Chlorothiazide

What is Chlorothiazide?

• Chlorothiazide (Chlotride; Diuril) is a diuretic and antihypertensive used alone or in combination with other medications to treat high blood pressure.
• Chlorothiazide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease and to treat edema caused by using certain medications including estrogen and corticosteroids.

Chlorothiazide

Chlorothiazide-from-xtal-3D-balls

What are the uses of this medicine?

Chlorothiazide (Chlotride; Diuril) is indicated as:

• adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy.
• edema due to various forms of renal dysfunction such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure.
• management of hypertension either as the sole therapeutic agent or to enhance the effectiveness of other antihypertensive drugs in the more severe forms of hypertension.

How does this medicine work?

• The mechanism of the antihypertensive effect of thiazides is unknown.
• Chlorothiazide does not usually affect normal blood pressure.
• Chlorothiazide affects the distal renal tubular mechanism of electrolyte reabsorption.
• At maximal therapeutic dosage all thiazides are approximately equal in their diuretic efficacy.
• Chlorothiazide increases excretion of sodium and chloride in approximately equivalent amounts.
• Natriuresis may be accompanied by some loss of potassium and bicarbonate.
• After oral use diuresis begins within 2 hours, peaks in about 4 hours and lasts about 6 to 12 hours.
• Following intravenous use of chlorothiazide sodium, onset of the diuretic action occurs in 15 minutes and the maximal action in 30 minutes.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Anuria
• Hypersensitivity to any component of this product or to other sulfonamide-derived drugs

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• barbiturates such as phenobarbital and secobarbital (Seconal)
• corticosteroids such as betamethasone (Celestone), budesonide (Entocort), cortisone (Cortone), dexamethasone (Decadron, Dexpak, Dexasone, others), fludrocortisone (Floriner), hydrocortisone (Cortef, Hydrocortone), methylprednisolone (Medrol), prednisolone (Prelone, others), prednisone (Deltasone, Meticorten, Sterapred, others), and triamcinolone (Aristocort, Azmacort)
• corticotropin (ACTH H.P., Acthar Gel)
• digoxin (Lanoxin)
• insulin and oral medications for diabetes, lithium (Lithobid), medications for high blood pressure or pain; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others).
• if you are taking cholestyramine or colestipol, take them 1 hour before or 4 hours after taking chlorothiazide.

Is this medicine FDA approved?

• It was patented in 1956 and approved for medical use in 1958.

How should this medicine be used?

Recommended dosage: Adults: For Edema:

• The usual adult dosage is 500 mg to 1,000 mg (10 mL to 20 mL) once or twice a day.

For Control of Hypertension:

• The usual adult starting dosage is 500 mg or 1,000 mg (10 mL to 20 mL) a day as a single or divided dose.

Infants and Children: For Diuresis and For Control of Hypertension:

• The usual pediatric dosage is 5 mg to 10 mg per pound (10 mg/kg to 20 mg/kg) per day in single or two divided doses, not to exceed 375 mg per day (2.5 mL to 7.5 mL or ½ to 1½ teaspoonfuls of the oral suspension daily) in infants up to 2 years of age or 1,000 mg per day in children 2 to 12 years of age.
• In infants less than 6 months of age, doses up to 15 mg per pound (30 mg/kg) per day in two divided doses may be required.

Administration:

• Chlorothiazide comes as a tablet and suspension (liquid) to take by mouth.
• It usually is taken once or twice a day.
• When used to treat hypertension, take chlorothiazide around the same time(s) every day.
• When used to treat edema, chlorothiazide may be taken daily or only on certain days of the week. Take this medication with meals or a snack.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As a tablet and suspension (liquid)

This medicine is available in fallowing brand namesː

• Chlotride; Diuril

What side effects can this medication cause?

The most common side effects of this medicine include:

• Weakness
• Hypotension, including orthostatic hypotension
• Pancreatitis
• jaundice (intrahepatic cholestatic jaundice)
• diarrhea
• vomiting
• sialadenitis
• cramping
• constipation
• gastric irritation
• nausea
• anorexia
• Aplastic anemia
• agranulocytosis
• leukopenia
• hemolytic anemia
• thrombocytopenia
• Anaphylactic reactions
• necrotizing angiitis (vasculitis and cutaneous vasculitis)
• respiratory distress including pneumonitis and pulmonary edema
• photosensitivity
• fever
• urticaria
• rash
• purpura
• Electrolyte imbalance
• hyperglycemia
• glycosuria
• hyperuricemia
• Muscle spasm
• Vertigo
• paresthesias
• dizziness
• headache
• restlessness
• Renal failure
• renal dysfunction
• interstitial nephritis
• Erythema multiforme including Stevens-Johnson syndrome
• exfoliative dermatitis including toxic epidermal necrolysis
• alopecia
• Transient blurred vision
• xanthopsia
• Impotence

What special precautions should I follow?

• Use with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia.
• Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease.
• Sensitivity reactions may occur in patients with or without a history of allergy or bronchial asthma.
• The possibility of exacerbation or activation of systemic lupus erythematosus has been reported.
• All patients receiving diuretic therapy should be observed for evidence of fluid or electrolyte imbalance: namely, hyponatremia, hypochloremic alkalosis, and hypokalemia.
• In diabetic patients dosage adjustments of insulin or oral hypoglycemic agents may be required. Hyperglycemia may occur with thiazide diuretics. Thus latent diabetes mellitus may become manifest during thiazide therapy.
• Thiazides have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.
• Thiazides may decrease urinary calcium excretion.
• Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.
• Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• hypokalemia
• hypochloremia
• hyponatremia
• dehydration
• cardiac arrhythmias

Management of overdosage:

• In the event of overdosage, symptomatic and supportive measures should be employed.
• Emesis should be induced or gastric lavage performed.
• Correct dehydration, electrolyte imbalance, hepatic coma and hypotension by established procedures.
• If required, give oxygen or artificial respiration for respiratory impairment.
• The degree to which chlorothiazide sodium is removed by hemodialysis has not been established.

Can this medicine be used in pregnancy?

• It is not known whether chlorothiazide can cause fetal harm when administered to a pregnant woman; however, thiazides cross the placental barrier and appear in cord blood.
• chlorothiazide should be used during pregnancy only if clearly needed.

Can this medicine be used in children?

• There are no well-controlled clinical trials in pediatric patients.

What are the active and inactive ingredients in this medicine?

Diuril

Active ingredients:

• chlorothiazide

Inactive Ingredients:

• alcohol
• methylparaben
• propylparaben
• benzoic acid
• d&c yellow no. 10
• glycerin
• water
• sucrose
• tragacanth

Who manufactures and distributes this medicine?

As Diuril Distributed by:

• Salix Pharmaceuticals,
• a division of Bausch Health US, LLC
• Bridgewater, NJ USA

• DIURIL is a registered trademark of Merck Sharp & Dohme Corp. used under license.

As Injection: Manufactured by:

• Fresenius Kabi
• Lake Zurich, IL

What should I know about storage and disposal of this medication?

DIURIL (chlorothiazide) Oral Suspension:

• Keep container tightly closed.
• Protect from freezing, –20°C (–4°F) and store at room temperature, 15° to 30°C (59° to 86°F).

Injection:

• STORE LYOPHILIZED POWDER BETWEEN: 2° and 25°C (36° and 77°F).

• Dailymed label info on Chlorothiazide
• FDA Chlorothiazide

Chlorothiazide Resources
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