Severe allergic reaction to hydrochlorothiazide mimicking septic shock

Hydrochlorothiazide (HCTZ) is a sulfonamide-containing drug with commonly reported adverse effects that include electrolyte abnormalities, orthostatic hypotension, hyperglycemia, and photosensitivity. A few reports have described rare but serious drug complications such as interstitial pneumonitis, angioedema, and aplastic anemia. We describe a patient who experienced a serious HCTZ-induced adverse event that, to our knowledge, has not yet been reported in the literature. A 78-year-old woman came to the emergency department with dyspnea and severe fatigue; her signs and symptoms were suggestive of septic shock from pneumonia. She was treated accordingly, her condition improved, and she was discharged home. During the next 2 months, the patient returned to the emergency department 2 more times and was hospitalized each time with the same diagnosis. During her third admission, it was discovered that the patient’s primary care physician had restarted her HCTZ for hypertension after it had been discontinued during each of the first two hospitalizations. The patient’s symptoms began within hours of the first and second hospitalizations and almost immediately after taking a dose of HCTZ on the day of the third hospitalization. Her medical history revealed documented allergic reactions to sulfonamide drugs and penicillin; thus a hypersensitivity reaction to HCTZ was suspected. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient’s hypersensitivity reactions and HCTZ therapy. Because of a lack of evidence showing cross-reactivity among the different classes of sulfonamides, the mechanism of the allergic reaction to HCTZ was unlikely to be cross-sensitivity between sulfonamide antibiotics and sulfonamide nonantibiotic drugs. Although the mechanism is not clear, evidence shows that the allergy to the HCTZ (sulfonamide nonantibiotic) may be due to a predisposition to drug allergies rather than sulfonamide cross-sensitivity. Clinicians should be aware of the potential for these types of allergic reactions.

Side effects, dosage, uses, and more

1. Hydrochlorothiazide oral tablet is only available as a generic drug.
2. Hydrochlorothiazide comes as a tablet or capsule that you take by mouth.
3. Hydrochlorothiazide oral tablet is used to treat high blood pressure, and swelling caused by heart failure, liver damage, and certain medications.

Hydrochlorothiazide is a prescription drug. It comes as a tablet or capsule that you take by mouth.

Hydrochlorothiazide oral tablet is available in a generic form only. Generic drugs usually cost less than brand-name drugs.

Why it’s used

Hydrochlorothiazide is used to treat high blood pressure. It’s also used to treat swelling that’s caused by heart failure, liver damage (cirrhosis), and taking medications called corticosteroids or estrogens. It may also help treat swelling that’s caused by kidney problems.

This drug may be used alone or in combination with other drugs.

How it works

Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how hydrochlorothiazide works. It’s thought that it works to remove excess salt and water from your body. This action keeps your heart from working as hard to pump blood, which lowers blood pressure and reduces swelling.

Hydrochlorothiazide can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking hydrochlorothiazide. This list does not include all possible side effects.

For more information on the possible side effects of hydrochlorothiazide, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects that can occur with hydrochlorothiazide include:

• blood pressure that’s lower than normal (especially when standing up after sitting or lying down)
• dizziness
• headache
• weakness
• erectile dysfunction (trouble getting or keeping an erection)
• tingling in your hands, legs, and feet

These effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• severe skin reactions such as Stevens-Johnson syndrome and exfoliative dermatitis, with symptoms such as:
  • painful skin rash
  • skin peeling and blisters
  • fever
  • mouth sores
• kidney failure, with symptoms such as:
  • weakness
  • shortness of breath
  • tiredness
  • confusion
  • abnormal heart rate or chest pain
  • producing less urine than normal
  • increased swelling in your legs, ankles, or feet
• blurred vision, with symptoms such as:

Hydrochlorothiazide oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with hydrochlorothiazide. This list does not contain all drugs that may interact with hydrochlorothiazide.

Before taking hydrochlorothiazide, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Barbiturates

If you take these drugs with hydrochlorothiazide, your blood pressure may be lowered too much. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down. Examples of these drugs include:

• phenobarbital
• pentobarbital

Lithium

In general, lithium shouldn’t be taken with hydrochlorothiazide. That’s because hydrochlorothiazide slows the clearance of lithium from your body. This increases your risk of high levels of lithium in your body, which can cause dangerous side effects.

Blood pressure drugs

Taking hydrochlorothiazide with other blood pressure medications can make your blood pressure drop too low. Examples of these drugs include:

• angiotensin-converting enzyme (ACE) inhibitors, such as:
  • lisinopril
  • fosinopril
  • enalapril
• angiotensin receptor blockers (ARBs), such as:
  • losartan
  • valsartan
  • candesartan
• beta-blockers, such as:
  • atenolol
  • metoprolol
  • bisoprolol
• calcium channel blockers, such as:
  • amlodipine
  • verapamil
  • diltiazem

Cholesterol-lowering drugs

Taking hydrochlorothiazide with certain drugs that lower cholesterol levels may make hydrochlorothiazide less effective. This means it may not work as well to treat your blood pressure or swelling. Examples of these cholesterol drugs include:

Corticosteroids

Hydrochlorothiazide can lower your electrolyte levels. Taking corticosteroids with hydrochlorothiazide can cause further loss of electrolytes (especially potassium). Low potassium levels can lead to constipation, fatigue, muscle breakdown, and weakness. Examples of these drugs include:

• prednisone
• methylprednisolone

Diabetes drugs

Hydrochlorothiazide can cause high blood sugar levels. If you take hydrochlorothiazide with diabetes drugs, your doctor may increase your dosage of your diabetes medications. Examples of these drugs include:

• insulin
• oral diabetes drugs, such as:
  • metformin
  • glimepiride
  • pioglitazone
  • sitagliptin

Narcotics

Taking hydrochlorothiazide with narcotics can make your blood pressure drop too low. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down. Examples of these drugs include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Taking NSAIDs with hydrochlorothiazide can make hydrochlorothiazide less effective. This means it may not work as well to treat your blood pressure or swelling.

If you’re taking an NSAID with hydrochlorothiazide, your doctor will closely monitor you. Examples of these drugs include:

Muscle relaxant

Taking hydrochlorothiazide with tubocurarine, a muscle relaxant, may increase the effects of tubocurarine. This could lead to more side effects.

