What Is Tetracycline?

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Tetracycline hydrochloride is a prescription antibiotic used to treat a wide range of infections.

It's effective against a broad spectrum of bacteria, as well as other organisms, including some protozoan
parasites.

Tetracycline has commonly been used to treat acne and other skin infections; respiratory tract infections such
as pneumonia; genital and urinary infections; and Helicobacter pylori (the bacteria that can lead to stomach
ulcers).

It's also sometimes used for treating Lyme disease and for preventing anthrax infections.
The first drug in the tetracycline family, chlortetracycline, was introduced in 1948.

Tetracycline and Antibiotic Resistance

Overuse of tetracycline (and other antibiotics) in humans and farm animals has allowed some bacteria to build
up a resistance to antibiotics.
The development of these so-called "superbug" bacteria limits the number of infections that antibiotics such as
tetracycline can treat. (Partly as a result of antibiotic resistance, tetracycline is prescribed less often today than
other, more effective antibiotics.)

Doctors are now strongly advised to prescribe tetracycline only when there is proof, or a strong suspicion, that
bacteria - not a virus - is causing an infection.
Since tetracycline does not work for colds, influenza (flu), or other viral infections, if you take it for these
conditions, you may be promoting the development of drug-resistant diseases while doing nothing to help your
illness.

Tetracycline for Dogs and Other Animals

Tetracycline is prescribed for dogs, other household pets, and livestock. Low doses are commonly fed to farm
animals to promote their growth.
It's often used in dogs and cats to treat leptospirosis, toxoplasmosis, mycoplasma, and psittacosis. Tetracycline
is also effective in animals that have tick-borne infections, such as Lyme disease, ehrlichiosis, and Rocky
Mountain spotted fever.

Tetracycline Warnings
Before taking tetracycline, you should tell your doctor if you have or have ever had:
  Allergies
 Asthma
 Hay fever
 Hives
 Kidney disease
 Liver disease
 Diabetes
You should tell your physician that you are taking this medication before having any type of surgery, including
dental surgery.

Tetracycline can cause false readings on tests for sugar in urine. If you have diabetes, you should talk to your
doctor about this possibility before altering your diet or changing your diabetes medication dosage.

You should not take this medication after it expires. Consuming expired tetracycline can lead to a dangerous
syndrome that can result in kidney damage.

Tetracycline and Children

When this medication is used to treat children up to age 8, it can cause lifelong tooth discoloration. It can also
affect a child's growth.
Tetracycline should therefore not be used in children under age 8 unless directed by a doctor.

Pregnancy and Tetracycline

Tetracycline is a pregnancy category D drug. Studies show the medication can impair the development of
bones in infants. Use during pregnancy can also cause lifelong tooth discoloration in your child.
This drug should not be used during pregnancy unless the benefits outweigh the risks.

Tetracycline is secreted in breast milk and may affect bone and tooth development in a nursing infant. Women
should not use this medication while breastfeeding.
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Tetracycline Side Effects

Common Side Effects of Tetracycline
You should call your doctor if any of the following side effects become severe or do not go away:

 Diarrhea
 Upset stomach
 Sore mouth
 Skin color changes
 Rectum or vaginal itching
 Sunburn

Serious Side Effects of Tetracycline

You should contact your doctor immediately if you experience any of the following serious symptoms:

 Blurred vision
 Skin rash, itching, or hives
 Severe headache
 Difficulty swallowing or breathing
 Yellowing of the skin or eyes
 Light-colored bowel movements
 Dark-colored urine or decreased urination
 Loss of appetite
 Vomiting
 Stomach pain
 Confusion
 Extreme fatigue or weakness
 Throat sores or pain in the mouth
 Fever or chills
 Unusual bleeding or bruising
 Joint stiffness or swelling
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Tetracycline Interactions
Tetracycline may reduce the effectiveness of some oral birth control pills. You should use another method of
birth control while taking this medication.
Calcium supplements, iron products, laxatives containing magnesium, and antacids may make tetracycline less
effective. You should take tetracycline one hour before or two hours after taking antacids, calcium
supplements, and laxatives containing magnesium.
You should take tetracycline two hours before or three hours after taking iron products and vitamins that
contain iron.
Tell your doctor about all prescription, nonprescription, illegal, recreational, herbal, nutritional, or dietary
drugs you're taking, especially:

 Anticoagulants (blood thinners), such as warfarin (Coumadin)

 Penicillin
 Isotretinoin (Accutane)
 Tretinoin (Retin-A)
 Cholesterol-lowering drugs, such as cholestyramine (Prevalite,
Questran) or colestipol (Colestid)
 Any product that contains bismuth subsalicylate, such as Pepto-
Bismol
 Phenytoin (Dilantin)
  Carbamazepine (Tegretol)
 Barbiturates, such as phenobarbital

Tetracycline and Other Interactions

Consuming dairy products, such as milk, yogurt, cheese, and ice cream, may interfere with the absorption of
tetracycline. You should talk to your doctor about this interaction.
This medication may make your skin more sensitive to sunlight. You should avoid unnecessary or prolonged
sun exposure while taking tetracycline.
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Tetracycline Dosage
Tetracycline is taken by mouth as either a capsule or liquid, typically two to four times a day for seven to 14
days.
The usual dose of tetracycline for adults is 1-2 grams (g) per day in two or four divided doses.

You should take tetracycline on an empty stomach with a full glass of water. Take the drug at least one hour
before or two hours after meals or snacks.

Tetracycline Overdose
Symptoms of overdose may include nausea, vomiting, and diarrhea. If you suspect an overdose, you should
contact a poison-control center or emergency room immediately. You can call a poison-control center at (800)
222-1222.

Missed Dose of Tetracycline

If you miss a dose of tetracycline, take it as soon as you remember, unless it's almost time for your next dose.
In that case, skip the missed dose and continue on your regular medication schedule.
Do not double up on doses to make up for a missed one.

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Tetracycline Pictures

Sumycin 500 mg Tab, pink, oblong,

Sumycin 250 mg Cap, pink, capsule,

Sumycin 250 mg Tab, pink, oblong, film coated

Sumycin 500 mg Cap, pink/white, capsule,

Antacids neutralise the acid made by your stomach. They are commonly
used in conditions where it is helpful to neutralise the acid made in the
stomach. For example, for acid reflux which causes heartburn. Most
people who take antacids do not develop any side-effects.

What are antacids?

Antacids are a group (class) of medicines which help to neutralise the acid content of your stomach. Antacids

include aluminium hydroxide, magnesium carbonate and magnesium trisilicate. These come in various brand names

and are available as tablets and liquids.

Some antacids are combined with another medicine called simeticone which helps to reduce wind (flatulence).

Another group of medicines called alginates are found in some brands of antacid medication. Alginates are added to

help protect the lining of the gullet (oesophagus) from stomach acid. Alginates include sodium alginate and alginic

acid. They are present in antacid medications with various brand names.

What conditions are antacids used to treat?

Antacids may be used:

 To reduce the symptoms of acid reflux which may cause heartburn or inflammation of the gullet (oesophagitis).

These conditions are sometimes called gastro-oesophageal reflux disease (GORD).

 To relieve some of the symptoms caused by ulcers in the stomach and part of the gut called the duodenum.

 In other conditions where it is helpful to neutralise stomach acid. For example, for occasional bouts of

indigestion (dyspepsia).

Before the discovery of other more modern medicines, antacids were commonly used for the above conditions. They

were also used to help heal ulcers in the stomach and duodenum.

