How does hydrochlorothiazide interact with alcohol. What are the potential risks of combining hydrochlorothiazide and alcohol. Why should patients be cautious when consuming alcohol while taking hydrochlorothiazide. What are the effects of hydrochlorothiazide on blood pressure and lipid levels. How can patients manage potential side effects of hydrochlorothiazide.

Understanding Hydrochlorothiazide: Uses and Mechanisms

Hydrochlorothiazide is a commonly prescribed diuretic medication used to treat high blood pressure and fluid retention. It belongs to a class of drugs known as thiazide diuretics, which work by promoting the excretion of excess water and salt from the body through urine. This action helps reduce blood volume, thereby lowering blood pressure and alleviating fluid buildup in tissues.

The effectiveness of hydrochlorothiazide in managing hypertension has made it a cornerstone of cardiovascular treatment. However, its use comes with potential interactions and side effects that patients and healthcare providers must be aware of.

How Does Hydrochlorothiazide Lower Blood Pressure?

Hydrochlorothiazide primarily acts on the distal convoluted tubule in the kidneys. It inhibits the sodium-chloride symporter, preventing the reabsorption of sodium and chloride ions. This leads to increased excretion of these electrolytes, along with water, resulting in decreased blood volume and, consequently, lower blood pressure.

Hydrochlorothiazide and Alcohol: A Potentially Risky Combination

The interaction between hydrochlorothiazide and alcohol is a significant concern for patients prescribed this medication. Both substances can independently affect blood pressure, and their combined use may lead to enhanced effects and potential complications.

What Happens When Alcohol is Consumed with Hydrochlorothiazide?

When alcohol is consumed while taking hydrochlorothiazide, the following effects may occur:

• Additive blood pressure-lowering effects
• Increased risk of orthostatic hypotension
• Heightened likelihood of dizziness and lightheadedness
• Potential for fainting or syncope
• Changes in heart rate or pulse

These effects are particularly pronounced at the beginning of treatment, after a dose increase, or when resuming treatment following an interruption. Patients should be vigilant for these symptoms and report persistent or troublesome side effects to their healthcare provider.

Managing the Risks: Precautions and Recommendations

To minimize the risks associated with the combination of hydrochlorothiazide and alcohol, patients should consider the following precautions:

1. Avoid or limit alcohol consumption while taking hydrochlorothiazide
2. If alcohol is consumed, do so in moderation and under medical supervision
3. Be cautious when standing up from a sitting or lying position to prevent orthostatic hypotension
4. Refrain from driving or operating heavy machinery until the effects of the medication are well-understood
5. Stay hydrated, as both alcohol and hydrochlorothiazide can contribute to dehydration

Patients should always consult their healthcare provider about safe alcohol consumption while on hydrochlorothiazide therapy.

Hydrochlorothiazide’s Impact on Lipid Metabolism

Beyond its interaction with alcohol, hydrochlorothiazide can affect lipid metabolism, potentially leading to changes in cholesterol and triglyceride levels. This is an important consideration for patients, especially those with pre-existing hyperlipidemia.

Can Hydrochlorothiazide Affect Cholesterol Levels?

Studies have shown that thiazide diuretics, including hydrochlorothiazide, may increase serum triglyceride and cholesterol levels, particularly LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein) cholesterol. The extent and duration of these effects during long-term therapy are not fully understood and may vary among individuals.

Patients with existing hyperlipidemia should undergo closer monitoring of their lipid profiles during hydrochlorothiazide therapy. Healthcare providers may need to adjust lipid-lowering regimens accordingly to manage these potential metabolic effects.

Monitoring and Managing Side Effects

Regular monitoring is crucial for patients taking hydrochlorothiazide, especially when considering its potential effects on blood pressure, electrolyte balance, and lipid metabolism. Healthcare providers should implement a comprehensive management plan that includes:

• Periodic blood pressure checks
• Regular blood tests to assess electrolyte levels
• Lipid profile monitoring
• Assessment of kidney function
• Evaluation of potential side effects and drug interactions

Patients should be encouraged to maintain open communication with their healthcare providers, reporting any unusual symptoms or concerns promptly.