The hydrochlorothiazide dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using hydrochlorothiazide to treat
• your age
• the form of hydrochlorothiazide you take
• other medical conditions you may have, such as kidney damage

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Generic: Hydrochlorothiazide

• Form: oral tablet
• Strengths: 12.5 mg, 25 mg, and 50 mg

Dosage for high blood pressure

Adult dosage (ages 18 to 64 years)

• Typical starting dosage: 25 mg taken by mouth once per day.
• Dosage increases: If your blood pressure stays high, your doctor may increase your dosage to 50 mg per day given as a single or two divided doses.

Child dosage (ages 12 to 17 years)

• Typical starting dosage: 25 mg taken by mouth once per day.
• Dosage increases: If your child’s blood pressure stays high, their doctor may increase your child’s dosage to 50 mg per day given as a single dose, or as two divided doses.

Child dosage (ages 3 to 11 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 100 mg.

Child dosage (ages 6 months to 2 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 37.5 mg.

Child dosage (ages 0 to 6 months)

• Typical dosage: The usual dosage is up to 1.5 mg per pound per day, taken by mouth in two divided doses.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dosage may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different dosing schedule.

Dosage for edema

Adult dosage (ages 18 to 64 years)

• Typical dosage: 25 to 100 mg each day, taken by mouth as a single or divided dose.
• Intermittent therapy: Many people respond to intermittent therapy. This means that you may need to take this drug every other day or for three to five days each week. Taking the drug this way lowers your risk of an imbalance in your electrolytes.

Child dosage (ages 12 to 17 years)

• Typical dosage: 25 to 100 mg each day, taken by mouth as a single or divided dose.
• Intermittent therapy: Many people respond to intermittent therapy. This means your child may need to take this drug every other day or for three to five days each week. Taking the drug this way lowers your child’s risk of an imbalance in their electrolytes.

Child dosage (ages 3 to 11 years)

• Typical dosage: The usual dosage is 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 100 mg.

Child dosage (ages 6 months to 2 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 37.5 mg.

Child dosage (ages 0 to 6 months)

• Typical dosage: Up to 1.5 mg per pound per day, taken by mouth in two divided doses.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dosage may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different dosing schedule.

This drug comes with several warnings.

Fluid and electrolyte imbalance warning

Your doctor should check your fluid and electrolyte levels while you’re taking hydrochlorothiazide. This drug can cause a fluid or electrolyte imbalance. Symptoms can include:

• dry mouth
• thirst
• weakness
• tiredness
• restlessness
• confusion
• seizures
• muscle pain or cramps
• muscle fatigue
• lower than normal blood pressure
• higher than normal heart rate
• producing less urine than normal
• nausea or vomiting

Vision problems warning

Hydrochlorothiazide can cause blurred vision and glaucoma. Symptoms include eye pain and trouble seeing. These problems often occur within hours to weeks after starting this medication.

Tell your doctor if you have any vision problems while taking this drug. If you have blurred vision, it may return to normal after you stop taking this medication. However, if left untreated, certain vision problems can lead to permanent vision loss.

Sulfonamide allergy warning

If you’re allergic to medications that contain sulfonamide, you shouldn’t take this drug.

Allergy warning

Hydrochlorothiazide can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue
• hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol warning

Drinking alcohol while taking hydrochlorothiazide can make your blood pressure drop too low. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down.

Warnings for people with certain health conditions

For people with kidney problems: Use caution when taking hydrochlorothiazide if you have poor kidney function. This drug is cleared from your body by your kidneys. If your kidneys don’t work as well, this drug may build up in your body and cause more side effects. If your kidney function gets worse, your doctor might stop your treatment with this medication.

For people with kidneys that don’t make enough urine: You can’t take hydrochlorothiazide if your kidneys can’t make enough urine. This drug can cause electrolyte and fluid loss, which may make you produce even less urine.

For people with poor liver function: Use this drug with caution if you have poor liver function or progressive liver disease. Hydrochlorothiazide can cause electrolyte and fluid imbalance. This can make your liver function worse.

For people with lupus: This drug can cause your lupus to flare up.

Warnings for certain groups

For pregnant women: Hydrochlorothiazide is a category B pregnancy drug. That means two things:

1. Research in animals hasn’t shown a risk to the fetus when the mother takes the drug.
2. There aren’t enough studies done in humans to show if the drug poses a risk to the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. Animal studies don’t always predict the way humans would respond. Therefore, this drug should only be used in pregnancy if clearly needed.

For women who are breastfeeding: Hydrochlorothiazide may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Hydrochlorothiazide is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Your swelling and high blood pressure might get worse. High blood pressure raises your risk of heart attack or stroke.

If you stop taking the drug suddenly, your swelling can increase and your blood pressure might increase rapidly. High blood pressure raises your risk of heart attack or stroke.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: If you take too much hydrochlorothiazide, your blood pressure might drop too low. You might feel faint or dizzy.

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause dangerous side effects.

How to tell if the drug is working: Your blood pressure should be lower or the swelling in your legs and feet should get better.

Your doctor will monitor your blood pressure at your checkups. You can also check your blood pressure at home. Keep a log with the date, time of day, and your blood pressure readings. Bring this log with you to your doctor appointments.

Keep these considerations in mind if your doctor prescribes hydrochlorothiazide for you.

General

• You can take hydrochlorothiazide with or without food.
• Take this drug in the morning, not the evening. This drug may make you urinate more. Taking it in the evening can make you need to get up at night to use the bathroom.
• You can crush hydrochlorothiazide tablets.

Storage

• Store hydrochlorothiazide at a temperature between 68°F and 77°F (20°C and 25°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to check your blood pressure at home. You should keep a log with the date, time of day, and your blood pressure readings. Bring this log with you to your checkups.

Shop for blood pressure monitors.

Clinical monitoring

During treatment with this drug, your doctor may check your potassium levels. This will help make sure you don’t have any imbalances.

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Side effects, dosage, uses, and more

1. Hydrochlorothiazide oral tablet is only available as a generic drug.
2. Hydrochlorothiazide comes as a tablet or capsule that you take by mouth.
3. Hydrochlorothiazide oral tablet is used to treat high blood pressure, and swelling caused by heart failure, liver damage, and certain medications.

Hydrochlorothiazide is a prescription drug. It comes as a tablet or capsule that you take by mouth.

Hydrochlorothiazide oral tablet is available in a generic form only. Generic drugs usually cost less than brand-name drugs.

Why it’s used

Hydrochlorothiazide is used to treat high blood pressure. It’s also used to treat swelling that’s caused by heart failure, liver damage (cirrhosis), and taking medications called corticosteroids or estrogens. It may also help treat swelling that’s caused by kidney problems.