Modern medicines called proton pump inhibitors and H2-receptor antagonists (commonly called H2 blockers) are now

more widely used for these conditions. They are much more effective than antacids. Unlike antacids, which simply

neutralise the acid for a short period, these modern medicines work by reducing the amount of acid made by the

stomach.
However, antacids still have a place. They are most commonly used to provide quick relief of symptoms caused by

stomach acid. In particular, in people who get occasional bouts of mild dyspepsia or heartburn.

How do antacids work?

Your stomach normally produces acid to help with the digestion of food and to kill germs (bacteria). This acid is

corrosive so your body produces a natural mucous barrier which protects the lining of the stomach from being worn

away (eroded).

In some people this barrier may have broken down allowing the acid to damage the stomach, causing an ulcer. In

others there may be a problem with the muscular band at the top of the stomach (the sphincter) that keeps the

stomach tightly closed. This may allow the acid to escape and irritate the gullet (oesophagus). This is called acid

reflux, which can cause heartburn and/or inflammation of the gullet (oesophagitis).

Antacids work by counteracting (neutralising) the acid in your stomach. They do this because the chemicals in

antacids are bases (alkalis) which are the opposite of acids. A reaction between an acid and base is called

neutralisation. This neutralisation makes the stomach contents less corrosive. This can help to relieve the pain

associated with ulcers and the burning sensation in acid reflux.

When antacids work on stomach acid, they can produce gas which may cause wind (flatulence). Simeticone helps to

stop this foaming effect and may sometimes be included within antacid medications.
 Many of the common antacids also include alginates. Most alginates work by forming a gel which floats on top of the

stomach contents. The gel acts as a protective barrier, preventing stomach acid from irritating the oesophagus.

Can I buy antacids or do I need a

prescription?
You can buy most brands of antacids at pharmacies, or you may get them on prescription.

How do I take antacids?

Antacids are often taken to relieve symptoms or when symptoms are expected. Your doctor or pharmacist will advise

you of the dose needed and how often you should take it. Read the leaflet that comes with your particular brand for

further information.

How quickly do antacids work?

Generally antacids provide quick relief for problems such as heartburn caused by reflux. However, the relief of

symptoms may only be short-lived.

How long is treatment needed?

Your doctor may prescribe an antacid to have on standby so that you only take it to relieve your symptoms when they

occur, rather than every day. Read the leaflet that comes with your particular brand for further information.

Who can and cannot take antacids?

A full list of people who should not take antacids is included with the information leaflet that comes in the medicine

packet. If you are prescribed or buy an antacid, read this to be sure you are safe to take it.

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What about side-effects?

Most people who take an antacid do not have any side-effects. However, side-effects occur in a small number of

users. The most common are diarrhoea, constipation and belching.

Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating.

Antacids containing both magnesium and aluminium may balance out these effects and so minimise any possible

side-effects of diarrhoea or constipation.

For a full list of all the side-effects and possible interactions associated with your medicine, consult the leaflet that

comes with your medication.

If you are taking antacids, you should avoid taking them at the same time as you take other medication. This is

because antacids can affect how well other medication is absorbed.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You

can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that

medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to

provide basic information about:

 The side-effect.

 The name of the medicine which you think caused it.

 The person who had the side-effect.

 Your contact details as the reporter of the side-effect.

It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.

Other considerations
You should consult your doctor if your symptoms worsen, or if you experience any of the following problems which

can indicate a serious gut disorder:

 Bringing up (vomiting) blood. This may be obviously fresh blood but altered blood in vomit can look like ground

coffee. Doctors call this coffee-ground vomit.

 Blood in your stools (faeces). This may be obvious blood, or it may just make your stools black.

 Unintentional weight loss.

  Difficulty swallowing, including food getting stuck in the gullet (oesophagus).

 Persistent tummy (abdominal) pain or persistent vomiting.

Captopril

Pharmacology

Competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to

angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase
in plasma renin activity and a reduction in aldosterone secretion

Absorption

60% to 75%; rapid

Distribution

Vdss: 0.7 L/kg (Duchin 1982)

Metabolism

50% metabolized

Excretion

Urine (>95%) within 24 hours (40% to 50% as unchanged drug)

Onset of Action

Within 15 minutes; Peak effect: Blood pressure reduction: 1 to 1.5 hours after dose; Maximum effect:
Antihypertensive: 60-90 minutes; may require several weeks of therapy before full hypotensive effect is
seen

Time to Peak

Within 1-2 hours

Duration of Action

Dose related, may require several weeks of therapy before full hypotensive effect

Half-Life Elimination

Infants with CHF: 3.3 hours; range: 1.2-12.4 hours (Pereira 1991)
Children: 1.5 hours; range: 0.98-2.3 hours (Levy 1991)

Adults: Healthy volunteers: ~1.7 hours (Duchin 1982). In two studies, patients with chronic renal failure
demonstrated approximately 2-fold longer half-lives as compared to normal subjects (Giudicelli 1984;
Onoyama 1981). Half-life was up to 21 hours in patients with severe renal impairment and up to 32
hours in patients on chronic hemodialysis in another study (Duchin 1984)

Protein Binding

25% to 30%

Use: Labeled Indications

Diabetic nephropathy: Treatment of diabetic nephropathy (proteinuria more than 500 mg daily) in
patients with type 1 insulin-dependent diabetes mellitus and retinopathy

Heart failure: Treatment of congestive heart failure

Hypertension: Management of hypertension

Left ventricular dysfunction after myocardial infarction: To improve survival following myocardial
infarction in clinically stable patients with left ventricular dysfunction manifested as an ejection fraction
of 40% or less, and to reduce the incidence of overt heart failure and subsequent hospitalizations for
congestive heart failure in these patients.

Guideline recommendations:

Heart failure: The American College of Cardiology Foundation/American Heart Association (ACCF/AHA)
2013 heart failure guidelines recommend the use of angiotensin-converting enzyme (ACE) inhibitors,
along with other guideline directed medical therapies, to prevent heart failure in patients with a
reduced ejection fraction who have a history of myocardial infarction (stage B heart failure), to prevent
heart failure in any patient with a reduced ejection fraction (stage B heart failure), or to treat those with
heart failure and reduced ejection fraction (stage C heart failure) (Yancy, 2013).

Hypertension: The 2014 guideline for the management of high blood pressure in adults (Eighth Joint
National Committee [JNC 8]) recommends initiation of pharmacologic treatment to lower blood
pressure for the following patients:

• Patients ≥60 years of age with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure
(DBP) ≥90 mm Hg. Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

• Patients <60 years of age with SBP ≥140 mm Hg or DBP is ≥90 mm Hg. Goal of therapy is SBP <140 mm
Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with diabetes and SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is
SBP <140 mm Hg and DBP <90 mm Hg.
• Patients ≥18 years of age with chronic kidney disease (CKD) and SBP ≥140 mm Hg or DBP ≥90 mm Hg.
Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

Chronic kidney disease (CKD) and hypertension: Regardless of race or diabetes status, the use of an ACE
inhibitor (ACEI) or angiotensin receptor blocker (ARB) as initial therapy is recommended to improve
kidney outcomes. In the general nonblack population (without CKD) including those with diabetes, initial
antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or
ARB. In the general black population (without CKD) including those with diabetes, initial
antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel
blocker instead of an ACEI or ARB.