Alternative Treatments and Considerations

For patients who experience significant side effects or interactions with hydrochlorothiazide, alternative treatments may be considered. These could include:

• Other classes of antihypertensive medications (e.g., ACE inhibitors, ARBs, calcium channel blockers)
• Different types of diuretics with potentially fewer metabolic effects
• Combination therapies that allow for lower doses of individual medications
• Lifestyle modifications to support blood pressure management

The choice of treatment should be individualized based on the patient’s overall health status, comorbidities, and response to therapy.

Lifestyle Modifications to Complement Hydrochlorothiazide Therapy

While medication is often necessary for managing hypertension, lifestyle modifications can play a crucial role in enhancing the effectiveness of hydrochlorothiazide and minimizing potential side effects. Patients should be encouraged to adopt the following lifestyle changes:

1. Reduce sodium intake to support the medication’s diuretic effects
2. Maintain a balanced diet rich in fruits, vegetables, and whole grains
3. Engage in regular physical activity as approved by a healthcare provider
4. Achieve and maintain a healthy weight
5. Limit alcohol consumption and avoid tobacco use
6. Practice stress-reduction techniques such as meditation or yoga
7. Monitor blood pressure at home and keep a log for healthcare provider review

These lifestyle modifications can contribute to better blood pressure control and may allow for lower medication doses over time.

Patient Education and Empowerment

Effective management of hypertension with hydrochlorothiazide requires active patient involvement. Healthcare providers should focus on educating patients about their medication, potential interactions, and the importance of adherence to treatment plans.

How Can Patients Maximize the Benefits of Hydrochlorothiazide Therapy?

To optimize treatment outcomes, patients should:

• Take the medication as prescribed, at the same time each day
• Understand the potential side effects and know when to seek medical attention
• Be aware of drug interactions, including those with alcohol and over-the-counter medications
• Maintain regular follow-up appointments with healthcare providers
• Participate in shared decision-making regarding their treatment plan
• Stay informed about hypertension management and new developments in treatment options

Empowering patients with knowledge and encouraging their active participation in care can lead to better adherence and improved health outcomes.

Long-term Considerations and Follow-up Care

Managing hypertension with hydrochlorothiazide is often a long-term commitment. As such, ongoing care and periodic reassessment of treatment efficacy are essential. Long-term considerations include:

What Should Patients Expect in Long-term Hydrochlorothiazide Therapy?

Patients undergoing long-term hydrochlorothiazide therapy should anticipate:

• Regular blood pressure checks and medication adjustments as needed
• Periodic laboratory tests to monitor electrolyte levels and kidney function
• Assessments of cardiovascular risk factors and overall health status
• Discussions about potential long-term effects on bone density and glucose metabolism
• Evaluation of the need for continued therapy or possible medication changes
• Ongoing education about hypertension management and lifestyle modifications

Healthcare providers should work collaboratively with patients to ensure that the benefits of hydrochlorothiazide therapy continue to outweigh any potential risks or side effects over time.

Addressing Concerns About Long-term Use

Some patients may have concerns about the long-term use of hydrochlorothiazide, particularly regarding its effects on electrolyte balance and metabolic parameters. Healthcare providers should address these concerns by:

• Providing clear information about the medication’s safety profile
• Discussing the importance of ongoing monitoring and follow-up care
• Exploring alternative treatment options if concerns persist
• Emphasizing the benefits of controlled blood pressure in preventing cardiovascular complications

Open dialogue and shared decision-making can help alleviate patient concerns and promote treatment adherence.

Emerging Research and Future Directions

The field of hypertension management is continually evolving, with ongoing research into the efficacy and long-term effects of medications like hydrochlorothiazide. Current areas of investigation include:

• Genetic factors influencing response to thiazide diuretics
• Combination therapies that may enhance efficacy while minimizing side effects
• Long-term cardiovascular outcomes in patients treated with hydrochlorothiazide
• Potential protective effects of hydrochlorothiazide against certain types of cancer
• Development of novel diuretics with improved metabolic profiles

As new evidence emerges, treatment guidelines and recommendations may be updated to reflect the latest understanding of hydrochlorothiazide’s role in hypertension management.

Future Perspectives in Hypertension Management

Looking ahead, the management of hypertension is likely to become increasingly personalized. Future approaches may include:

• Tailored medication regimens based on genetic profiles
• Integration of wearable technology for continuous blood pressure monitoring
• Development of more targeted antihypertensive medications with fewer side effects
• Enhanced focus on preventive strategies and early intervention
• Greater emphasis on lifestyle modifications as a cornerstone of treatment

As research progresses, patients and healthcare providers can look forward to more refined and effective strategies for managing hypertension, potentially reducing the reliance on medications like hydrochlorothiazide for some individuals.

