Known brand names include No current brand name for single-agent tablets or capsules; marketed as generic hydrochlorothiazide (HCTZ). RxNorm brands are mostly combination products, plus Inzirqo, an oral suspension outside this scope..
A thiazide "water pill" that helps the kidneys remove extra salt and water. It treats high blood pressure and swelling from heart, liver, or kidney disease or from steroid or estrogen therapy.
Labeled use. Adjunct for edema from heart failure, cirrhosis, steroid or estrogen therapy, and renal disease.
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Thiazides are a first-line choice for uncomplicated hypertension and pair well with ACE inhibitors or ARBs. Chlorthalidone is longer acting and favored by some guidelines. Thiazides lose effect when GFR is low, where a loop diuretic is preferred for edema. Avoid or use caution with gout, sulfa allergy, or hyponatremia.
A thiazide diuretic. It acts on the distal renal tubule to block salt reabsorption, so sodium and chloride are lost in roughly equal amounts, with some potassium and bicarbonate. How it lowers blood pressure is not fully known. Diuresis starts within 2 hours, peaks near 4 hours, and lasts about 6 to 12 hours.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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No dose table. Use with caution in severe renal disease, where thiazides may cause azotemia and the drug can accumulate. Contraindicated in anuria; consider holding or stopping if renal impairment progresses.
No dose table. Use with caution in impaired liver function or progressive liver disease, because small fluid and electrolyte shifts can trigger hepatic coma.
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No antidote. Overdose mainly causes dehydration and loss of potassium, chloride, and sodium; with digitalis, hypokalemia can worsen arrhythmias. Give supportive care and correct fluids, electrolytes, and blood pressure. It is not known how well hemodialysis removes it.
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Animal studies showed no fetal harm, but there are no adequate human studies; use only if clearly needed. Thiazides cross the placenta and can cause newborn jaundice or thrombocytopenia. Routine diuretic use in normal pregnancy is not appropriate.
Thiazides pass into breast milk. Because of possible serious reactions in the infant, decide whether to stop breastfeeding or stop the drug.
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No well-controlled pediatric trials; dosing comes from empiric use. Usual dose 1 to 2 mg/kg per day in 1 or 2 doses, at most 37.5 mg/day up to age 2 and 100 mg/day for ages 2 to 12. Infants under 6 months may need up to 3 mg/kg per day in 2 doses.