Exploring the potential side effects of the medication chlorthalidone. What are the common and serious side effects to be aware of? Learn about the interactions with other drugs and how to manage them.

Understanding Chlorthalidone

Chlorthalidone is a prescription medication primarily used to treat high blood pressure and fluid retention (edema). It belongs to a class of drugs called diuretics, which work by increasing the body’s elimination of water and salt through urine. This, in turn, helps lower blood pressure and reduce swelling caused by conditions like heart, liver, or kidney disease.

Common Side Effects of Chlorthalidone

The more common side effects associated with chlorthalidone oral tablets include:

• Stomach problems such as nausea, vomiting, stomach cramping, diarrhea, and constipation
• Loss of appetite
• Dizziness
• Headache
• Increased thirst

If these side effects are mild, they may go away within a few days or a couple of weeks. However, if they are more severe or persistent, it is important to consult your healthcare provider.

Serious Side Effects of Chlorthalidone

Call your doctor right away if you experience any serious side effects, such as:

• Sore throat and fever
• Unusual bleeding or bruising
• Severe skin rash with peeling skin
• Trouble breathing or swallowing
• Reduced potassium levels, with symptoms like extreme thirst, tiredness, drowsiness, restlessness, muscle pains or cramps, nausea or vomiting, and increased heart rate

These side effects can be life-threatening and require immediate medical attention.

Drug Interactions with Chlorthalidone

Chlorthalidone can interact with various medications, vitamins, or herbs you may be taking. These interactions can be harmful or prevent the drug from working effectively. Some examples of drugs that can interact with chlorthalidone include:

• Blood pressure medications: ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, loop diuretics, and potassium-sparing diuretics
• Diabetes medications: Chlorthalidone may affect the dosage requirements of your diabetes medication

It is crucial to inform your healthcare provider about all the medications, vitamins, and herbs you are taking to avoid potentially harmful interactions.

Maximizing the Benefits of Chlorthalidone

To ensure the safe and effective use of chlorthalidone, it is essential to follow your healthcare provider’s instructions carefully. Take the medication as prescribed, and report any side effects or concerns to your doctor immediately. Regular monitoring of your blood pressure, fluid balance, and electrolyte levels may be necessary while taking chlorthalidone.

Frequently Asked Questions

What is the purpose of chlorthalidone?
Chlorthalidone is primarily used to treat high blood pressure and fluid retention (edema).

How does chlorthalidone work?
Chlorthalidone belongs to a class of drugs called diuretics. It helps the body eliminate extra water and salt through the urine, which in turn lowers blood pressure and reduces fluid buildup.

What are the most common side effects of chlorthalidone?
The more common side effects of chlorthalidone include stomach problems (nausea, vomiting, diarrhea, constipation), loss of appetite, dizziness, headache, and increased thirst.

When should I seek medical attention for serious side effects?
Call your doctor right away if you experience serious side effects like sore throat and fever, unusual bleeding or bruising, severe skin rash, trouble breathing or swallowing, or signs of reduced potassium levels.

How can I avoid interactions with chlorthalidone?
It is important to inform your healthcare provider about all the medications, vitamins, and herbs you are taking to help them manage your treatment and avoid potentially harmful interactions.

Conclusion

Chlorthalidone is a widely used medication for the treatment of high blood pressure and fluid retention. While it is generally well-tolerated, it is essential to be aware of the potential side effects, both common and serious, as well as the drug interactions that can occur. By working closely with your healthcare provider and reporting any concerns, you can maximize the benefits of chlorthalidone while minimizing the risks. Remember, your health and safety are the top priorities when it comes to managing your medical conditions.

Side Effects, Dosage, Uses, and More

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Healthline only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Highlights for chlorthalidone

1. Chlorthalidone oral tablet is only available as a generic drug. It doesn’t have a brand-name version.
2. Chlorthalidone only comes as a tablet you take by mouth.
3. Chlorthalidone oral tablet is used to treat high blood pressure and edema (fluid retention).

Chlorthalidone is a prescription drug. It comes only as a tablet you take by mouth.

Chlorthalidone oral tablet is only available as a generic drug. Generic drugs usually cost less than brand-name versions.

Why it’s used

Chlorthalidone is used to treat high blood pressure. It’s also used to treat edema. This is swelling caused by fluid buildup in your body. Edema may be caused by conditions such as heart, liver, or kidney disease.