Coronary artery disease (CAD) and hypertension: The American Heart Association, American College of
Cardiology and American Society of Hypertension (AHA/ACC/ASH) 2015 scientific statement for the
treatment of hypertension in patients with CAD recommends the use of an ACE inhibitor (or an ARB) as
part of a regimen in patients with hypertension and chronic stable angina if there is prior MI, LV systolic
dysfunction, diabetes mellitus, or CKD. A BP target of <140/90 mm Hg is reasonable for the secondary
prevention of cardiovascular events. A lower target BP (<130/80 mm Hg) may be appropriate in some
individuals with CAD, previous MI, stroke or transient ischemic attack, or CAD risk equivalents
(AHA/ACC/ASH [Rosendorff 2015]).

STEMI: The 2013 American College of Cardiology Foundation/American Heart Association guidelines for
the management of patients with ST-elevation myocardial infarction (STEMI) states that an ACE inhibitor
(eg, captopril) should be initiated within the first 24 hours after STEMI in patients with anterior MI, heart
failure, or left ventricular ejection fraction ≤40%. It is also reasonable to initiate an ACE inhibitor in all
patients with STEMI (ACCF/AHA [O'Gara, 2013]).

Use: Unlabeled

To delay the progression of nephropathy and reduce risks of cardiovascular events in hypertensive
patients with type 1 or 2 diabetes mellitus; treatment of hypertensive crisis, diagnosis of anatomic renal
artery stenosis, hypertension secondary to scleroderma renal crisis; diagnosis of aldosteronism, Bartter's
syndrome, postmyocardial infarction for prevention of ventricular failure; increase circulation in
Raynaud's phenomenon, hypertension secondary to Takayasu's disease

Contraindications

Hypersensitivity to captopril, any other ACE inhibitor, or any component of the formulation; angioedema
related to previous treatment with an ACE inhibitor; concomitant use with aliskiren in patients with
diabetes mellitus

Canadian labeling: Additional contraindications (not in US labeling): Concomitant use with aliskiren in
patients with moderate to severe renal impairment (GFR <60 mL/minute/1.73 m2).

Dosing: Adult
Note: Titrate dose according to patient's response; use lowest effective dose.

Acute hypertension (urgency/emergency): Oral, sublingual: 25 mg, may repeat as needed; consider
alternative therapy if blood pressure is nonresponsive within 20 to 30 minutes (Angeli, 1991; Castro del
Castillo, 1988; Ceyhan, 1990; Damasceno, 1997; Tschollar, 1985). Note: May be given sublingually, but
therapeutic advantage has not been demonstrated over oral administration (Karakilic, 2012).

Heart failure with reduced ejection fraction (HFrEF) (ACCF/AHA [Yancy, 2013]): Oral:

Initial dose: 6.25 mg 3 times daily

Target dose: 50 mg 3 times daily

Hypertension: Oral: Initial dose: 25 mg 2 to 3 times daily (a lower initial dose of 12.5 mg 3 times daily
may also be considered [VA Cooperative Study Group, 1984]); may increase at 1- to 2-week intervals up
to 50 mg 3 times daily; add thiazide diuretic, unless severe renal impairment coexists then consider loop
diuretic, before further dosage increases or consider other treatment options; maximum dose: 150 mg 3
times daily

Target dose (JNC 8 [James, 2013]): 75 to 100 mg twice daily

Usual dose range (7ASH/ISH [Weber, 2014]): 50 to 100 mg twice daily

LV dysfunction following MI: Oral: Initial: 6.25 mg; if tolerated, follow with 12.5 mg 3 times daily; then
increase to 25 mg 3 times daily during next several days and then gradually increase over next several
weeks to target dose of 50 mg 3 times daily (some dose schedules are more aggressive to achieve an
increased goal dose within the first few days of initiation). Note: In those patients with STEMI in the
anterior location, heart failure, or LV ejection fraction ≤0.4, an ACE inhibitor (eg, captopril) should be
initiated within the first 24 hours after MI (ACCF/AHA [O'Gara, 2013]).

Diabetic nephropathy: Oral: Initial: 25 mg 3 times daily. May be taken with other antihypertensive
therapy if required to further lower blood pressure.

Raynaud phenomenon (off-label use): Oral: 12.5 mg twice daily; may gradually increase to 25 mg 3 times
daily (Tosi 1987). Clinical trial evaluated patients for up to 3 months. Additional data is necessary to
further define the role of captopril in the treatment of this condition.

Dosing: Geriatric

Refer to adult dosing. In the management of hypertension, consider lower initial doses and titrate to
response (Aronow, 2011).

Dosing: Pediatric

Note: Titrate dose according to patient's response; use lowest effective dose.
Hypertension: Children ≤1 year and Adolescents ≤17 years: Oral: Initial: 0.3 to 0.5 mg/kg/dose every 8
hours; titrate upward to maximum of 6 mg/kg/day in 2 to 4 divided doses (NHBPEP, 2004; NHLBI, 2011);
maximum daily dose: 450 mg daily.

Dosing: Renal Impairment

Manufacturers recommendations: Reduce initial daily dose and titrate slowly (1- to 2-week intervals)
with smaller increments. Slowly back titrate to determine the minimum effective dose once the desired
therapeutic effect has been reached.

Alternative recommendations (Aronoff, 2007):

Adults:

CrCl 10 to 50 mL/minute: Administer at 75% of normal dose every 12-18 hours.

CrCl <10 mL/minute: Administer at 50% of normal dose every 24 hours.

Intermittent hemodialysis (IHD): Administer after hemodialysis on dialysis days

Peritoneal dialysis: Dose for CrCl 10-50 mL/minute; supplemental dose is not necessary

Infants, Children, and Adolescents: Note: Renally adjusted dose recommendations are based on doses of
0.1 to 0.5 mg/kg/dose every 6 to 8 hours; maximum daily dose: 6 mg/kg/day.

GFR 10 to 50 mL/minute/1.73 m2: Administer 75% of dose

GFR <10 mL/minute/1.73 m2: Administer 50% of dose

Intermittent hemodialysis: Administer 50% of dose

Peritoneal dialysis (PD): Administer 50% of dose

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Extemporaneously Prepared

A 1 mg/mL oral solution may be made by allowing two 50 mg tablets to dissolve in 50 mL of distilled
water. Add the contents of one 500 mg sodium ascorbate injection ampul or one 500 mg ascorbic acid
tablet and allow to dissolve. Add quantity of distilled water sufficient to make 100 mL. Label “shake
well” and “refrigerate”. Stable for 56 days refrigerated.

Nahata MC, Pai VB, and Hipple TF, Pediatric Drug Formulations, 5th ed, Cincinnati, OH: Harvey Whitney
Books Co, 2004.

Administration
Administer at least 1 hour before meals. Unstable in aqueous solutions; to prepare solution for oral
administration, mix prior to administration and use within 10 minutes (Allen, 1996).

Dietary Considerations

Should be taken at least 1 hour before eating.

Storage

Store at 20°C to 25°C (68°F to 77°F); protect from moisture.