This drug may be used alone or in combination with other drugs.

How it works

Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how hydrochlorothiazide works. It’s thought that it works to remove excess salt and water from your body. This action keeps your heart from working as hard to pump blood, which lowers blood pressure and reduces swelling.

Hydrochlorothiazide can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking hydrochlorothiazide. This list does not include all possible side effects.

For more information on the possible side effects of hydrochlorothiazide, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects that can occur with hydrochlorothiazide include:

• blood pressure that’s lower than normal (especially when standing up after sitting or lying down)
• dizziness
• headache
• weakness
• erectile dysfunction (trouble getting or keeping an erection)
• tingling in your hands, legs, and feet

These effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• severe skin reactions such as Stevens-Johnson syndrome and exfoliative dermatitis, with symptoms such as:
  • painful skin rash
  • skin peeling and blisters
  • fever
  • mouth sores
• kidney failure, with symptoms such as:
  • weakness
  • shortness of breath
  • tiredness
  • confusion
  • abnormal heart rate or chest pain
  • producing less urine than normal
  • increased swelling in your legs, ankles, or feet
• blurred vision, with symptoms such as:

Hydrochlorothiazide oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with hydrochlorothiazide. This list does not contain all drugs that may interact with hydrochlorothiazide.

Before taking hydrochlorothiazide, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Barbiturates

If you take these drugs with hydrochlorothiazide, your blood pressure may be lowered too much. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down. Examples of these drugs include:

• phenobarbital
• pentobarbital

Lithium

In general, lithium shouldn’t be taken with hydrochlorothiazide. That’s because hydrochlorothiazide slows the clearance of lithium from your body. This increases your risk of high levels of lithium in your body, which can cause dangerous side effects.

Blood pressure drugs

Taking hydrochlorothiazide with other blood pressure medications can make your blood pressure drop too low. Examples of these drugs include:

• angiotensin-converting enzyme (ACE) inhibitors, such as:
  • lisinopril
  • fosinopril
  • enalapril
• angiotensin receptor blockers (ARBs), such as:
  • losartan
  • valsartan
  • candesartan
• beta-blockers, such as:
  • atenolol
  • metoprolol
  • bisoprolol
• calcium channel blockers, such as:
  • amlodipine
  • verapamil
  • diltiazem

Cholesterol-lowering drugs

Taking hydrochlorothiazide with certain drugs that lower cholesterol levels may make hydrochlorothiazide less effective. This means it may not work as well to treat your blood pressure or swelling. Examples of these cholesterol drugs include:

Corticosteroids

Hydrochlorothiazide can lower your electrolyte levels. Taking corticosteroids with hydrochlorothiazide can cause further loss of electrolytes (especially potassium). Low potassium levels can lead to constipation, fatigue, muscle breakdown, and weakness. Examples of these drugs include:

• prednisone
• methylprednisolone

Diabetes drugs

Hydrochlorothiazide can cause high blood sugar levels. If you take hydrochlorothiazide with diabetes drugs, your doctor may increase your dosage of your diabetes medications. Examples of these drugs include:

• insulin
• oral diabetes drugs, such as:
  • metformin
  • glimepiride
  • pioglitazone
  • sitagliptin

Narcotics

Taking hydrochlorothiazide with narcotics can make your blood pressure drop too low. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down. Examples of these drugs include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Taking NSAIDs with hydrochlorothiazide can make hydrochlorothiazide less effective. This means it may not work as well to treat your blood pressure or swelling.

If you’re taking an NSAID with hydrochlorothiazide, your doctor will closely monitor you. Examples of these drugs include:

Muscle relaxant

Taking hydrochlorothiazide with tubocurarine, a muscle relaxant, may increase the effects of tubocurarine. This could lead to more side effects.

The hydrochlorothiazide dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using hydrochlorothiazide to treat
• your age
• the form of hydrochlorothiazide you take
• other medical conditions you may have, such as kidney damage

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Generic: Hydrochlorothiazide

• Form: oral tablet
• Strengths: 12.5 mg, 25 mg, and 50 mg

Dosage for high blood pressure

Adult dosage (ages 18 to 64 years)

• Typical starting dosage: 25 mg taken by mouth once per day.
• Dosage increases: If your blood pressure stays high, your doctor may increase your dosage to 50 mg per day given as a single or two divided doses.

Child dosage (ages 12 to 17 years)

• Typical starting dosage: 25 mg taken by mouth once per day.
• Dosage increases: If your child’s blood pressure stays high, their doctor may increase your child’s dosage to 50 mg per day given as a single dose, or as two divided doses.

Child dosage (ages 3 to 11 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 100 mg.

Child dosage (ages 6 months to 2 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 37.5 mg.

Child dosage (ages 0 to 6 months)

• Typical dosage: The usual dosage is up to 1.5 mg per pound per day, taken by mouth in two divided doses.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dosage may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different dosing schedule.

Dosage for edema

Adult dosage (ages 18 to 64 years)

• Typical dosage: 25 to 100 mg each day, taken by mouth as a single or divided dose.
• Intermittent therapy: Many people respond to intermittent therapy. This means that you may need to take this drug every other day or for three to five days each week. Taking the drug this way lowers your risk of an imbalance in your electrolytes.

Child dosage (ages 12 to 17 years)

• Typical dosage: 25 to 100 mg each day, taken by mouth as a single or divided dose.
• Intermittent therapy: Many people respond to intermittent therapy. This means your child may need to take this drug every other day or for three to five days each week. Taking the drug this way lowers your child’s risk of an imbalance in their electrolytes.

Child dosage (ages 3 to 11 years)

• Typical dosage: The usual dosage is 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 100 mg.

Child dosage (ages 6 months to 2 years)

• Typical dosage: 0.5 to 1 mg per pound per day, taken in a single dose or two divided doses.
• Maximum daily dosage: 37.5 mg.

Child dosage (ages 0 to 6 months)

• Typical dosage: Up to 1.5 mg per pound per day, taken by mouth in two divided doses.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dosage may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different dosing schedule.

This drug comes with several warnings.

Fluid and electrolyte imbalance warning

Your doctor should check your fluid and electrolyte levels while you’re taking hydrochlorothiazide. This drug can cause a fluid or electrolyte imbalance. Symptoms can include:

• dry mouth
• thirst
• weakness
• tiredness
• restlessness
• confusion
• seizures
• muscle pain or cramps
• muscle fatigue
• lower than normal blood pressure
• higher than normal heart rate
• producing less urine than normal
• nausea or vomiting

Vision problems warning

Hydrochlorothiazide can cause blurred vision and glaucoma. Symptoms include eye pain and trouble seeing. These problems often occur within hours to weeks after starting this medication.

