Hydrochlorothiazide

Aka: Hydrochlorothiazide, HCTZ, Esidrex, HydroDIURIL

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II. Indications

  1. Hypertension

III. Contraindications

  1. Hypercalcemia
  2. Gouty Arthritis

IV. Epidemiology

  1. Hydrochlorothiazide is the most commonly prescribed Thiazide Diuretic for Hypertension

V. Dosing: Hypertension (Adults)

  1. Start: 12 to 25 mg orally daily
  2. Typical maintenance dose 25 mg orally daily
  3. Maximum 50 mg/day
    1. Higher doses worsen Hypokalemia without additional Antihypertensive benefit
  4. Available as generic scored tablets (25 and 50 mg) and capsules (25 mg)

VI. Medications: Combinations

  1. Many ACE and ARBs are combined with Hydrochlorothiazide
  2. Hydrochlorothiazide and Triamterene
    1. Hctz/Triamterene 25/50 (Dyazide) once daily
    2. Hctz/Triamterene 50/75 (Maxzide) once daily

VII. Pharmacokinetics

  1. Renal excretion, unchanged in urine
  2. Onset of activity: 2 hours
  3. Shorter Half-Life (6-12 hours) than the 24 hour half life of Chlorthalidone and Indapamide
    1. Immediate release Hydrochlorothiazide may only reduce daytime systolic Blood Pressure
    2. Controlled release Hydrochlorothiazide (available outside the U.S.) has 24 hour activity

VIII. Efficacy

  1. Less potent than Chlorthalidone
    1. Chlorthalidone reduces systolic Blood Pressure 10 mmHg more than Hydrochlorothiazide
    2. However, Hydrochlorothiazide and Chlorthalidone are associated with similar cardiovascular outcomes
      1. Chlorthalidone also raises the risk of Hypokalemia
      2. Ishani (2022) N Engl J Med 387(26):2401-10 +PMID: 36516076 [PubMed]

IX. Mechanism

  1. See Thiazide Diuretic

X. Adverse Effects

  1. See Thiazide Diuretic

XI. Safety

  1. Considered Safe in Lactation
  2. Pregnancy Category B
    1. Pregnancy Category D for Pregnancy Induced Hypertension
    2. See Thiazide Diuretic

XII. Drug Interactions

  1. Cyclosporine
    1. Increased risk of Hypercalcemia, Gouty Arthritis
  2. Corticosteroids
    1. Increased risk of Hypokalemia
  3. Cytotoxic medications (e.g. Cyclophosphamide, Methotrexate)
    1. Hydrochlorothiazide may decrease renal excretion of cytotoxic medications

XIII. Resources

  1. Hydrochlorothiazide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c59c4230-7cea-4259-9f2f-6a568716fedf

XIV. References

  1. (2021) Presc Lett, Resource #370507, Commonly Used Diuretics
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 62-3
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

hydrochlorothiazide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
HYDROCHLOROTHIAZIDE 12.5 MG CP Generic $0.03 each
HYDROCHLOROTHIAZIDE 12.5 MG TB Generic $0.04 each
HYDROCHLOROTHIAZIDE 25 MG TAB Generic $0.01 each
HYDROCHLOROTHIAZIDE 50 MG TAB Generic $0.03 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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