Drug Interactions

Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid
concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever
possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of
toxicity. Consider therapy modification

Ajmaline: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Aliskiren: May enhance the hyperkalemic effect of ACE Inhibitors. Aliskiren may enhance the
hypotensive effect of ACE Inhibitors. Aliskiren may enhance the nephrotoxic effect of ACE Inhibitors.
Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined
use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined,
monitor potassium, creatinine, and blood pressure closely. Consider therapy modification

Allopurinol: ACE Inhibitors may enhance the potential for allergic or hypersensitivity reactions to
Allopurinol. Consider therapy modification

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine.
Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications
should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy
cannot be withheld, amifostine should not be administered. Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Angiotensin II Receptor Blockers: May enhance the adverse/toxic effect of ACE Inhibitors. Angiotensin II
Receptor Blockers may increase the serum concentration of ACE Inhibitors. Management: In US labeling,
use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE
inhibitor and an ARB would be any safer. Consider alternatives to the combination when
possible. Consider therapy modification

Antacids: May decrease the serum concentration of Captopril. Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the
hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy

Aprotinin: May diminish the antihypertensive effect of ACE Inhibitors. Monitor therapy

Asunaprevir: May increase the serum concentration of CYP2D6 Substrates. Consider therapy
modification

AzaTHIOprine: ACE Inhibitors may enhance the myelosuppressive effect of AzaTHIOprine. Monitor
therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor
therapy

Canagliflozin: May enhance the hyperkalemic effect of ACE Inhibitors. Canagliflozin may enhance the
hypotensive effect of ACE Inhibitors. Monitor therapy

Ciprofloxacin (Systemic): ACE Inhibitors may enhance the arrhythmogenic effect of Ciprofloxacin
(Systemic). Monitor therapy

Cobicistat: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

CYP2D6 Inhibitors (Moderate): May decrease the metabolism of CYP2D6 Substrates. Monitor therapy

CYP2D6 Inhibitors (Strong): May decrease the metabolism of CYP2D6 Substrates. Consider therapy
modification

Dapoxetine: May enhance the orthostatic hypotensive effect of ACE Inhibitors. Monitor therapy

Darunavir: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

DPP-IV Inhibitors: May enhance the adverse/toxic effect of ACE Inhibitors. Specifically, the risk of
angioedema may be increased. Monitor therapy

Drospirenone: ACE Inhibitors may enhance the hyperkalemic effect of Drospirenone. Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of
DULoxetine. Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy
Everolimus: May enhance the adverse/toxic effect of ACE Inhibitors. Specifically, the risk of angioedema
may be increased. Monitor therapy

Ferric Gluconate: ACE Inhibitors may enhance the adverse/toxic effect of Ferric Gluconate. Monitor
therapy

Ferric Hydroxide Polymaltose Complex: ACE Inhibitors may enhance the adverse/toxic effect of Ferric
Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be
increased. Monitor therapy

Gold Sodium Thiomalate: ACE Inhibitors may enhance the adverse/toxic effect of Gold Sodium
Thiomalate. An increased risk of nitritoid reactions has been appreciated. Monitor therapy

Grass Pollen Allergen Extract (5 Grass Extract): ACE Inhibitors may enhance the adverse/toxic effect of
Grass Pollen Allergen Extract (5 Grass Extract). Specifically, ACE inhibitors may increase the risk of severe
allergic reaction to Grass Pollen Allergen Extract (5 Grass Extract). Consider therapy modification

Heparin: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Heparin (Low Molecular Weight): May enhance the hyperkalemic effect of ACE Inhibitors. Monitor
therapy

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive

Agents. Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering
Agents. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of
Hypotension-Associated Agents. Monitor therapy

Icatibant: May diminish the antihypertensive effect of ACE Inhibitors. Monitor therapy

Imatinib: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Iron Dextran Complex: ACE Inhibitors may enhance the adverse/toxic effect of Iron Dextran Complex.
Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type
reactions. Management: Follow iron dextran recommendations closely regarding both having
resuscitation equipment and trained personnel on-hand prior to iron dextran administration and the use
of a test dose prior to the first therapeutic dose. Consider therapy modification

Lanthanum: May decrease the serum concentration of ACE Inhibitors. Management: Administer
angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. Consider
therapy modification

Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor
therapy
Lithium: ACE Inhibitors may increase the serum concentration of Lithium. Management: Lithium dosage
reductions will likely be needed following the addition of an ACE inhibitor. Monitor patient response to
lithium closely following addition or discontinuation of concurrent ACE inhibitor treatment. Consider
therapy modification

Loop Diuretics: May enhance the hypotensive effect of ACE Inhibitors. Loop Diuretics may enhance the
nephrotoxic effect of ACE Inhibitors. Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor
therapy

Lumefantrine: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor

therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of
Nitroprusside. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: ACE Inhibitors may enhance the adverse/toxic effect of
Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant
decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive
effect of ACE Inhibitors. Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management:
Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to
obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy
modification

Panobinostat: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid
concurrent use of sensitive CYP2D6 substrates when possible, particularly those substrates with a
narrow therapeutic index. Consider therapy modification

Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Peginterferon Alfa-
2b may increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Perhexiline: CYP2D6 Substrates may increase the serum concentration of Perhexiline. Perhexiline may
increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering
Agents. Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Potassium-Sparing Diuretics: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Pregabalin: ACE Inhibitors may enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of
angioedema may be increased. Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering
Agents. Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

QuiNINE: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy

Sacubitril: ACE Inhibitors may enhance the adverse/toxic effect of Sacubitril. Specifically, the risk of
angioedema may be increased with this combination. Avoid combination

Salicylates: May enhance the nephrotoxic effect of ACE Inhibitors. Salicylates may diminish the
therapeutic effect of ACE Inhibitors. Monitor therapy

Sirolimus: May enhance the adverse/toxic effect of ACE Inhibitors. Monitor therapy

Sodium Phosphates: ACE Inhibitors may enhance the nephrotoxic effect of Sodium Phosphates.
Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider
avoiding this combination by temporarily suspending treatment with ACEIs, or seeking alternatives to
oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate
hydration and monitor renal function closely. Consider therapy modification

Temsirolimus: May enhance the adverse/toxic effect of ACE Inhibitors. Monitor therapy

Thiazide and Thiazide-Like Diuretics: May enhance the hypotensive effect of ACE Inhibitors. Thiazide and
Thiazide-Like Diuretics may enhance the nephrotoxic effect of ACE Inhibitors. Monitor therapy

TiZANidine: May enhance the hypotensive effect of ACE Inhibitors. Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Trimethoprim: May enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Test Interactions
Positive Coombs' [direct]; may cause false-positive results in urine acetone determinations using sodium
nitroprusside reagent

Adverse Reactions

Frequency not defined:

Cardiovascular: Angina pectoris, cardiac arrest, cardiac arrhythmia, cardiac failure, flushing, myocardial
infarction, orthostatic hypotension, Raynaud's phenomenon, syncope

Central nervous system: Ataxia, cerebrovascular insufficiency, confusion, depression, drowsiness,

myasthenia, nervousness

Dermatologic: Bullous pemphigoid, erythema multiforme, exfoliative dermatitis, pallor, Stevens-Johnson

syndrome

Endocrine & metabolic: Gynecomastia, hyponatremia (symptomatic)

Gastrointestinal: Cholestasis, dyspepsia, glossitis, pancreatitis

Genitourinary: Impotence, nephrotic syndrome, oliguria, urinary frequency

Hematologic & oncologic: Agranulocytosis, anemia, pancytopenia, thrombocytopenia

Hepatic: Hepatic necrosis (rare), hepatitis, increased serum alkaline phosphatase, increased serum
bilirubin, increased serum transaminases, jaundice

Hypersensitivity: Anaphylactoid reaction, angioedema

Neuromuscular & skeletal: Myalgia, weakness

Ophthalmic: Blurred vision

Renal: Polyuria, renal failure, renal insufficiency

Respiratory: Bronchospasm, eosinophilic pneumonitis, rhinitis

1% to 10%:

Cardiovascular: Hypotension (1% to 3%), chest pain (1%), palpitations (1%), tachycardia (1%)

Dermatologic: Skin rash (maculopapular or urticarial [4% to 7%]; in patients with rash, a positive ANA
and/or eosinophilia has been noted in 7% to 10%), pruritus (2%)

Endocrine & metabolic: Hyperkalemia (1% to 11%)

Gastrointestinal: Dysgeusia (2% to 4%; loss of taste or diminished perception)

Genitourinary: Proteinuria (1%)

Hematologic & oncologic: Neutropenia (≤4%; in patients with renal insufficiency or collagen-vascular
disease)

Hypersensitivity: Hypersensitivity reaction (rash, pruritus, fever, arthralgia, and eosinophilia: 4% to 7%;
depending on dose and renal function)

Renal: Increased serum creatinine, renal insufficiency (worsening; may occur in patients with bilateral
renal artery stenosis or hypovolemia)

Respiratory: Cough (<1% to 2%)

Miscellaneous: Hypersensitivity reactions (rash, pruritus, fever, arthralgia, and eosinophilia) have
occurred in 4% to 7% of patients (depending on dose and renal function); dysgeusia - loss of taste or
diminished perception (2% to 4%)

<1% (Limited to important or life-threatening): Alopecia, angina pectoris, anorexia, aphthous stomatitis,
aplastic anemia, cholestatic jaundice, eosinophilia, glomerulonephritis, Guillain-Barre syndrome,
hemolytic anemia, Huntington's chorea (exacerbation), hyperthermia, increased erythrocyte
sedimentation rate, insomnia, interstitial nephritis, Kaposi's sarcoma, peptic ulcer, pericarditis, psoriasis,
seizure (in premature infants), systemic lupus erythematosus, vasculitis, visual hallucination (Doane,
2013)

ALERT: U.S. Boxed Warning

Fetal toxicity:

When pregnancy is detected, discontinue captopril as soon as possible. Drugs that act directly on the
renin-angiotensin system can cause injury and even death to the developing fetus.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: At any time during treatment (especially following first dose) angioedema may occur
rarely with ACE inhibitors; it may involve the head and neck (potentially compromising airway) or the
intestine (presenting with abdominal pain). African-Americans and patients with idiopathic or hereditary
angioedema may be at an increased risk. Risk may also be increased with concomitant use of mTOR
inhibitor (eg, everolimus) therapy. Prolonged frequent monitoring may be required especially if tongue,
glottis, or larynx are involved as they are associated with airway obstruction. Patients with a history of
airway surgery may have a higher risk of airway obstruction. Aggressive early and appropriate
management is critical. Use in patients with previous angioedema associated with ACE inhibitor therapy
is contraindicated.

• Cholestatic jaundice: A rare toxicity associated with ACE inhibitors includes cholestatic jaundice, which
may progress to fulminant hepatic necrosis (some fatal); discontinue if marked elevation of hepatic
transaminases or jaundice occurs.
• Cough: An ACE inhibitor cough is a dry, hacking, nonproductive one that usually occurs within the first
few months of treatment and should generally resolve within 1 to 4 weeks after discontinuation of the
ACE inhibitor. Other causes of cough should be considered (eg, pulmonary congestion in patients with
heart failure) and excluded prior to discontinuation.

• Hematologic effects: Captopril has been associated with neutropenia with myeloid hypoplasia and
agranulocytosis; anemia and thrombocytopenia have also occurred. Patients with renal impairment are
at high risk of developing neutropenia. Patients with both renal impairment and collagen vascular
disease (eg, systemic lupus erythematosus) are at an even higher risk of developing neutropenia. Closely
monitor CBC with differential for the first 3 months of therapy and periodically thereafter in these
patients. Onset of neutropenia is usually within 3 months of captopril initiation. Neutrophil count
generally returns to baseline within 2 weeks of discontinuation. If neutropenia develops (neutrophil
count <1,000/mm3), discontinue therapy.

• Hyperkalemia: May occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus,
concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing
salts. Use cautiously, if at all, with these agents and monitor potassium closely.

• Hypersensitivity reactions: Anaphylactic/anaphylactoid reactions can occur with ACE inhibitors. Severe
anaphylactoid reactions may be seen during hemodialysis (eg, CVVHD) with high-flux dialysis
membranes (eg, AN69), and rarely, during low density lipoprotein apheresis with dextran sulfate
cellulose. Rare cases of anaphylactoid reactions have been reported in patients undergoing sensitization
treatment with hymenoptera (bee, wasp) venom while receiving ACE inhibitors.

• Hypotension/syncope: Symptomatic hypotension with or without syncope can occur with ACE
inhibitors (usually with the first several doses); effects are most often observed in volume-depleted
patients; correct volume depletion prior to initiation; close monitoring of patient is required especially
with initial dosing and dosing increases; blood pressure must be lowered at a rate appropriate for the
patient's clinical condition. Although dose reduction may be necessary, hypotension is not a reason for
discontinuation of future ACE inhibitor use especially in patients with heart failure where a reduction in
systolic blood pressure is a desirable observation.

• Proteinuria: Total urinary proteins greater than 1 g per day have been reported (<1%); nephrotic
syndrome occurred in about one-fifth of proteinuric patients. In most cases, proteinuria subsided or
cleared within six months (whether or not captopril was continued).

• Renal function deterioration: May be associated with deterioration of renal function and/or increases
in BUN and serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis,
heart failure) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction
by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia.
Small benign increases in serum creatinine may occur following initiation; consider discontinuation only
in patients with progressive and/or significant deterioration in renal function (Bakris, 2000).

Disease-related concerns:
• Aortic stenosis: Use with caution in patients with aortic stenosis; may reduce coronary perfusion
resulting in ischemia.

• Cardiovascular disease: Initiation of therapy in patients with ischemic heart disease or cerebrovascular
disease warrants close observation due to the potential consequences posed by falling blood pressure
(eg, MI, stroke). Fluid replacement, if needed, may restore blood pressure; therapy may then be
resumed. Discontinue therapy in patients whose hypotension recurs.

• Collagen vascular disease: Use with caution in patients with collagen vascular disease especially with
concomitant renal impairment; may be at increased risk for hematologic toxicity.

• Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use with caution in patients with
HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with
this condition (ACCF/AHA [Gersh, 2011]).

• Renal artery stenosis: Use with caution in patients with unstented unilateral/bilateral renal artery
stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the
elevated risk of deterioration in renal function unless possible benefits outweigh risks.

• Renal impairment: Use with caution in preexisting renal insufficiency; dosage adjustment may be
needed. Avoid rapid dosage escalation which may lead to further renal impairment.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency
adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions
database for more detailed information.

Special populations:

• Black patients: ACE inhibitors effectiveness is less in black patients than in non-blacks. In addition, ACE
inhibitors cause a higher rate of angioedema in black than in non-black patients.

• Pregnancy: [U.S. Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and
death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

Other warnings/precautions:

• Extemporaneous oral solutions: Extemporaneous preparations of liquid formulations may vary; this
may affect the rate and extent of absorption causing intrapatient variability regarding dosing and safety
profile for the patient; use with caution and monitor closely if dosage formulations are changed (Bhatt,
2011; Mulla, 2007).