In conclusion, while hydrochlorothiazide remains an important tool in the management of hypertension, its use requires careful consideration of potential interactions, side effects, and long-term implications. By fostering a collaborative approach between patients and healthcare providers, implementing appropriate monitoring strategies, and staying informed about emerging research, optimal outcomes can be achieved in the treatment of hypertension with hydrochlorothiazide.

Hydrochlorothiazide and Alcohol/Food Interactions – Drugs.com

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There are 2 alcohol/food/lifestyle interactions with hydrochlorothiazide.

HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

thiazides – hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

1. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
2. Ames RP, Hill P “Increase in serum-lipids during treatment of hypertension with chlorthalidone.” Lancet 1
   (1976): 721-3
3. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
4. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O “Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide.” Artery 11
   (1983): 283-96
5. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M “Long-term experience with indapamide.” Am Heart J 106
   (1983): 258-62
6. Slotkoff L “Clinical efficacy and safety of indapamide in the treatment of edema.” Am Heart J 106
   (1983): 233-7
7. “Product Information. HydroDIURIL (hydrochlorothiazide).” Merck & Co., Inc
   (2002):
8. “Product Information. Lozol (indapamide).” Rhone Poulenc Rorer
   (2002):
9. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC “The effects of terazosin and methyclothiazide on blood pressure and serum lipids.” Am Heart J 117
   (1989): 842-7
10. “Product Information. Zaroxolyn (metolazone).” Rhone Poulenc Rorer
    (2001):
11. “Product Information. Thalitone (chlorthalidone).” Monarch Pharmaceuticals Inc
    (2001):
12. “Product Information. Diuril (chlorothiazide).” Merck & Co., Inc
    (2001):
13. Smith WM “Diuretics and cholesterol elevation.” JAMA 242
    (1979): 1612
14. “Product Information. Enduron (methyclothiazide).” Abbott Pharmaceutical
    (2001):
15. “Product Information. Metahydrin (trichlormethiazide).” Hoechst Marion Roussel
    (2001):
16. “Product Information. Diucardin (hydroflumethiazide).” Wyeth-Ayerst Laboratories
    (2001):
17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L “Incidence and importance of metabolic side-effects during antihypertensive therapy.” Acta Med Scand Suppl 672
    (1983): 79-83
18. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC “Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations. ” Clin Pharmacol Ther 28
    (1980): 611-8
19. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H “The metabolic effects of thiazide therapy in the elderly: a population study.” Age Ageing 15
    (1986): 151-5
20. “Product Information. Renese-R (reserpine-polythiazide).” Pfizer US Pharmaceuticals, New York, NY.
21. Kasiske BL, Ma JZ, Kalil RS, Louis TA “Effects of antihypertensive therapy on serum lipids.” Ann Intern Med 122
    (1995): 133-41
22. Freis ED “The efficacy and safety of diuretics in treating hypertension.” Ann Intern Med 122
    (1995): 223-6
23. Ames RP “A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides.” Am J Cardiol 77
    (1996): b12-6

View all 23 references

Hydrochlorothiazide drug interactions

There are 452 drug interactions with hydrochlorothiazide.

Hydrochlorothiazide disease interactions

There are 11 disease interactions with hydrochlorothiazide which include:

• anuria
• electrolyte losses
• liver disease
• lupus erythematosus
• renal function disorders
• asthma
• diabetes
• hyperlipidemia
• hyperparathyroidism
• hyperuricemia
• thyroid function tests

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More about hydrochlorothiazide

• hydrochlorothiazide consumer information
• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (183)
• Drug images
• Latest FDA alerts (2)
• Side effects
• Dosage information
• Patient tips
• During pregnancy
• Support group
• Drug class: thiazide diuretics
• Breastfeeding
• En español

Related treatment guides

• Edema
• Diabetes Insipidus
• Osteoporosis
• High Blood Pressure
• Nephrocalcinosis

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Hydrochlorothiazide/lisinopril and Alcohol/Food Interactions – Drugs.com

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Save

There are 5 alcohol/food/lifestyle interactions with hydrochlorothiazide / lisinopril.