Tell your doctor if you have any vision problems while taking this drug. If you have blurred vision, it may return to normal after you stop taking this medication. However, if left untreated, certain vision problems can lead to permanent vision loss.

Sulfonamide allergy warning

If you’re allergic to medications that contain sulfonamide, you shouldn’t take this drug.

Allergy warning

Hydrochlorothiazide can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue
• hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol warning

Drinking alcohol while taking hydrochlorothiazide can make your blood pressure drop too low. You may have symptoms such as feeling dizzy when you stand up after sitting or lying down.

Warnings for people with certain health conditions

For people with kidney problems: Use caution when taking hydrochlorothiazide if you have poor kidney function. This drug is cleared from your body by your kidneys. If your kidneys don’t work as well, this drug may build up in your body and cause more side effects. If your kidney function gets worse, your doctor might stop your treatment with this medication.

For people with kidneys that don’t make enough urine: You can’t take hydrochlorothiazide if your kidneys can’t make enough urine. This drug can cause electrolyte and fluid loss, which may make you produce even less urine.

For people with poor liver function: Use this drug with caution if you have poor liver function or progressive liver disease. Hydrochlorothiazide can cause electrolyte and fluid imbalance. This can make your liver function worse.

For people with lupus: This drug can cause your lupus to flare up.

Warnings for certain groups

For pregnant women: Hydrochlorothiazide is a category B pregnancy drug. That means two things:

1. Research in animals hasn’t shown a risk to the fetus when the mother takes the drug.
2. There aren’t enough studies done in humans to show if the drug poses a risk to the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. Animal studies don’t always predict the way humans would respond. Therefore, this drug should only be used in pregnancy if clearly needed.

For women who are breastfeeding: Hydrochlorothiazide may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Hydrochlorothiazide is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Your swelling and high blood pressure might get worse. High blood pressure raises your risk of heart attack or stroke.

If you stop taking the drug suddenly, your swelling can increase and your blood pressure might increase rapidly. High blood pressure raises your risk of heart attack or stroke.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: If you take too much hydrochlorothiazide, your blood pressure might drop too low. You might feel faint or dizzy.

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause dangerous side effects.

How to tell if the drug is working: Your blood pressure should be lower or the swelling in your legs and feet should get better.

Your doctor will monitor your blood pressure at your checkups. You can also check your blood pressure at home. Keep a log with the date, time of day, and your blood pressure readings. Bring this log with you to your doctor appointments.

Keep these considerations in mind if your doctor prescribes hydrochlorothiazide for you.

General

• You can take hydrochlorothiazide with or without food.
• Take this drug in the morning, not the evening. This drug may make you urinate more. Taking it in the evening can make you need to get up at night to use the bathroom.
• You can crush hydrochlorothiazide tablets.

Storage

• Store hydrochlorothiazide at a temperature between 68°F and 77°F (20°C and 25°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to check your blood pressure at home. You should keep a log with the date, time of day, and your blood pressure readings. Bring this log with you to your checkups.

Shop for blood pressure monitors.

Clinical monitoring

During treatment with this drug, your doctor may check your potassium levels. This will help make sure you don’t have any imbalances.

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Read the article in Spanish.

Common and Rare Side Effects for hydrochlorothiazide oral

COMMON side effects

If experienced, these tend to have a Severe expression i

• low amount of sodium in the blood
• low amount of potassium in the blood
• low blood pressure
• acid base problem with low chloride and basic pH blood

If experienced, these tend to have a Less Severe expression i

Sorry, we have no data available. Please contact your doctor or pharmacist.

INFREQUENT side effects

If experienced, these tend to have a Severe expression i

• low amount of magnesium in the blood
• damage to the kidneys
• decreased kidney function
• high blood sugar

If experienced, these tend to have a Less Severe expression i

• abnormal sexual function
• orthostatic hypotension, a form of low blood pressure
• dizziness
• low energy
• decreased appetite
• nausea
• vomiting
• diarrhea
• stomach cramps

RARE side effects

If experienced, these tend to have a Severe expression i

• increased activity of the parathyroid gland
• a type of joint disorder due to excess uric acid in the blood called gout
• high amount of calcium in the blood
• a type of blood disorder where the red blood cells burst called hemolytic anemia
• low blood counts due to bone marrow failure
• large purple or brown skin blotches
• decreased blood platelets
• very low levels of granulocytes, a type of white blood cell
• low levels of white blood cells
• nearsightedness
• allergic reaction causing inflammation of blood vessels
• inflammation of the blood vessels
• a type of inflammation of the lung called interstitial pneumonitis
• inflammation of the liver called hepatitis
• a blockage of the bile duct that resulting in high bilirubin levels
• acute inflammation of the pancreas
• a type of kidney inflammation called interstitial nephritis
• erythema multiforme, a type of allergic skin reaction
• a skin disorder with blistering and peeling skin called toxic epidermal necrolysis
• a skin disorder with blistering and peeling skin called Stevens-Johnson syndrome
• skin rash with sloughing
• systemic lupus erythematosus, an autoimmune disease
• high amount of uric acid in the blood
• a significant type of allergic reaction called anaphylaxis
• secondary angle-closure glaucoma, a type of eye disorder
• a yellowing of the eyes or skin from buildup of bilirubin called jaundice
• cancer of the squamous cells in the skin
• choroidal effusion

If experienced, these tend to have a Less Severe expression i

• high cholesterol
• high amount of triglyceride in the blood
• blurred vision
• inflammation of the salivary glands
• irritation of the stomach or intestines
• constipation
• the inability to have an erection
• muscle spasm
• sensation of spinning or whirling
• fever
• headache
• nervousness
• a feeling of pins and needles on skin
• generalized weakness

Hydrochlorothiazide-induced angioedema in a patient allergic to sulfonamide antibiotics: Evidence from a case report and a review of the literature

Abstract

Background:

Hypersensitivity reactions in patients receiving sulfonamide antibiotics have been frequently documented in the literature, but cross-reactivity with sulfonamide nonantibiotics rarely has been reported.