Chlorthalidone may be taken in combination with other blood pressure medications.

How it works

Chlorthalidone belongs to a class of drugs called 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.

Chlorthalidone makes your body get rid of extra water and salt through the urine. This helps lower blood pressure. It also helps decrease fluid buildup, which reduces swelling.

Chlorthalidone oral tablet may cause drowsiness. It may also cause other side effects.

More common side effects

The more common side effects that can occur with chlorthalidone oral tablet include:

• stomach problems, such as:
  • nausea
  • vomiting
  • stomach cramping
  • diarrhea
  • constipation
  • loss of appetite
  • dizziness
  • headache
  • increased thirst

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with 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:

• sore throat and fever
• unusual bleeding or bruising
• severe skin rash with peeling skin
• trouble breathing or swallowing
• reduced potassium levels, with symptoms such as:
  • extreme thirst
  • tiredness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • nausea or vomiting
  • increased heart rate

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

Chlorthalidone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with chlorthalidone are listed below.

Blood pressure drugs

When chlorthalidone is taken with other medications that lower your blood pressure, your blood pressure may become dangerously low. Examples of these drugs include:

• angiotensin-converting enzyme (ACE) inhibitors, such as:
  • benazepril
  • captopril
  • enalapril
  • fosinopril
  • moexipril
  • perindopril
  • quinapril
  • ramipril
  • trandolapril
• angiotensin II receptor blockers (ARBs), such as:
  • irbesartan
  • losartan
  • olmesartan
  • telmisartan
  • valsartan
• beta-blockers, such as:
  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • timolol
• calcium channel blockers, such as:
  • amlodipine
  • felodipine
  • nicardipine
  • nifedipine
• loop diuretics, such as:
  • bumetanide
  • furosemide
  • indapamide
  • torsemide
• potassium-sparing diuretics, such as:
  • eplerenone
  • spironolactone
  • triamterene

Diabetes drugs

Your doctor may need to adjust the dose of your diabetes medication. Chlorthalidone may keep some diabetes drugs from working well. Examples of these drugs include:

• pramlintide
• metformin
• exenatide
• liraglutide
• lixisenatide
• saxagliptin
• sitagliptin
• insulin
• nateglinide
• repaglinide
• glimepiride
• glipizide
• glyburide
• canagliflozin
• dapagliflozin
• empagliflozin
• pioglitazone
• rosiglitazone

Digoxin

Digoxin is used to treat certain heart conditions, such as irregular heart rhythms or heart failure. Taking digoxin with chlorthalidone may change the amount of electrolytes in your blood. Your doctor will monitor your electrolytes closely and adjust your medication doses if needed.

Lithium

Lithiumis used to treat certain mental health conditions, such as bipolar disorder. Taking lithium with chlorthalidone may cause a buildup of lithium in your body. Therefore, your doctor may need to adjust your dosage of lithium while you take chlorthalidone.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Chlorthalidone can cause a severe allergic reaction. Symptoms include:

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

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

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

Alcohol interaction warning

Having drinks that contain alcohol while taking chlorthalidone can increase your risk of dizziness.

Warnings for people with certain health conditions

For people with kidney disease: Chlorthalidone can make your kidney problems worse. Talk with your doctor about whether taking this drug is safe for you.

For people with liver disease: Chlorthalidone can cause changes in your fluid and electrolyte levels. This may even lead to coma. Talk with your doctor about whether taking this drug is safe for you.

For people with gout: This drug may cause gout episodes. Before taking this medication, make sure your doctor knows that you have gout.

For people with lupus: Chlorthalidone may make your condition worse. Before taking this medication, make sure your doctor knows that you have lupus.

For people with allergies or asthma: Chlorthalidone can cause a sensitivity reaction. Before taking this medication, make sure your doctor knows that you have allergies or asthma.

For people with low potassium: This drug can cause low potassium levels. If you already have low potassium levels, your potassium could become too low.

For people with diabetes: Drugs used to treat diabetes may not work as well when taken with chlorthalidone. This could cause higher blood sugar levels. Your doctor may adjust the dose of your diabetes medication.

Warnings for other groups

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

1. Studies of the drug in pregnant animals haven’t shown risk to the fetus.
2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Chlorthalidone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: Chlorthalidone may pass into breast milk and cause serious effects in a child who is breastfed.