Although hydroCHLOROthiazide and lisinopril are frequently combined together, their effects may be additive on lowering your blood pressure. You may need a dose adjustment or special tests to safely take both medications. Contact your doctor if you have a reduced heart rate, dizziness, fainting, or headaches. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Consumer information for this interaction is not currently available.

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

1. Sternbach H “Fluoxetine-associated potentiation of calcium-channel blockers.” J Clin Psychopharmacol 11
   (1991): 390-1
2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA “Ethanol intoxication complicating intravenous nitroglycerin therapy.” Ann Intern Med 101
   (1984): 498-9
3. Feder R “Bradycardia and syncope induced by fluoxetine.” J Clin Psychiatry 52
   (1991): 139
4. Ellison JM, Milofsky JE, Ely E “Fluoxetine-induced bradycardia and syncope in two patients. ” J Clin Psychiatry 51
   (1990): 385-6
5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. “Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients.” Ther Drug Monit 23
   (2001): 435-40
6. Cerner Multum, Inc. “Australian Product Information.” O 0
7. Pacher P, Kecskemeti V “Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?” Curr Pharm Des 10
   (2004): 2463-75
8. Andrews C, Pinner G “Postural hypotension induced by paroxetine.” BMJ 316
   (1998): 595

View all 8 references

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References

1. “Product Information. Vasotec (enalapril).” Merck & Co., Inc
   (2002):
2. Good CB, McDermott L “Diet and serum potassium in patients on ACE inhibitors.” JAMA 274
   (1995): 538
3. Ray K, Dorman S, Watson R “Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction.” J Hum Hypertens 13
   (1999): 717-20

thiazides – hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

1. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
2. Ames RP, Hill P “Increase in serum-lipids during treatment of hypertension with chlorthalidone.” Lancet 1
   (1976): 721-3
3. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
4. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O “Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide.” Artery 11
   (1983): 283-96
5. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M “Long-term experience with indapamide.” Am Heart J 106
   (1983): 258-62
6. Slotkoff L “Clinical efficacy and safety of indapamide in the treatment of edema.” Am Heart J 106
   (1983): 233-7
7. “Product Information. HydroDIURIL (hydrochlorothiazide).” Merck & Co., Inc
   (2002):
8. “Product Information. Lozol (indapamide).” Rhone Poulenc Rorer
   (2002):
9. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC “The effects of terazosin and methyclothiazide on blood pressure and serum lipids.” Am Heart J 117
   (1989): 842-7
10. “Product Information. Zaroxolyn (metolazone).” Rhone Poulenc Rorer
    (2001):
11. “Product Information. Thalitone (chlorthalidone).” Monarch Pharmaceuticals Inc
    (2001):
12. “Product Information. Diuril (chlorothiazide).” Merck & Co., Inc
    (2001):
13. Smith WM “Diuretics and cholesterol elevation.” JAMA 242
    (1979): 1612
14. “Product Information. Enduron (methyclothiazide).” Abbott Pharmaceutical
    (2001):
15. “Product Information. Metahydrin (trichlormethiazide).” Hoechst Marion Roussel
    (2001):
16. “Product Information. Diucardin (hydroflumethiazide).” Wyeth-Ayerst Laboratories
    (2001):
17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L “Incidence and importance of metabolic side-effects during antihypertensive therapy.” Acta Med Scand Suppl 672
    (1983): 79-83
18. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC “Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations. ” Clin Pharmacol Ther 28
    (1980): 611-8
19. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H “The metabolic effects of thiazide therapy in the elderly: a population study.” Age Ageing 15
    (1986): 151-5
20. “Product Information. Renese-R (reserpine-polythiazide).” Pfizer US Pharmaceuticals, New York, NY.
21. Kasiske BL, Ma JZ, Kalil RS, Louis TA “Effects of antihypertensive therapy on serum lipids.” Ann Intern Med 122
    (1995): 133-41
22. Freis ED “The efficacy and safety of diuretics in treating hypertension.” Ann Intern Med 122
    (1995): 223-6
23. Ames RP “A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides.” Am J Cardiol 77
    (1996): b12-6

View all 23 references

Hydrochlorothiazide/lisinopril drug interactions

There are 595 drug interactions with hydrochlorothiazide / lisinopril.