• Surgery: In patients on chronic ACE inhibitor therapy, intraoperative hypotension may occur with
induction and maintenance of general anesthesia; use with caution before, during, or immediately after
major surgery. Cardiopulmonary bypass, intraoperative blood loss, or vasodilating anesthesia increases
endogenous renin release. Use of ACE inhibitors perioperatively will blunt angiotensin II formation and
may result in hypotension. However, discontinuation of therapy prior to surgery is controversial. If
continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis, 2011).

Monitoring Parameters

BUN, electrolytes, serum creatinine; blood pressure. In patients with renal impairment and/or collagen
vascular disease, closely monitor CBC with differential for the first 3 months of therapy and periodically
thereafter.

2013 ACCF/AHA Heart Failure guideline recommendations: Within 1-2 weeks after initiation and
periodically thereafter, reassess renal function and serum potassium especially in patients with
preexisting hypotension, hyponatremia, diabetes mellitus, azotemia, or those taking potassium
supplements (ACCF/AHA [Yancy, 2013]).

Pregnancy Risk Factor

Pregnancy Considerations

[U.S. Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the
developing fetus. Discontinue as soon as possible once pregnancy is detected. Captopril crosses the
placenta (Hurault de Lingy 1987). Drugs that act on the renin-angiotensin system are associated with
oligohydramnios. Oligohydramnios, due to decreased fetal renal function, may lead to fetal lung
hypoplasia and skeletal malformations. Their use in pregnancy is also associated with anuria,
hypotension, renal failure, skull hypoplasia, and death in the fetus/neonate. Teratogenic effects may
occur following maternal use of an ACE inhibitor during the first trimester, although this finding may be
confounded by maternal disease. Because adverse fetal events are well documented with exposure later
in pregnancy, ACE inhibitor use in pregnant women is not recommended (Seely 2014; Weber 2014).
Infants exposed to an ACE inhibitor in utero should be monitored for hyperkalemia, hypotension, and
oliguria. Oligohydramnios may not appear until after irreversible fetal injury has occurred. Exchange
transfusions or dialysis may be required to reverse hypotension or improve renal function, although
data related to the effectiveness in neonates is limited.

Chronic maternal hypertension itself is also associated with adverse events in the fetus/infant and
mother. ACE inhibitors are not recommended for the treatment of uncomplicated hypertension in
pregnancy (ACOG 2013) and they are specifically contraindicated for the treatment of hypertension and
chronic heart failure during pregnancy by some guidelines (Regitz-Zagrosek 2011). In addition, ACE
inhibitors should generally be avoided in women of reproductive age (ACOG 2013). If treatment for
hypertension or chronic heart failure in pregnancy is needed, other agents should be used (ACOG 2013;
Regitz-Zagrosek 2011).

Patient Education
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During
this hospital stay, were you given any medicine that you had not taken before? Before giving you any
new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital
staff describe possible side effects in a way you could understand?)

• Patient may experience change in taste. Have patient report immediately to prescriber signs of
infection, signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or
weight gain), signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness,
shortness of breath, or numbness or tingling feeling), signs of liver problems (dark urine, fatigue, lack of
appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), severe dizziness, passing
out, persistent cough, severe abdominal pain, severe nausea, vomiting, angina, tachycardia, bruising,
bleeding, or severe loss of strength and energy (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad
cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a
comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended
to serve as a concise initial reference for health care professionals to use when discussing medications
with a patient. You must ultimately rely on your own discretion, experience, and judgment in
diagnosing, treating, and advising patients.

hydrochlorothiazide
COMMON BRAND NAME(S): Microzide
GENERIC NAME(S): HYDROCHLOROTHIAZIDE

Uses
This medication is used to treat high blood pressure. Lowering high blood pressure helps prevent
strokes, heart attacks, and kidney problems. Hydrochlorothiazide is a "water pill" (diuretic) that
causes you to make more urine. This helps your body get rid of extra salt and water.

This medication also reduces extra fluid in the body (edema) caused by conditions such as heart
failure, liver disease, or kidney disease. This can lessen symptoms such as shortness of breath or
swelling in your ankles or feet.

How to use hydrochlorothiazide

Take this medication by mouth as directed by your doctor, usually once daily in the morning with or
without food. It is best to avoid taking this medication within 4 hours of your bedtime to prevent
having to get up to urinate.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the
same time each day. It is important to continue taking this medication even if you feel well. Most
people with high blood pressure do not feel sick.

Cholestyramine and colestipol can decrease the absorption of hydrochlorothiazide. If you are taking
either of these drugs, take them at least 4 hours before or after taking hydrochlorothiazide.

Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure
readings increase).

What is Hydrochlorothiazide (Microzide)?




19 Reviews
Hydrochlorothiazide is the generic form of the brand-name drug Microzide.
It's a prescription diuretic ("water pill") that's used to treat high blood pressure and other
conditions.
Hydrochlorothiazide is designed to help eliminate the excessive fluid accumulation and swelling
that’s often caused by congestive heart failure, cirrhosis of the liver, chronic kidney failure,
corticosteroid medications and nephrotic syndrome.
Hydrochlorothiazide is the second most commonly prescribed antihypertensive in the United
States. Despite its popularity, researchers do not have a clear grasp as to how it works to lower
blood pressure.
Most blood pressure lowering medications, including hydrochlorothiazide, are prescribed
together with other hypertensive products, along with dietary restrictions, exercise, and, in some
cases, weight loss.
Hydrochlorothiazide may also be prescribed to treat calcium-containing kidney stones because it
decreases the amount of calcium excreted by the kidneys in the urine, thus reducing the amount
of calcium available to form stones.
Although hydrochlorothiazide is approved to treat edema in cirrhosis of the liver, it’s rarely used
for that purpose because other diuretics are considered more effective.
The Food and Drug Administration (FDA) approved hydrochlorothiazide in 1959. It's
manufactured by several companies, including Mylan, Vintage Pharmaceuticals, and Watson
Labs.
In addition to Microzide, hydrochlorothiazide is available as:

 Hydrodiuril
 Oretic

Hydrochlorothiazide and Weight Loss

Because hydrochlorothiazide is designed to help eliminate the excessive fluid accumulation and
swelling, its use may cause weight loss.
If you experience significant weight loss and/or weakness/fatigue, talk with your doctor.
Use hydrochlorothiazide only as directed. The FDA hasn't approved hydrochlorothiazide for use
as a weight-loss supplement.

Hydrochlorothiazide Warnings
To ensure that you can safely take hydrochlorothiazide, it’s important that you tell your doctor if
you are suffering from any of the following:

 Kidney disease
 Liver disease
 Glaucoma
 Asthma or allergies
 Gout
 Diabetes
 An allergy to sulfa drugs or penicillin
Talk to your doctor immediately if you experience any of the following while taking
hydrochlorothiazide:

 Seizures or convulsions
 Decreased urine
 Drowsiness
 Dry mouth/excessive thirst
 Increased heart rate
 Muscle pain
 Nausea
  Vomiting
 Fatigue
 Weakness
These may be symptoms of a condition called hypokalemia or potassium loss.
Hydrochlorothiazide can lower potassium levels.
While taking hydrochlorothiazide, you may need to take potassium supplements, decrease salt
intake, and eat a diet rich in potassium with foods like bananas.
Stop using hydrochlorothiazide if you have:

 Blurred vision
 Difficulty reading
 Eye pain
These may be symptoms of a serious eye problem. Your doctor may refer you to an
ophthalmologist.
Hydrochlorothiazide can cause dizziness. Do not drive or use machinery while taking
hydrochlorothiazide.
Hydrochlorothiazide might increase your blood sugar levels, so it’s important that if you have
diabetes, you check your blood sugar levels regularly.
You should also avoid sun exposure, as hydrochlorothiazide can increase sun sensitivity.
If you go out in hot weather, especially if you are exercising, avoid becoming overheated or
dehydrated.