You and your doctor may need to decide if you’ll take chlorthalidone or breastfeed.

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.

For children: This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

This dosage information is for chlorthalidone oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Chlorthalidone

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

Dosage for high blood pressure (hypertension)

Adult dosage (ages 18–64 years)

• Typical starting dosage: 25 mg taken once per day.
• Dosage increases: Your doctor may increase your once-daily dose to 50 mg and then to 100 mg if additional control is required.
• Maintenance dosage: Maintenance doses may be lower than initial doses. Your doctor should adjust your dosage based on how your body responds to the medication.
• Maximum dosage: 100 mg once daily.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

Senior dosage (ages 65 years and older)

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.

Dosage for fluid retention (edema)

Adult dosage (ages 18–64 years)

• Typical starting dosage: 50–100 mg taken once per day, or 100 mg taken every other day. Some people may need 150–200 mg taken once per day or every other day.
• Maximum dosage: 200 mg per day.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

Senior dosage (ages 65 years and older)

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.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

For high blood pressure, chlorthalidone oral tablet is used for long-term treatment. For edema, it’s used for short-term or long-term treatment. This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all:

• For high blood pressure: Your blood pressure may stay high. This raises your risk for heart attack or stroke.
• For edema: Your swelling and fluid buildup won’t decrease. This can lead to serious problems, such as pain, infections, leg ulcers, or blood clots.

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 chlorthalidone, you may have these symptoms:

• nausea
• weakness
• dizziness
• extreme thirst
• confusion
• seizures

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 serious side effects.

How to tell if the drug is working:

• For high blood pressure: Your blood pressure should go down. Your doctor can check your blood pressure, or you can check it at home using a blood pressure monitor.
• For edema: Your swelling or fluid retention should decrease.

Keep these considerations in mind if your doctor prescribes chlorthalidone oral tablet for you.

General

• Chlorthalidone should be taken with food.
• Chlorthalidone should be taken in the morning. Take it at the same time each day.
• You can crush or cut the tablet.

Storage

• Store at a temperature between 68°F and 77°F (20°C and 25°C).
• Don’t freeze chlorthalidone.
• Keep it 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 shouldn’t 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, such as in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt 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 doctor appointments. You may need to buy a blood pressure monitor. These are available at most pharmacies and online.

Shop online for a blood pressure monitor.

Clinical monitoring

While being treated with chlorthalidone, your doctor will check your blood pressure and weight. Your doctor may also do blood tests to check your potassium level.

Your diet

Your doctor may have you follow a specific diet, such as a low-salt or high-potassium diet. Foods high in potassium include prunes, bananas, and orange juice.

Sun sensitivity

Chlorthalidone may make your skin more sensitive to sunlight. You should wear protective clothing, sunscreen, and limit time out in the sun while you’re taking this drug.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Healthline 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.

Side Effects, Dosage, Uses, and More

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Healthline only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Highlights for chlorthalidone

1. Chlorthalidone oral tablet is only available as a generic drug. It doesn’t have a brand-name version.
2. Chlorthalidone only comes as a tablet you take by mouth.
3. Chlorthalidone oral tablet is used to treat high blood pressure and edema (fluid retention).

Chlorthalidone is a prescription drug. It comes only as a tablet you take by mouth.

Chlorthalidone oral tablet is only available as a generic drug. Generic drugs usually cost less than brand-name versions.

Why it’s used

Chlorthalidone is used to treat high blood pressure. It’s also used to treat edema. This is swelling caused by fluid buildup in your body. Edema may be caused by conditions such as heart, liver, or kidney disease.

Chlorthalidone may be taken in combination with other blood pressure medications.

How it works

Chlorthalidone belongs to a class of drugs called 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.

Chlorthalidone makes your body get rid of extra water and salt through the urine. This helps lower blood pressure. It also helps decrease fluid buildup, which reduces swelling.

Chlorthalidone oral tablet may cause drowsiness. It may also cause other side effects.

More common side effects

The more common side effects that can occur with chlorthalidone oral tablet include:

• stomach problems, such as:
  • nausea
  • vomiting
  • stomach cramping
  • diarrhea
  • constipation
  • loss of appetite
  • dizziness
  • headache
  • increased thirst

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with 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:

• sore throat and fever
• unusual bleeding or bruising
• severe skin rash with peeling skin
• trouble breathing or swallowing
• reduced potassium levels, with symptoms such as:
  • extreme thirst
  • tiredness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • nausea or vomiting
  • increased heart rate

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

Chlorthalidone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with chlorthalidone are listed below.

