II. Indications
III. Contraindications
IV. Epidemiology
- Hydrochlorothiazide is the most commonly prescribed Thiazide Diuretic for Hypertension
V. Dosing: Hypertension (Adults)
- Start: 12 to 25 mg orally daily
- Typical maintenance dose 25 mg orally daily
- Maximum 50 mg/day
- Higher doses worsen Hypokalemia without additional Antihypertensive benefit
- Available as generic scored tablets (25 and 50 mg) and capsules (25 mg)
VI. Medications: Combinations
- Many ACE and ARBs are combined with Hydrochlorothiazide
- Hydrochlorothiazide and Triamterene
- Hctz/Triamterene 25/50 (Dyazide) once daily
- Hctz/Triamterene 50/75 (Maxzide) once daily
VII. Pharmacokinetics
- Renal excretion, unchanged in urine
- Onset of activity: 2 hours
- Shorter Half-Life (6-12 hours) than the 24 hour half life of Chlorthalidone and Indapamide
- Immediate release Hydrochlorothiazide may only reduce daytime systolic Blood Pressure
- Controlled release Hydrochlorothiazide (available outside the U.S.) has 24 hour activity
VIII. Efficacy
- Less potent than Chlorthalidone
- Chlorthalidone reduces systolic Blood Pressure 10 mmHg more than Hydrochlorothiazide
- However, Hydrochlorothiazide and Chlorthalidone are associated with similar cardiovascular outcomes
- Chlorthalidone also raises the risk of Hypokalemia
- Ishani (2022) N Engl J Med 387(26):2401-10 +PMID: 36516076 [PubMed]
IX. Mechanism
X. Adverse Effects
XI. Safety
- Considered Safe in Lactation
- Pregnancy Category B
- Pregnancy Category D for Pregnancy Induced Hypertension
- See Thiazide Diuretic
XII. Drug Interactions
-
Cyclosporine
- Increased risk of Hypercalcemia, Gouty Arthritis
-
Corticosteroids
- Increased risk of Hypokalemia
- Cytotoxic medications (e.g. Cyclophosphamide, Methotrexate)
- Hydrochlorothiazide may decrease renal excretion of cytotoxic medications
XIII. Resources
- Hydrochlorothiazide (DailyMed)
XIV. References
- (2021) Presc Lett, Resource #370507, Commonly Used Diuretics
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 62-3
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
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 |
Ontology: Hydrochlorothiazide (C0020261)
Definition (MSH) | A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It is used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. |
Definition (CHV) | drug that increases voiding |
Definition (CHV) | drug that increases voiding |
Definition (NCI) | A short acting thiazide diuretic. Hydrochlorothiazide (HCTZ) is widely used to treat hypertension and edema. This agent's metabolite appears to preferentially bind to and accumulate in red blood cells. This agent is primarily excreted by the kidneys. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D006852 |
SnomedCT | 387525002, 91667005 |
LNC | LP16160-1, MTHU016732 |
English | Dichlothiazide, Dihydrochlorothiazide, HCTZ, Hydrochlorothiazide, 2H-1,2,4-Benzothiadiazine-7-sulfonamide, 6-chloro-3,4-dihydro-, 1,1-dioxide, 6-Chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide, hydrochlorothiazide, hydrochlorothiazide (medication), HYDROCHLOROTHIAZIDE, Hydrochlorothiazide [Chemical/Ingredient], hctz, Hydrochlorothiazide (product), Hydrochlorothiazide (substance) |
Spanish | Hidroclorotiazida, hidroclorotiazida (producto), hidroclorotiazida (sustancia), hidroclorotiazida |
Swedish | Hydroklortiazid |
Czech | hydrochlorthiazid |
Finnish | Hydroklooritiatsidi |
Russian | NEFRIKS, GIPOTIAZID, EZIDREKS, GIDROKHLOROTIAZID, DIKHLOTIAZID, GIDROKHLORTIAZID, ГИДРОХЛОРОТИАЗИД, ГИДРОХЛОРТИАЗИД, ГИПОТИАЗИД, НЕФРИКС, ЭЗИДРЕКС, ДИХЛОТИАЗИД |
Japanese | ヒドロクロロチアジド |
Italian | HCTZ, Diidroclorotiazide, Idroclorotiazide |
Croatian | HIDROKLOROTIAZID |
Polish | Hydrochlorotiazyd |
French | Hydrochlorothiazide |
German | Hydrochlorothiazid |
Portuguese | Hidroclorotiazida |