Hydrochlorothiazide and Pregnancy

Be sure to let your doctor know if you're pregnant or are planning to become pregnant while on
hydrochlorothiazide.
Thiazides like hydrochlorothiazide may increase the risk of fetal or neonatal jaundice and low
platelet levels, and perhaps lead to other adverse reactions.
If taken during pregnancy, hydrochlorothiazide could be toxic to the fetus, leading to death. Stop
taking hydrochlorothiazide as soon as you find out you're pregnant.
You shouldn't use hydrochlorothiazide while breastfeeding since it may pass into your breast
milk and could harm a nursing baby. Be sure your doctor knows that you're breastfeeding before
taking hydrochlorothiazide.
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Hydrochlorothiazide Side Effects

The most common side effects associated with hydrochlorothiazide include:
  Thirst
 Muscle weakness
 Constipation
 Blurred vision
 Dizziness
 Photosensitivity
If you notice any of the following severe side effects, stop taking hydrochlorothiazide and call
your doctor immediately:

 Severe allergic reaction (rash, hives, difficulty

breathing, swelling of face, lips, tongue, or throat)
 Severe stomach pain, loss of appetite, dark urine, or clay
colored stools
 Bleeding or bruising that seems unusual
 A severe skin rash which includes peeling skin
 Heartbeats that are fast or uneven
 Tingling or numbness
 Skin or eye yellowing (jaundice)
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Hydrochlorothiazide Interactions
It's very important to let your doctor know about all drugs you're taking, including illegal drugs,
any over-the-counter (OTC) drugs, and any herbs or supplements.
Before taking hydrochlorothiazide, tell your doctor if you're using any of the following drugs:

 Lithium/Eskalith (Lithobid)
 Digoxin/Lanoxin
 Cholestyramine/Prevalite
 Cholestyramine (Questran)
 Colestipol/Colestid
 Phenobarbital (Luminal)
 Secobarbital (Seconal)
If you're also taking digoxin, the potassium-lowering effects of hydrochlorothiazide may worsen
cardiac arrhythmias.
Cholestyramine and colestipol may decrease the absorption of hydrochlorothiazide. If you’re
taking either one, do so at least four hours before or after taking hydrochlorothiazide.
Tell your doctor if you take cold and pain medicine, muscle relaxers, or medication for
seizures, depression, or anxiety. These are known to make you light headed and may increase the
side effects of hydrochlorothiazide.
Drugs that may interact with acyclovir include steroids such as:

 Prednisone (Deltasone, Meticorten, Sterapred, others)

 Betamethasone (Celestone)
 Budesonide (Entocort, Uceris)
 Cortisone (Cortone)
 Dexamethasone (Decadron, Dexpak, Dexasone, others)
 Fludrocortisone (Florinef)
 Hydrocortisone (Cortef, Hydrocortone)
 Methylprednisolone (Solu-Medrol, Meprolone, others)
 Prednisolone (Prelone, others)
 Triamcinolone (Aristocort, Azmacort)
In addition, other blood pressure medications as well as NSAIDs (non-steroidal anti-
inflammatory drugs) may interact with hydrochlorothiazide. Examples of NSAIDs include:

 Aspirin
 Ibuprofen (Advil, Motrin)
 Naproxen (Aleve, Naprosyn)
 Naprelan
 Treximet
 Celecoxib/Celebrex
 Diclofenac/Arthrotec (Cambia, Cataflam, Voltaren,
Flector Patch, Pennsaid)
 Solareze
 Indomethacin/Indocin
 Meloxicam/Mobic
Finally, other medications that may interact with hydrochlorothiazide include:

 Insulin or oral diabetes medication

 Corticotropin (ACTH, H.P., Acthar Gel)
If you're taking any of these medications, or others, your doctor may need to change the doses of
these medications or monitor you carefully for side effects.

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Hydrochlorothiazide and Alcohol
While on hydrochlorothiazide it’s important to avoid drinking alcohol because it can worsen
some of the side effects, such as low blood pressure, dizziness, or blurred vision.
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Hydrochlorothiazide Dosage
Hydrochlorothiazide comes in tablet form and is meant to be taken orally.
Hydrochlorothiazide can be taken with or without food.
In adults being treated for hypertension, the usual dose is 12.5 to 50 mg once daily.
If the medicine has been prescribed for edema, most adults will take 25 to 100 mg once a day or
in divided doses.
Your doctor will likely advise you to take your medication at the same time each day.
Don't stop taking hydrochlorothiazide even if you feel well; your blood pressure may still be
high even when you don’t feel sick.
It’s not a good idea to take hydrochlorothiazide within four hours of going to bed since it may
result in your having to urinate during the night.
If your condition doesn’t improve and/or gets worse, let your doctor know right away. Your
doctor may need to adjust the dose.
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Hydrochlorothiazide and Overdose

Signs of an overdose may include:

 Nausea
 Weakness
 Dizziness
 Dry mouth
 Thirst
 Muscle pain/weakness
In the event of an accidental overdose, call 911 immediately or contact a poison control center at
1-800-222-1222.
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Hydrochlorothiazide and Missed Dose

If you miss a dose, don’t take extra medication to make up for it.
In some cases, you may be able to take the missed dose as soon as you remember. However, if
it's almost time for the next scheduled dose, you should skip the one you missed.
If you're not sure what to do, contact your doctor or pharmacist to avoid overdosing.
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Hydrochlorothiazide (Microzide) Pictures

Hydrochlorothiazide 25 mg-ESI, peach, round,

Hydrochlorothiazide 12.5 mg Cap-TEV, white, capsule,

Hydrochlorothiazide 25 mg-TEV, orange, round,

 Drugs and Supplements

Griseofulvin (Oral Route)

Print

1. Description and Brand Names

2. Before Using
3. Proper Use
4. Precautions
5. Side Effects
Products and services

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Proper Use
Drug information provided by: Micromedex
Keep using this medicine for the full treatment time, even if you feel better after the first few doses.
Your infection may not clear up if you stop using the medicine too soon.
Keep yourself clean to help control infection and prevent reinfection.
Griseofulvin is absorbed best when it is taken with a high fat meal, such as a cheeseburger, whole
milk, or ice cream. Tell your doctor if you are on a low-fat diet.
Griseofulvin is best taken with or after meals, especially fatty ones (e.g., whole milk or ice cream).
This lessens possible stomach upset and helps to clear up the infection by helping your body absorb
the medicine better. However, if you are on a low-fat diet, check with your doctor.
For patients taking the oral liquid:

 Use a specially marked measuring spoon or other device to measure each dose accurately. The
average household teaspoon may not hold the right amount of liquid.
You may swallow the tablets whole or sprinkle the crushed tablets in one tablespoonful of
applesauce. Swallow it immediately without chewing.

Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the
directions on the label. The following information includes only the average doses of this medicine. If
your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of
doses you take each day, the time allowed between doses, and the length of time you take the
medicine depend on the medical problem for which you are using the medicine.