Blood pressure drugs

When chlorthalidone is taken with other medications that lower your blood pressure, your blood pressure may become dangerously low. Examples of these drugs include:

• angiotensin-converting enzyme (ACE) inhibitors, such as:
  • benazepril
  • captopril
  • enalapril
  • fosinopril
  • moexipril
  • perindopril
  • quinapril
  • ramipril
  • trandolapril
• angiotensin II receptor blockers (ARBs), such as:
  • irbesartan
  • losartan
  • olmesartan
  • telmisartan
  • valsartan
• beta-blockers, such as:
  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • timolol
• calcium channel blockers, such as:
  • amlodipine
  • felodipine
  • nicardipine
  • nifedipine
• loop diuretics, such as:
  • bumetanide
  • furosemide
  • indapamide
  • torsemide
• potassium-sparing diuretics, such as:
  • eplerenone
  • spironolactone
  • triamterene

Diabetes drugs

Your doctor may need to adjust the dose of your diabetes medication. Chlorthalidone may keep some diabetes drugs from working well. Examples of these drugs include:

• pramlintide
• metformin
• exenatide
• liraglutide
• lixisenatide
• saxagliptin
• sitagliptin
• insulin
• nateglinide
• repaglinide
• glimepiride
• glipizide
• glyburide
• canagliflozin
• dapagliflozin
• empagliflozin
• pioglitazone
• rosiglitazone

Digoxin

Digoxin is used to treat certain heart conditions, such as irregular heart rhythms or heart failure. Taking digoxin with chlorthalidone may change the amount of electrolytes in your blood. Your doctor will monitor your electrolytes closely and adjust your medication doses if needed.

Lithium

Lithiumis used to treat certain mental health conditions, such as bipolar disorder. Taking lithium with chlorthalidone may cause a buildup of lithium in your body. Therefore, your doctor may need to adjust your dosage of lithium while you take chlorthalidone.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Chlorthalidone can cause a severe allergic reaction. Symptoms include:

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

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

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

Alcohol interaction warning

Having drinks that contain alcohol while taking chlorthalidone can increase your risk of dizziness.

Warnings for people with certain health conditions

For people with kidney disease: Chlorthalidone can make your kidney problems worse. Talk with your doctor about whether taking this drug is safe for you.

For people with liver disease: Chlorthalidone can cause changes in your fluid and electrolyte levels. This may even lead to coma. Talk with your doctor about whether taking this drug is safe for you.

For people with gout: This drug may cause gout episodes. Before taking this medication, make sure your doctor knows that you have gout.

For people with lupus: Chlorthalidone may make your condition worse. Before taking this medication, make sure your doctor knows that you have lupus.

For people with allergies or asthma: Chlorthalidone can cause a sensitivity reaction. Before taking this medication, make sure your doctor knows that you have allergies or asthma.

For people with low potassium: This drug can cause low potassium levels. If you already have low potassium levels, your potassium could become too low.

For people with diabetes: Drugs used to treat diabetes may not work as well when taken with chlorthalidone. This could cause higher blood sugar levels. Your doctor may adjust the dose of your diabetes medication.

Warnings for other groups

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

1. Studies of the drug in pregnant animals haven’t shown risk to the fetus.
2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Chlorthalidone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: Chlorthalidone may pass into breast milk and cause serious effects in a child who is breastfed.

You and your doctor may need to decide if you’ll take chlorthalidone or breastfeed.

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.

For children: This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

This dosage information is for chlorthalidone oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Chlorthalidone

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

Dosage for high blood pressure (hypertension)

Adult dosage (ages 18–64 years)

• Typical starting dosage: 25 mg taken once per day.
• Dosage increases: Your doctor may increase your once-daily dose to 50 mg and then to 100 mg if additional control is required.
• Maintenance dosage: Maintenance doses may be lower than initial doses. Your doctor should adjust your dosage based on how your body responds to the medication.
• Maximum dosage: 100 mg once daily.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

Senior dosage (ages 65 years and older)

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.