Case summary:

An 82-year-old woman with a history of hypersensitivity reactions to sulfamethoxazole-trimethoprim resulting in angioedema and rash presented to the emergency department (ED) with angioedema and severe dysphagia, shortness of breath, and rash after receiving valsartan and hydrochlorothiazide (HCTZ) for 4 months. Valsartan was identified as the most likely cause of the symptoms and was discontinued; however, the patient continued to have weekly episodes of angioedema and eventually returned to the ED. HCTZ was discontinued at the second ED visit, and the angioedema disappeared. However, it reappeared after reinitiation of HCTZ, and the patient returned to the ED again; this time with more severe symptoms. After the third ED visit and second hospitalization, HCTZ was permanently discontinued, and the angioedema has not returned. HCTZ was the definite cause of angioedema in this patient based on a score of 9 on the 10-point Naranjo adverse drug reaction probability scale.

Conclusions:

Although the probability of true cross-reactivity is not known, clinicians should be aware that an allergic-like reaction to sulfonamide-containing nonantibiotics may occur in patients with known allergies to sulfonamide-containing antibiotics. These patients should be monitored closely when receiving these drugs. Further evaluation is needed to determine whether angioedema should be added to the list of adverse events associated with HCTZ.

Key words

angioedema

thiazide diuretics

sulfonamide

allergy

cross-reactivity

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Hydrochlorothiazide, HCTZ; Metoprolol tablets

What is this medicine?

METOPROLOL; HYDROCHLOROTHIAZIDE (me TOE proe lole; hye droe klor oh THYE a zide) is a combination of a beta-blocker and a diuretic. It is used to treat high blood pressure.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Lopressor HCT

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• circulation problems, or blood vessel disease
• decreased urine
• diabetes
• heart disease, heart failure or a history of heart attack
• kidney disease
• liver disease
• lung or breathing disease, like asthma or emphysema
• pheochromocytoma
• slow heart rate
• thyroid disease
• an unusual or allergic reaction to hydrochlorothiazide, metoprolol, sulfa drugs, or other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take this medicine with food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor’s advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

• antiinflammatory drugs, NSAIDs like ibuprofen
• barbiturates like phenobarbital
• corticosteroids like prednisone
• lithium
• medicines for chest pain or angina
• medicines for diabetes
• medicines for high blood pressure or heart failure
• medicines to control heart rhythm
• prescription pain medicines
• rifampin
• skeletal muscle relaxants like tubocurarine
• some medicines for lowering cholesterol like colestipol or cholestyramine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress. Check your blood pressure as directed. Ask your doctor or health care professional what your blood pressure should be and when you should contact him or her.

Check with your doctor or health care professional if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.

This medicine may increase blood sugar. Ask your healthcare provider if changes in diet or medicines are needed if you have diabetes.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care professional for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• changes in vision
• cold, tingling, or numb hands or feet
• difficulty breathing, wheezing
• eye pain
• irregular heart beat, palpitations, or chest pain
• muscle cramps
• redness, blistering, peeling or loosening of the skin, including inside the mouth

signs and symptoms of high blood sugar such as being more thirsty or hungry or having to urinate more than normal. You may also feel very tired or have blurry vision.

• swollen legs or ankles
• tremor, shakes
• unusual skin rash or bruising
• unusually weak
• vomiting
• worsened gout pain
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• change in sex drive or performance
• cough
• depression
• diarrhea
• nausea

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light and moisture. Keep container tightly closed. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Patient Says Allergic to Penicillin? Maybe, Maybe Not

PHILADELPHIA — The big buzz for 2019 on medication interactions is: Don’t overreact to a history of penicillin allergy, Douglas Paauw, MD, of the University of Washington, said at the annual meeting of the American College of Physicians.

“[You have patients who] are 60-70 years old and they say, ‘You know, when I was a baby, my mom told me I had a reaction to penicillin and [I should] never take it.’ How many have heard that story?” said Paauw. However, “most of those are probably not real … and most people outgrow those allergies. With that type of distant history, it’s safe to go ahead and treat them.”

On the other hand, “if they said, ‘I was put in the ICU and intubated because I had anaphylaxis and was on a ventilator for 2 months’ — yeah, I probably wouldn’t reach out to that person, or if I did anything I’d probably skin test them, but be ready to be a little more liberal about re-challenging these patients,” he added. That can be done in a controlled setting in the office — “have epinephrine ready, give the medicine, [have them] stay around for a few hours, and then go home. If you’re uncomfortable with that, you can send them to the allergist … That’s where we are in 2019 with this allergy.”

This can be especially helpful when a physician is considering alternatives to fluoroquinolones, according to Paauw. He gave the example of a 75-year-old man who develops a fever, chills, and a cough. He has a history of coronary artery disease, hypertension, prostate cancer, colon cancer, and an aortic aneurysm. He is allergic to amoxicillin and is currently taking atorvastatin, amlodipine, lisinopril, and aspirin, and his chest x-ray shows a right middle lobe infiltrate.

One medication that should not be prescribed to this patient is a fluoroquinolone such as levofloxacin, Paauw said. He cited a Canadian study involving 1.7 million patients age 65 and older who were tracked for 15 years; in particular, fluoroquinolone prescriptions were tracked, with patients considered at risk for an allergic reaction during the course of treatment and for 30 days after. The researchers found that tendon ruptures and aortic aneurysms were significantly more likely to occur when patients took fluoroquinolones (HR [hazard ratio] 3.13 and HR 2.72, respectively, P<0.001 for both).

Due to such study results as well as an association with peripheral neuropathy and arrhythmia, the FDA has warned physicians not to prescribe fluoroquinolones for common ailments such as acute sinusitis, which is where the alternatives come in, Paauw said. “Cephalosporins are a very good option for those we [would] choose fluoroquinolones for,” he said.

He discussed other adverse events associated with commonly used medications, including:

• Canagliflozin in diabetes patients. The SGLT-2 inhibitors “are great drugs … but there are some concerns about them,” Paauw said. In particular, a 2017 FDA warning about canagliflozin cited an increased risk of amputation in some patients; risk factors include prior amputations, peripheral vascular disease, neuropathy, and diabetic foot ulcers. In such patients, “you should probably consider a different option,” he said.

• Hydrochlorothiazide in patients with skin cancers. One study found that high use of hydrochlorothiazide — 50,000 mg or more — was associated with odds ratios of 1.29 for basal cell carcinoma and 3.98 for squamous cell carcinomas. “This is not a reason not to use thiazide diuretics, but in patients who have already had skin cancer … we might think of alternatives,” Paauw said.