Hydrochlorothiazide/lisinopril disease interactions

There are 19 disease interactions with hydrochlorothiazide / lisinopril which include:

• angioedema
• bone marrow suppression
• CHF
• hemodialysis
• hyperkalemia
• hypotension
• anuria
• electrolyte losses
• liver disease
• lupus erythematosus
• renal function disorders
• liver disease
• renal dysfunction
• asthma
• diabetes
• hyperlipidemia
• hyperparathyroidism
• hyperuricemia
• thyroid function tests

Report options

Loading…

QR code containing a link to this page

More about hydrochlorothiazide / lisinopril

• hydrochlorothiazide/lisinopril consumer information
• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (78)
• Drug images
• Side effects
• Dosage information
• During pregnancy
• Drug class: ACE inhibitors with thiazides
• En español

Related treatment guides

• Heart Failure
• High Blood Pressure

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Hydrochlorothiazide – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English title

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Hydrochlorothiazide

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• Application of the substance Hydrochlorothiazide

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• Side effects of hydrochlorothiazide

• Interaction

• Overdose

• Dosage and administration

• Precautionary measures

• Trade names with the active substance Hydrochlorothiazide

Structural formula

Russian name

Hydrochlorothiazide

English name

Hydrochlorothiazide

Latin name

Hydrochlorothiazidum ( genus Hydrochlorothiazidi)

Chemical name

3

C ₇ H ₈ ClN ₃ O ₄ S ₂

Pharmacological group of the substance Hydrochlorothiazide

Diuretics

Nosological classification

ICD-10 code list

CAS code

58-93-5

Pharmacological action

Pharmacological action –

hypotensive , diuretic .

Characteristics

White or yellowish crystalline powder. Slightly soluble in water, sparingly soluble in methanol, insoluble in ether, freely soluble in alkaline solutions. Molecular weight 297.72.

Pharmacology

Reduces the reabsorption of sodium and chloride ions (to a lesser extent – potassium and bicarbonates) in the proximal tubules of the kidneys, increases the excretion of magnesium ions, reduces – calcium ions, uric acid. It inhibits the reactivity of the vascular wall in relation to the vasoconstrictive effects of mediators due to a decrease in the concentration of sodium ions in the cytoplasm of vascular myocytes, reduces BCC, lowers blood pressure.

Incompletely, but fairly rapidly absorbed from the gastrointestinal tract. In the blood, 40–60% binds to proteins. Penetrates through the hematoplacental barrier and into breast milk. Excreted by the kidneys. The diuretic effect develops after 30-60 minutes, reaches a maximum after 4-6 hours, persists for 6-12 hours.

The use of the substance Hydrochlorothiazide

chronic heart failure, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, corticosteroid treatment), control of polyuria (mainly in nephrogenic diabetes insipidus), prevention of urinary tract stones in predisposed patients (reduction of hypercalciuria).

Contraindications

Hypersensitivity (including to other sulfonamides), anuria, severe renal (Cl creatinine – less than 30 ml / min) or liver failure, difficult-to-control diabetes mellitus, Addison’s disease, gout, children’s age (up to 3 years ).

Restrictions for use

Hypokalemia, hyponatremia and hypercalcemia, ischemic heart disease, concomitant use of cardiac glycosides, impaired liver and kidney function, pregnancy, old age.

Use during pregnancy and lactation

FDA fetal category B.

Breastfeeding should be discontinued during treatment.

Substance side effects Hydrochlorothiazide

Electrolyte imbalance

Hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis: dry mouth, thirst, irregular heart rhythm, changes in mood or psyche, cramps and muscle pain, nausea, vomiting, unusual tiredness or weakness. Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma.

Hyponatremia: confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps.

Metabolic effects: hyperglycemia, glucosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may reduce glucose tolerance, and latent diabetes mellitus may manifest. At high doses, serum lipid levels may increase.

From the digestive tract: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): arrhythmias, orthostatic hypotension, vasculitis; very rarely – leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.

From the nervous system and sensory organs: dizziness, blurred vision (temporarily), headache, paresthesia.

Hypersensitivity reactions: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.

Other: decreased potency, impaired renal function, interstitial nephritis.

Interactions

Simultaneous use of hydrochlorothiazide with lithium salts should be avoided (renal clearance of lithium decreases, its toxicity increases).