 For oral dosage forms (microsize capsules, tablets, or suspension):

o Treatment of fungus infections of the feet and nails:
 Adults and teenagers—500 milligrams (mg) every 12 hours.
 Children—Dose is based on body weight and must be determined by your doctor. The
usual dose is 5 milligrams (mg) per kilogram (kg) (2.3 mg per pound) of body weight every
12 hours, or 10 milligrams (mg) per kilogram (kg) (4.6 mg per pound) of body weight once
a day.
o Treatment of fungus infections of the scalp, skin, and groin:
 Adults and teenagers—250 milligrams (mg) every 12 hours or 500 mg once a day.
 Children—Dose is based on body weight and must be determined by your doctor. The
usual dose is 5 milligrams (mg) per kilogram (kg) (2.3 mg per pound) of body weight every
12 hours, or 10 milligrams (mg) per kilogram (kg) (4.6 mg per pound) of body weight once
a day.
 For oral dosage form (ultramicrosize tablets):
o Treatment of fungus infections:
 Adults—375 milligrams (mg) per day, taken as a single dose or divided in small doses.
Some patients may need 750 mg divided in small doses.
 Children 3 years of age and older weighing over 60 pounds—Dose is based on body
weight and must be determined by your doctor. The usual dose is 187.5 to 375 mg per
day.
 Children 3 years of age and older weighing 35 to 60 pounds—Dose is based on body
weight and must be determined by your doctor. The usual dose is 125 to 187.5 mg per
day.
 Children up to 2 years of age—Use and dose must be determined by your doctor.
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your
next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct
light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions
Drug information provided by: Micromedex
It is very important that your doctor should check the progress of you or your child at regular visits to
make sure that this medicine is working properly and to check for unwanted effects.
If your symptoms do not improve, or if they become worse, check with your doctor. You may need to
take this medicine for several weeks or months before your infection gets better.
Using this medicine while you are pregnant may cause serious unwanted effects in your newborn
baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant
while using this medicine.
Serious skin reactions can occur with this medicine. Stop using this medicine and check with your
doctor right away if you or your child have blistering, peeling, or loosening of the skin; red skin
lesions; severe acne or skin rash; sores or ulcers on the skin; or fever or chills while you are using
this medicine.
Stop using this medicine and check with your doctor right away if you or your child have pain or
tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness
or weakness; or yellow eyes or skin. These could be symptoms of a serious liver problem.
Griseofulvin has been shown to cause liver and thyroid tumors in some animals. You and your
doctor should discuss the good this medicine will do, as well as the risks of taking it.
Birth control pills containing estrogen may not work properly if you take them while you are taking
griseofulvin. Unplanned pregnancies may occur. To keep from getting pregnant, use another form of
birth control for up to 1 month after your last treatment. Other forms of birth control include condoms,
diaphragms, or contraceptive foams or jellies.
Griseofulvin may increase the effects of alcohol. If taken with alcohol it may also cause fast
heartbeat, flushing, increased sweating, or redness of the face. If you have these symptoms, do not
drink alcoholic beverages while you are taking this medicine, unless you have checked first with your
doctor.
This medicine may cause some people to become dizzy, drowsy, or less alert than they are
normally. Make sure you know how you react to this medicine before you drive, use machines, or do
other things that could be dangerous if you are dizzy or are not alert. If these reactions are especially
bothersome, check with your doctor.
Griseofulvin may cause your skin to be more sensitive to sunlight than it is normally. Exposure to
sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration
of the skin, or a severe sunburn. When you begin taking this medicine:
 Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
 Wear protective clothing, including a hat. Also, wear sunglasses.
 Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients
may require a product with a higher SPF number, especially if they have a fair complexion. If you
have any questions about this, check with your doctor.
 Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
 Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from the sun, check with your doctor.
Do not take other medicines unless they have been discussed with your doctor. This includes
prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin
supplements.

Side Effects
Drug information provided by: Micromedex
Along with its needed effects, a medicine 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:

More common

 Blistering, peeling, or loosening of the skin

 chills
 cough
 diarrhea
 fever
 itching
 joint or muscle pain
 red, irritated eyes
 sore throat
 sores, ulcers, or white spots in the mouth or on the lips
 unusual tiredness or weakness
Less common

 Confusion
 increased sensitivity of the skin to sunlight
 skin rash, hives, or itching
 soreness or irritation of the mouth or tongue
Rare

 Black, tarry stools

 chest pain
 cloudy urine
 large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex
organs
 numbness, tingling, pain, or weakness in the hands or feet
 painful or difficult urination
 shortness of breath
 swollen glands
 unusual bleeding or bruising
 yellow eyes or skin
Incidence not known

 Abdominal or stomach pain

 burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
 clay-colored stools
 dark urine
 dizziness
 headache
 loss of appetite
 nausea
 unpleasant breath odor
 vomiting of blood
Some side effects 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:

More common

 Hives or welts
 redness of the skin
Less common

 Trouble with sleeping

Incidence not known

 Heartburn
 pain or discomfort in the chest, upper stomach, or throat
 sleeplessness
 unable to sleep
 white patches in the mouth or throat or on the tongue
 white patches with diaper rash
Other side effects not listed may also occur in some patients. If you notice any other effects, check
with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-
800-FDA-1088.

Before Using
Drug information provided by: Micromedex
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it
will do. This is a decision you and your doctor will make. For this medicine, the following should be
considered:

Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other
medicines. Also tell your health care professional if you have any other types of allergies, such as to
foods, dyes, preservatives, or animals. For non-prescription products, read the label or package
ingredients carefully.

Pediatric
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would
limit the usefulness of griseofulvin in children. However, safety and efficacy have not been
established in children up to 2 years of age.

Geriatric
No information is available on the relationship of age to the effects of griseofulvin in geriatric
patients.

Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication
during breastfeeding. Weigh the potential benefits against the potential risks before taking this
medication while breastfeeding.

Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines
may be used together even if an interaction might occur. In these cases, your doctor may want to
change the dose, or other precautions may be necessary. When you are taking this medicine, it is
especially important that your healthcare professional know if you are taking any of the medicines
listed below. The following interactions have been selected on the basis of their potential
significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines may cause an increased risk of certain side
effects, but using both drugs may be the best treatment for you. If both medicines are prescribed
together, your doctor may change the dose or how often you use one or both of the medicines.

 Desogestrel
 Dienogest
 Drospirenone
 Estradiol Cypionate
 Estradiol Valerate
 Ethinyl Estradiol
 Ethynodiol Diacetate
 Etonogestrel
 Levonorgestrel
 Medroxyprogesterone Acetate
 Mestranol
 Norelgestromin
 Norethindrone
 Norgestimate
 Norgestrel
 Phenobarbital
 Warfarin
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of
food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause
interactions to occur. The following interactions have been selected on the basis of their potential
significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in
some cases. If used together, your doctor may change the dose or how often you use this medicine,
or give you special instructions about the use of food, alcohol, or tobacco.

 Ethanol
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your
doctor if you have any other medical problems, especially:

 Actinomycosis (bacterial infection) or

 Blastomycosis (Gilchrist’s disease) or
 Candidiasis (yeast infection) or
 Histoplasmosis (Darling’s disease) or
 Other infections (e.g., bacteria) or
 Sporotrichosis (Rose gardener's disease) or
 Tinea versicolor (Tinea flava)—Griseofulvin will not work in patients with these conditions.

 Liver failure or
 Porphyria (enzyme problem)—Should not be used in patients with these conditions.

 Lupus erythematosus or lupus-like diseases—Use with caution. May make this condition worse.