• Antibiotics, corticosteroids, and other drugs in patients on warfarin. Warfarin has a long list of drugs with proven and possible interactions; “the ‘possible’ category is harder in some ways” because it doesn’t always happen, Paauw said. “Interestingly, tramadol is recognized as having an impact on INR [international normalized ratio], with an average bump of 0.5,” said Paauw. “What’s hard is that it doesn’t always do it, so if you have to put somebody on medications like these, bring them back in 3-4 days and re-check their INR.”

One study found that concurrent azithromycin use bumped INR an average of .51, while trimethoprim/sulfamethoxazole (TMP/sulfa) increased it 1.76, he added. “If people are on these drugs, do they have an increased risk of [gastrointestinal] bleeding? the answer is Yes,” he said. “The greatest risk is TMP/sulfa because it has the greatest anti-coagulant effect.”

Oral corticosteroids also can bump up the INR numbers on warfarin patients. “This is important to know because we usually give people steroids for a short period of time, and if you happen to take the INR during that time, it’s going to be really high,” said Paauw. If the clinician then lowers the warfarin dose as a result of that reading, the next INR result will be really low because the patient is no longer on steroids, he said. “The bottom line is be aware of it, but don’t overreact to it.”

Quinapril and Hydrochlorothiazide | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Accuretic

Trade names: Canada

Accuretic

Warning

• Not for use by pregnant women.The use of the drug during pregnancy can cause birth defects or intrauterine death of the child. If you become pregnant or plan to become pregnant while taking this drug, call your doctor right away.

What is this drug used for?

• Used to treat high blood pressure.
• This medicinal product can be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you are allergic to sulfonamides.
• If you have ever had a serious allergic reaction called angioedema (angioedema). Symptoms include swelling of the hands, face, lips, tongue, or throat; breathing disorder; swallowing disorder; uncharacteristically hoarse voice.
• If you have kidney disease.
• Inability to urinate.
• When taking dofetilide.
• If you are taking a drug containing aliskiren if you have diabetes or kidney disease.
• If you have taken a preparation containing sacubitrile in the past 36 hours.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking.Do not start or stop taking any medication or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving or other activities that require increased attention until you see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when going up and down stairs.
• Check blood pressure as directed.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
• If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
• If you are using a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium supplement, consult your doctor.
• If you are on a salt-free or low-salt diet, consult your doctor.
• Talk to your doctor before taking an over-the-counter drug that can increase blood pressure.These drugs include medicines for coughs and colds, diet pills, stimulants, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and some naturally occurring drugs.
• Consult your doctor before using alcohol, marijuana or other forms of cannabis, or prescription and over-the-counter drugs that may slow you down.
• While using captopril (a drug similar to this drug), there was a decreased level of leukocytes.This can lead to an increased risk of infection. Most of the time, this has happened in people with kidney problems, mostly with some other health problem. See your doctor right away if you have symptoms of an infection such as high fever, chills, or sore throat.
• If you are taking cholestyramine or colestipol, talk with your pharmacist about how to take them with this drug.
• Watch for gout attacks.
• If you have lupus, this drug can make lupus active or make it worse. If any new symptom develops or symptoms worsen, contact your healthcare professional immediately.
• Caution should be exercised in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
• Tell your doctor if you experience excessive sweating, fluid loss, vomiting, or loose stools. This can lead to a drop in blood pressure.
• A serious and sometimes fatal reaction called angioedema has occurred. The risk of developing angioedema may be increased in the Negroid race.
• Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects.Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
• Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
• Signs of imbalance in fluid and electrolytes, incl. sudden changes in mood, confusion of thought, muscle pain or weakness, a feeling of disturbed heartbeat, severe dizziness or loss of consciousness, rapid heartbeat, intense thirst, seizures, feeling very tired or weak, lack of appetite, inability to urinate or change in the amount of urine excreted, dryness in mouth, dry eyes, severe stomach upset, or vomiting.
• Persistent cough.
• Chest pain.
• Severe abdominal pain.
• This drug may cause certain eye problems. Left untreated, these problems can lead to long-term vision loss. In cases where such eye problems have occurred, symptoms such as blurred vision or pain in the eyes usually appeared in the period from the first hours to the first weeks after starting the drug. Call your doctor immediately if you experience these symptoms.
• Liver dysfunctions have been reported while taking drugs of this kind. Sometimes these cases were fatal. Call your doctor right away if you have signs of liver dysfunction, such as dark urine, tired feeling, lack of appetite, nausea or abdominal pain, light colored stools, vomiting, yellow skin or eyes.
• In rare cases, the use of hydrochlorothiazide has been associated with the development of certain types of skin cancer.Protect your skin from the sun and have a skin exam as directed by your healthcare professional. If the color or size of birthmarks or any new or changing skin tumors or growths changes, contact your doctor immediately.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects.Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Dizziness.
• Cough.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

• Take this medication with or without food.
• Take this drug at about the same time of the day.
• This drug may cause frequent urination. This can lead to sleep disturbances, so try not to take the drug shortly before going to bed.
• Drink plenty of decaffeinated fluids, unless your doctor tells you to drink less fluids.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

What should I do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal schedule.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Hydrochlorothiazide instructions for use: indications, contraindications, side effects – description of Hydrochlorothiazide tab.100 mg: 20 pcs. (4403)

With the simultaneous use of antihypertensive drugs, non-depolarizing muscle relaxants, their effect is enhanced.

With the simultaneous use of barbiturates, diazepam, ethanol, the risk of orthostatic hypotension increases.

With simultaneous use with GCS, there is a risk of hypokalemia, as well as orthostatic hypotension.

With simultaneous use with ACE inhibitors (including captopril, enalapril), the antihypertensive effect is enhanced.

Severe arterial hypotension is possible, especially after taking the first dose of hydrochlorothiazide, apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of the ACE inhibitor.

The risk of impaired renal function is increased. The development of hypokalemia is not excluded.

With the simultaneous use of oral hypoglycemic drugs, their effectiveness decreases.

With the simultaneous use of calcium and / or vitamin D preparations in high doses, hypercalcemia and the risk of developing metabolic acidosis are possible due to a slowdown in the excretion of calcium in the urine under the influence of thiazide diuretics.

When used simultaneously with allopurinol, the risk of allergic reactions increases, especially in patients with impaired renal function.

Simultaneous use with digoxin may increase the risk of glycosidic intoxication.

With simultaneous use with indomethacin, piroxicam, naproxen, phenylbutazone, a slight decrease in the hypotensive effect is possible.