It should be used with caution with antihypertensive drugs (their action is potentiated, it may be necessary to adjust the dose), cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase digitalis toxicity), amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia), oral hypoglycemic agents (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effect of thiazides), non-depolarizing muscle relaxants (their the effect may be enhanced), amantadine (clearance of amantadine may be reduced by hydrochlorothiazide, which leads to an increase in plasma concentrations of amantadine and possible toxicity), colestyramine (reduces the absorption of hydrochlorothiazide), ethanol, barbiturates and narcotic analgesics, which increase the effect of orthostatic hypotension.

Thiazides may reduce plasma levels of protein-bound iodine.

Thiazides should be discontinued before performing parathyroid function tests. Serum bilirubin concentration may be elevated.

Overdose

Symptoms: dehydration, severe electrolyte disturbances, confusion, dry mouth, lethargy, muscle weakness, drowsiness, tachycardia, hypotension, oliguria, decreased blood pressure, shock.

Treatment: induction of vomiting, gastric lavage, intravenous fluid, electrolytes, symptomatic therapy. The specific antidote is unknown.

Dosage and administration

Inside. The dosing regimen is set individually. With constant medical supervision, the minimum effective dose is established. Due to the increased loss of potassium and magnesium ions during treatment (serum potassium levels may decrease below 3.0 mmol / l), it becomes necessary to replace potassium and magnesium. With arterial hypertension – 25-50 mg 1 time per day (for some patients, an initial dose of 12. 5 mg is enough), with edematous syndrome – 25-100 (up to 200) mg / day. For children from 3 years old, the daily dose is 1-2 mg / kg, 3-12 years old – 37.5-100 mg / day.

Precautions

With prolonged course treatment, it is necessary to carefully monitor the clinical symptoms of fluid and electrolyte imbalance, primarily in high-risk patients: patients with diseases of the cardiovascular system and impaired liver function; in case of severe vomiting or if there are signs of a violation of the water and electrolyte balance, such as dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, hypotension, oliguria, tachycardia, complaints from the gastrointestinal tract.

Hypokalemia, especially in case of increased potassium loss (increased diuresis, prolonged treatment) or concomitant treatment with digitalis glycosides or corticosteroid drugs, can be avoided by the use of potassium-containing drugs or potassium-rich foods (fruits, vegetables). Thiazides have been shown to increase urinary excretion of magnesium, which may lead to hypomagnesemia.

If renal function is impaired, creatinine clearance needs to be monitored. In patients with impaired renal function, the drug may cause azotemia, and cumulative effects may also develop. If impaired renal function is evident, discontinuation of the drug should be considered upon the onset of oliguria.

In patients with impaired liver function or progressive liver disease, thiazides should be used with caution because slight changes in fluid and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.

In the case of severe cerebral and coronary sclerosis, the administration of the drug requires special care.

Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment with manifesting or latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary; it may be necessary to change the dose of hypoglycemic drugs. Enhanced monitoring of patients with impaired uric acid metabolism is required.

Alcohol, barbiturates, narcotic analgesics increase the orthostatic hypotensive effect of thiazide diuretics.

With long-term therapy, in rare cases, a pathological change in the parathyroid glands was observed, accompanied by hypercalcemia and hypophosphatemia. Thiazides can reduce the amount of iodine that binds to serum proteins without showing signs of thyroid dysfunction.

Patients suffering from lactose intolerance may experience gastrointestinal complaints due to the presence of lactose in the composition of the tablets.

At the initial stage of drug use (the duration of this period is determined individually), it is forbidden to drive a car and perform work that requires increased attention.

Trade names with active substance Hydrochlorothiazide

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All dosages 100 mg 25 mg No dosage

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All manufacturers Biochemist JSC Biochemist JSC Borisov Plant of Medical Preparations JSC (JSC “BZMP”) Valenta Pharmaceutics JSC (JSC “Valenta Pharm”) Valenta Pharmaceutics PJSC (PJSC “Valenta Pharm”) Ipka Laboratories Ltd. Cambrex Propharmaco Milan S.r.L. Ozone LLC Opella Healthcare Hungary Ltd. Polpharma S.A., Poland Pharmaceutical plant Pranapharm CTIX Life Science Pvt. Ltd. Pharmasyntez-Tyumen Pharmstandard-Leksredstva LLC Quinoin Plant of Pharmaceutical and Chemical Products ZAO Chanzhou Pharmaceutical Factory Unikem Laboratories Ltd.

