-lab test
\u2022
Decreased PBI levels without clinical signs of thyroid disturbance
Nursing considerations
Assessment
\u2022
History: Allergy to thiazides, sulfonamides; fluid or electrolyte imbalance; renal
or liver disease; gout; SLE; glucose tolerance abnormalities, diabetes mellitus;
hyperparathyroidism; manic-depressive disorders; lactation, pregnancy
\u2022
Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength;

pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds, urinary output patterns; CBC, serum electrolytes, blood glucose, liver and renal function tests, serum uric acid, urinalysis

Interventions
\u2022
Give with food or milk if GI upset occurs.

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