With simultaneous use with irbesartan, an additive hypotensive effect may develop.

With simultaneous use with carbamazepine, there are reports of the development of hyponatremia.

When used simultaneously with colestipol, cholestyramine, the absorption and diuretic effect of hydrochlorothiazide decreases.

With simultaneous use with lithium carbonate, it is possible to increase the concentration of lithium salts in the blood to a toxic level.

When used simultaneously with orlistat, the effectiveness of hydrochlorothiazide decreases, which can lead to a significant increase in blood pressure and the development of a hypertensive crisis.

With simultaneous use with sotalol hypokalemia and the development of ventricular arrhythmias of the “pirouette” type are possible.

K76.6 – Portal hypertension – a list of drugs of the nosological group in the ICD-10 reference book

Coaprovel tablets 300mg / 25mg No. 28 (Hydrochlorothiazide + Irbesartan)

Arterial hypertension.

Second and third trimester of pregnancy.Lactation period.
Hypersensitivity to active substances, to any of the excipients or to other drugs derived from sulfonamides (Hydrochlorothiazide is a sulfonamide derivative). The following contraindications are associated with the use of hydrochlorothiazide:
severe renal failure, refractory hypokalemia, hypercalcemia, severe hepatic failure, biliary cirrhosis, cholestasis.

Active ingredients: Irbesartan + Hydrochlorothiazide.Release form: 1. Tablets 150 mg / 12.5 mg No. 28; 2. Tablets 300 mg / 12.5 mg No. 28; 2. Tablets 300 mg / 25 mg No. 28.

Coaprovel can be used once a day with meals or before in patients whose blood pressure is insufficiently controlled by irbesartan or hydrochlorothiazide alone.
Coaprovel 150 / 12.5 mg can be prescribed to patients whose blood pressure is insufficiently controlled by hydrochlorothiazide or irbesartan (150 mg / day) in monotherapy.Coaprovel 300 / 12.5 mg can be prescribed to patients whose blood pressure is insufficiently controlled by irbesartan (300 mg) or Coaprovel (150 / 12.5 mg).
Doses higher than irbesartan 300 mg / hydrochlorothiazide 25 mg once daily are not recommended.

Special instructions: Coaprovel rarely causes symptomatic hypotension in patients with high blood pressure. Symptomatic hypotension can presumably be observed in patients with reduced BCC or low sodium levels due to diuretic therapy, with a salt-restricted diet, with diarrhea or vomiting.Such conditions should be corrected before starting Coaprovel therapy.
The risk of developing severe arterial hypotension and renal failure increases in patients with stenosis of one or two renal arteries when using ACE inhibitors or angiotensin II receptor antagonists. Although there are no such messages when using Coaprovel, this effect must be taken into account.
When using Coaprovel in patients with impaired renal function, periodic monitoring of serum potassium, creatinine and uric acid levels is recommended.In patients after a recent kidney transplant, there is no experience with the use of Coaprovel. Coaprovel® should not be used in patients with severe renal insufficiency (CC 3 g / day and non-selective NSAIDs), the hypotensive effect of Coaprovel may weaken by reducing the effectiveness of hydrochlorothiazide.
As with ACE inhibitors, the combined use of angiotensin II antagonists and NSAIDs may increase the risk of renal impairment, including the likelihood of acute renal failure, and lead to an increase in serum potassium, especially in patients with already impaired renal function.This combination should be used with caution, especially in elderly patients. When using this combination, patients should not be dehydrated.
The pharmacokinetics of irbesartan are not affected when combined with hydrochlorothiazide and nifedipine. Irbesartan is mainly metabolized by CYP2C9 and to a lesser extent by glucuronidation. No significant pharmacokinetic and pharmacodynamic interactions were observed when irbesartan is used in conjunction with warfarin, a drug metabolized by CYP2C9.The effect of CYP2C9 inducers such as rifampicin on the pharmacokinetics of irbesartan has not been evaluated. The pharmacokinetics of digoxin did not change when combined with irbesartan.
With the simultaneous use of ethanol, barbiturates or anesthetics with thiazide diuretics, an increase in orthostatic hypotension may be observed.
When using hydrochlorothiazide, a dose adjustment of the hypoglycemic agent may be required, because hydrochlorothiazide may raise blood glucose levels.The absorption of hydrochlorothiazide is reduced in the presence of anion exchange resins. The intake of these drugs (cholestyramine or colestipol) should be separated in time by at least 4 hours.
With the simultaneous use of hydrochlorothiazide and GCS or ACTH, a more pronounced violation of the electrolyte balance is possible, in particular, increased hypokalemia.
A decrease in the effectiveness of catecholamines (for example, norepinephrine) under the influence of hydrochlorothiazide is possible.
The effect of non-depolarizing muscle relaxants can be enhanced by hydrochlorothiazide.With the simultaneous use of the drug Coaprovel® and anti-gout agents, an increase in the dose of anti-gout agents may be required, because hydrochlorothiazide can increase serum uric acid levels. Increasing doses of probenecid or sulfinpyrazone may be required. Concomitant use with thiazide diuretics may increase the frequency of allergic reactions to allopurinol.
Thiazide diuretics can increase serum calcium levels due to reduced excretion.If calcium supplements or drugs that affect calcium levels are to be prescribed (for example, during vitamin D therapy), then monitoring of serum calcium is necessary and an appropriate dose adjustment of the calcium drug is required.
Thiazide diuretics enhance the hyperglycemic effect of beta-blockers and diazoxide.
Anticholinergics (eg, atropine) can increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility.
Thiazides may increase the risk of side effects from amantadine.Thiazides can reduce the urinary excretion of cyclophosphamide and methotrexate and enhance their myelosuppressive effect.
Side effects: Coaprovel in placebo-controlled studies in patients with arterial hypertension:
From the side of the central nervous system: often – dizziness; sometimes – orthostatic dizziness.
From the side of the cardiovascular system: sometimes – an excessive decrease in blood pressure, peripheral edema (for example, of the lower extremities), syncope, tachycardia, flushing of the skin of the face.
From the digestive system: often – nausea, vomiting; sometimes diarrhea.From the urinary system: often – urination disorder.
From the reproductive system: sometimes – impaired libido, sexual dysfunction.
Others: often – feeling tired.
On the part of laboratory parameters: often – an increase in urea nitrogen, creatinine and plasma CPK; sometimes a decrease in serum potassium and sodium levels. These changes in laboratory parameters rarely reached the threshold of clinical significance.
Adverse reactions that were also observed with the use of Coaprovel in wide clinical practice:
Allergic reactions: rarely – rash, urticaria, angioedema.From the side of metabolism: very rarely – hyperkalemia.
From the side of the central nervous system: very rarely – headache.
From the senses: very rarely – ringing in the ears.
From the respiratory system: very rarely – cough.
On the part of the digestive system: very rarely – a change in taste, dry mouth, dyspepsia, liver dysfunction, hepatitis.
From the musculoskeletal system: very rarely – myalgia, arthralgia.
From the urinary system: very rarely – impaired renal function, incl.including isolated cases of renal failure in high-risk patients.
Adverse reactions previously reported with irbesartan:
General disorders: sometimes – chest pain.
Adverse reactions previously reported with hydrochlorothiazide (without specifying the frequency of occurrence)
From the hematopoietic system: aplastic anemia, bone marrow depression, hemolytic anemia, leukopenia, neutropenia / agranulocytosis, thrombocytopenia.
From the side of the central nervous system and peripheral nervous system: depression, sleep disturbances, dizziness, paresthesia, anxiety.From the side of the organ of vision: transient blurred vision, xanthopsia.
From the side of the cardiovascular system: arrhythmias, postural hypotension.
From the respiratory system: respiratory distress syndrome (including pneumonitis and pulmonary edema).
From the digestive system: jaundice (intrahepatic cholestatic jaundice).
Allergic reactions: anaphylactic reactions, toxic necrosis of the epidermis, lupus-like syndrome, necrotizing angiitis (vasculitis, cutaneous vasculitis), photosensitivity reactions, skin rash, weighting or exacerbation of SLE, urticaria.From the musculoskeletal system: muscle spasms, weakness.
From the urinary system: interstitial nephritis, renal dysfunction.
Others: fever.
On the part of laboratory parameters: electrolyte imbalance (including hypokalemia and hyponatremia), glucosuria, hyperglycemia, hyperuricemia, increased cholesterol and TG levels.
The dose-dependent side effects of hydrochlorothiazide (in particular electrolyte disturbances) may increase with an increase in the dose of hydrochlorothiazide.