Co-Vamloset tablet film 10 mg + 160 mg + 25 mg x30

Amlodipine + valsartan + hydrochlorothiazide

When using the drug, adverse events were mostly mild or moderately pronounced. Termination of treatment with the drug due to the development of adverse events was required in rare cases. Most often, the drug was discontinued due to the development of dizziness and a pronounced decrease in blood pressure.

No new adverse events were identified with the use of the drug compared with dual combination therapy and monotherapy with individual components.

As with short-term use, the drug was well tolerated with long-term use (within a year).

The incidence of adverse events was not related to gender, age or race.

When using the drug, changes in laboratory parameters were minimal and did not differ from those during monotherapy with individual components. With the simultaneous use of hydrochlorothiazide together with valsartan (triple combination therapy), there is a decrease in the hypokalemic effect of hydrochlorothiazide.

The most common adverse events reported in clinical studies (whether or not associated with the use of the drug) were dizziness, peripheral edema, headache, dyspepsia, fatigue, muscle spasm, back pain, nasopharyngitis, nausea.

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt.1/10), infrequently (≥1/1000, &lt.1/100) , rare (≥1 / 10,000, &lt,1/1000), very rare (&lt,1/10,000), frequency unknown (not enough data to estimate the frequency of development).

From the side of metabolism: often – hypokalemia, infrequently – hypercalcemia, hyperlipidemia, hyponatremia.

From the side of the nervous system: often – dizziness, headache, infrequently – insomnia / sleep disturbances, coordination disorders, postural dizziness and dizziness due to exercise, taste disorders, lethargy, paresthesia, neuropathy, incl. peripheral, drowsiness, fainting.

Sense organs: infrequently – visual disturbances, vertigo.

From the side of the cardiovascular system: often – a pronounced decrease in blood pressure, infrequently – tachycardia, orthostatic hypotension, phlebitis, thrombophlebitis.

From the respiratory system: infrequently – cough, shortness of breath, irritation in the throat.

From the digestive system: often – dyspepsia, infrequently – anorexia, abdominal discomfort, pain in the upper abdomen, bad breath, diarrhea, dry mouth, nausea, vomiting.

Dermatological reactions: infrequently – increased sweating, itching.

From the musculoskeletal system and connective tissue: infrequently – back pain, swelling in the joints, muscle spasms, muscle weakness, myalgia, pain in the extremities.

From the urinary system: often – pollakiuria, infrequently – increased plasma creatinine concentration, acute renal failure.

From the reproductive system: infrequently – erectile dysfunction.

On the part of the body as a whole: often – peripheral edema, increased fatigue, infrequently – abasia, gait disturbances, asthenia, general weakness, pain in the chest area.

From the side of laboratory parameters: infrequently – an increase in the content of urea nitrogen in the blood plasma, hyperuricemia, weight gain.

Amlodipine

, &lt,1/100), rarely (≥1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: very rarely – leukopenia, thrombocytopenia.

From the immune system: very rarely – hypersensitivity reactions.

From the side of metabolism: very rarely – hyperglycemia.

From the nervous system: often – dizziness, headache, drowsiness, infrequently – insomnia / sleep disturbances, mood lability, paresthesia, fainting, tremor, very rarely – muscular hypertension, peripheral neuropathy, neuropathy, frequency unknown – extrapyramidal disorders .

From the senses: infrequently – visual disturbances, tinnitus, taste disturbances.

From the side of the cardiovascular system: often – a feeling of palpitations, flushing of the face, infrequently – a pronounced decrease in blood pressure, very rarely – vasculitis, arrhythmias (including bradycardia, ventricular tachycardia, atrial fibrillation).

From the respiratory system: infrequently – shortness of breath, rhinitis, very rarely – cough.

From the digestive system: often – abdominal discomfort, pain in the upper abdomen, nausea, infrequently – change in the frequency of defecation, diarrhea, dry mouth, dyspepsia, vomiting, very rarely – gastritis, gingival hyperplasia, pancreatitis.

From the side of the liver and biliary tract: very rarely – increased activity of liver enzymes, increased plasma bilirubin concentration, hepatitis, intrahepatic cholestasis, jaundice.

Dermatological reactions: infrequently – alopecia, increased sweating, itching, rash, incl. exanthema, purpura, discoloration of the skin, very rarely – angioedema, erythema multiforme, urticaria.

From the musculoskeletal system and connective tissue: infrequently – arthralgia, back pain, muscle spasms, myalgia.