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To assess the effect of antihypertensive therapy on the sexual function of men with hypertension, the scale of the international index of erectile function (IIEF-15) was used [19].Based on the literature data, ACE inhibitors, apparently, do not affect the sexual function of men, but by reducing the level of insulin resistance, it is likely that they can have a positive effect on the synthesis of androgens in men with hypertension, regardless of the degree of their affinity [5]. The drugs of this group, as the selectivity increases, have less. How does antihypertensive therapy affect erectile function in men with hypertension? Rationale Numerous studies have shown. Both drugs did not significantly affect the patients’ EF.Conclusions. Thus, calcium channel blockers (ASCOT), ACE inhibitors (Speel T.G.), and angiotensin II receptor antagonists remain reliably safe groups of antihypertensive drugs in relation to the erectile function of men. treatment with two or more antihypertensive drugs, psychotropic or any other drugs that affect the sexual sphere; history of severe sexual dysfunction, drug addiction, alcoholism, or allergy to losartan; severe concomitant diseases (diabetes mellitus, mental illness, severe organ pathology, etc.)). The study included 5 visits (weeks 0, 4, 8, 12 and 13). Drugs to increase potency. Drugs affecting the tone of the genitourinary system. Medicines for prostatitis. Eye medications. The antihypertensive agent is a centrally acting alpha 2-adrenergic agonist. Elderly patients are advised to take it with caution, since a change in pharmacokinetics is possible, which is associated with increased bioavailability and insufficient metabolic activity. There is no clinical relevance. The drug acts on the central nervous system, selectively stimulating the receptors in the brain.What if taking heart medications affects interest in the opposite sex? We will advise. Antihypertensive drugs appeared on the pharmaceutical market without mention of their negative effects on male sexual function: calcium antagonists (amlodipine, lerkamen) and angiotensin-converting enzyme inhibitors (lisinopril, ramipril, fosinopril). Moreover, the combination of an ACE inhibitor and hydrochlorothiazide at a dose of 12.5 mg per day completely neutralized the negative effect of the latter. Certainly, not all pressure medications are suitable for men in their prime.Many drugs used to treat hypertension have been linked to erectile dysfunction. But some of them do not cause this problem. Not only that, certain high blood pressure medications can even improve erectile function in some men. It is known that diuretics (diuretics such as hydrochlorothiazide) and beta-blockers (such as Atenolol) can cause erection problems. Usually, these are the drugs that your doctor prescribes if you are unable to lower your blood pressure through diet and exercise.If you have been prescribed diuretics, you must take them until your blood pressure returns to normal. – Not all drugs affect potency. Erectile function is negatively affected by beta-1-blockers, central antihypertensive drugs and diuretics. But there are also medications for high blood pressure that do not affect potency. These are ACE inhibitors, sartans and calcium antagonists. Tell your doctor about your concerns and he will select the optimal treatment. Hypertension and potency: the best drugs to enhance erection.Selective phosphodiesterase inhibitors – sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) – are very effective. They relax the cavernous bodies of the penis, which leads to increased blood flow in them and the formation of an erection. One of these drugs – Viagra – can be used for hypertension. Hypertension directly affects potency – the disease weakens an erection and does not give a man the opportunity to fully have sex. However, this does not mean that you can put an end to your intimate life.Under the close supervision of cardiologists and urologists, arterial hypertension is curable. Doxazosin enhances the hypotensive effect / effect of antihypertensive drugs (when used in combinations, dose adjustment is required). It is not recommended to take doxazosin at the same time as other alpha-adrenergic receptor blockers. Doxazosin does not affect the degree of binding to plasma proteins of digoxin, phenytoin. With the simultaneous use of doxazosin with inducers of microsomal oxidation in the liver, an increase in the effectiveness of doxazosin is possible, with inhibitors – a decrease.Most antihypertensive drugs suppress sexual function, and in your case, both of these drugs reduce sexual function, and the instructions even say that in rare cases, impotence. Anyone who treats you from pressure should bear this in mind. There are antihypertensive drugs that do not affect sexual function (enalapril, lisinopril, atacand, nebilet, etc. Lozap from the same group as atacand. Let them choose the right therapy for you, but you also need to contact a urologist, not just anyone, but someone who understands sexual problems and erectile dysfunction.Having replaced antihypertensive therapy, it is now necessary to turn on the sexual mechanism again. Save. + 1.

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