From the urinary system: infrequently – urination disorders, nocturia, pollakiuria.

From the reproductive system: infrequently – erectile dysfunction, gynecomastia.

On the part of the body as a whole: often – increased fatigue, edema, infrequently – asthenia, discomfort, general weakness, pain in the chest, pain of various localization.

From the side of laboratory parameters: infrequently – increase or decrease in body weight.

Valsartan

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt,1/10), infrequently (≥ 1/1000, &lt ,1/100), rarely (≥ 1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: the frequency is unknown – a decrease in hemoglobin and hematocrit, leukopenia, thrombocytopenia.

From the immune system: frequency unknown – hypersensitivity reactions.

On the part of the organ of hearing: infrequently – vertigo.

From the side of the cardiovascular system: the frequency is unknown – vasculitis.

From the respiratory system: infrequently – cough.

From the digestive system: infrequently – abdominal discomfort, pain in the upper abdomen.

From the side of the liver and biliary tract: frequency unknown – increased activity of liver enzymes, increased plasma bilirubin concentration.

Allergic reactions: frequency unknown – angioedema, itching, rash.

From the musculoskeletal system: the frequency is unknown – myalgia.

From the urinary system: the frequency is unknown – an increase in the concentration of creatinine in the blood plasma, impaired renal function, including acute renal failure.

On the part of the body as a whole: infrequently – increased fatigue.

From the side of laboratory parameters: the frequency is unknown – an increase in the content of potassium in the blood plasma.

In clinical studies with the use of valsartan in monotherapy, the following adverse events were noted (regardless of their causal relationship with the study drug): viral infections, upper respiratory tract infections, sinusitis, rhinitis, neutropenia, insomnia.

In rare cases, the use of valsartan may be accompanied by a decrease in hemoglobin and hematocrit. In controlled studies, in 0.8% and 0.4% of patients treated with valsartan, there was a significant decrease (more than 20%) in hematocrit and hemoglobin, respectively. For comparison, in patients receiving placebo, a decrease in both hematocrit and hemoglobin was noted in 0.1% of cases.

Neutropenia was detected in 1.9% of patients treated with valsartan and in 1.6% of patients treated with an ACE inhibitor.

In controlled studies, 3.9% and 16.6% of patients with chronic heart failure treated with valsartan showed an increase in the concentration of creatinine and blood urea nitrogen by more than 50%, respectively. For comparison, in patients receiving placebo, an increase in the concentration of creatinine and urea nitrogen was observed in 0.9% and 6.3% of cases.

A doubling of serum creatinine concentration was detected in 4.2% of patients after myocardial infarction who received valsartan and in 3.4% who received captopril.

In controlled studies, 10% of patients with chronic heart failure showed an increase in serum potassium by more than 20%. For comparison, in patients receiving placebo, an increase in potassium was observed in 5.1% of cases.

Hydrochlorothiazide

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt,1/10), infrequently (≥1/1000, &lt ,1/100), rarely (≥1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: rarely – thrombocytopenia, very rarely – agranulocytosis, depression of bone marrow hematopoiesis, hemolytic anemia, leukopenia.

From the immune system: very rarely – hypersensitivity reactions.

From the side of metabolism: often – hypokalemia, infrequently – hyperuricemia, hypomagnesemia, hyponatremia, rarely – hypercalcemia, hyperglycemia, very rarely – hypochloremic alkalosis.

From the nervous system: rarely – insomnia / sleep disturbances, depression, dizziness, headache, lethargy.

On the part of the organ of vision: infrequently – visual disturbances.

From the side of the cardiovascular system: infrequently – orthostatic hypotension, rarely – arrhythmias (including bradycardia, ventricular tachycardia, atrial fibrillation).

From the respiratory system: very rarely – respiratory distress syndrome, pulmonary edema and pneumonitis.

From the digestive system: infrequently – loss of appetite, nausea, vomiting, rarely – abdominal discomfort, pain in the upper abdomen, constipation, diarrhea, very rarely – pancreatitis.

From the side of the liver and biliary tract: rarely – hepatitis, intrahepatic cholestasis, jaundice.

Dermatological reactions: infrequently – rash, urticaria, rarely – increased photosensitivity, purpura, very rarely – necrotizing vasculitis, toxic epidermal necrolysis, lupus-like reactions, exacerbation of skin manifestations of systemic lupus erythematosus ki.