Dosage for fluid retention (edema)

Adult dosage (ages 18–64 years)

• Typical starting dosage: 50–100 mg taken once per day, or 100 mg taken every other day. Some people may need 150–200 mg taken once per day or every other day.
• Maximum dosage: 200 mg per day.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people under the age of 18 years.

Senior dosage (ages 65 years and older)

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.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

For high blood pressure, chlorthalidone oral tablet is used for long-term treatment. For edema, it’s used for short-term or long-term treatment. This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all:

• For high blood pressure: Your blood pressure may stay high. This raises your risk for heart attack or stroke.
• For edema: Your swelling and fluid buildup won’t decrease. This can lead to serious problems, such as pain, infections, leg ulcers, or blood clots.

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 chlorthalidone, you may have these symptoms:

• nausea
• weakness
• dizziness
• extreme thirst
• confusion
• seizures

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 serious side effects.

How to tell if the drug is working:

• For high blood pressure: Your blood pressure should go down. Your doctor can check your blood pressure, or you can check it at home using a blood pressure monitor.
• For edema: Your swelling or fluid retention should decrease.

Keep these considerations in mind if your doctor prescribes chlorthalidone oral tablet for you.

General

• Chlorthalidone should be taken with food.
• Chlorthalidone should be taken in the morning. Take it at the same time each day.
• You can crush or cut the tablet.

Storage

• Store at a temperature between 68°F and 77°F (20°C and 25°C).
• Don’t freeze chlorthalidone.
• Keep it 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 shouldn’t 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, such as in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt 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 doctor appointments. You may need to buy a blood pressure monitor. These are available at most pharmacies and online.

Shop online for a blood pressure monitor.

Clinical monitoring

While being treated with chlorthalidone, your doctor will check your blood pressure and weight. Your doctor may also do blood tests to check your potassium level.

Your diet

Your doctor may have you follow a specific diet, such as a low-salt or high-potassium diet. Foods high in potassium include prunes, bananas, and orange juice.

Sun sensitivity

Chlorthalidone may make your skin more sensitive to sunlight. You should wear protective clothing, sunscreen, and limit time out in the sun while you’re taking this drug.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Healthline 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.

Chlorthalidone: side effects, dosages, treatment, interactions, warnings

Bliss

• What is
  • What is chlorthalidone and how does it work?
• Side effects
  • What side effects are associated with the use of chlorthalidone?
• Drug interactions
  • What other drugs interact with chlorthalidone?
• Warnings and precautions
  • What are the warnings and precautions for taking chlorthalidone?

Brand name: Hygroton, Thaliton, Chlorthalide

Generic name: Chlorthalidone

Drug class: diuretics, thiazide

What is chlorthalidone and how does it work?

uses for Adderall XR in adults

Chlorthalidone is a prescription medicine used to treat high blood pressure (hypertension). Reducing high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to reduce excess salt and water in the body caused by conditions such as heart failure, liver and kidney disease. Reducing the amount of salt and water in the body helps reduce swelling (swelling) and breathing problems caused by fluid in the lungs. Chlorthalidone is a “water pill” (diuretic). This increases the amount of urine you pass, especially when you first start taking the medicine. It also helps to relax the blood vessels so that blood can flow more easily.

Chlorthalidone is available under the following brand names: Hygroton, Taliton and Chlorthalide.

Chlorthalidone dosages:

Tablet

• 15 mg
• 25 mg
• 50 mg
• 1 00 mg

Dosage recommendations:

Hypertension

Adults and geriatrics:

• 25-100 mg/day orally; usual range, 12. 5-25 mg/day

Pediatrics (off-label):

• 0.3 mg/kg/day orally initially, may be increased to 2 mg/kg/day; no more than 50 mg per day

Edema

Adults and geriatrics:

• 50-100 mg/day orally or 100 mg orally every other day; no more than 200 mg/day

Diuresis

Charlotte NC 24-Hour Rite of Care

Geriatric:

• 12.5-25 mg/day po or 12.5-25 mg po every other day; dosage over 25mg/day provides only minimal benefit

Dosing advice

Take in the morning with food

Overdose management

• Saline may be used to replace volume
• Dopamine or norepinephrine may be used to treat hypotension

900 05 If an arrhythmia is suspected due to low levels of potassium or magnesium, strongly replace

• If no symptoms are observed after 6 hours, stop treatment.

Dosing modifications

benefits and side effects of mint tea

Renal failure

• Creatinine clearance less than 10 ml/min: ineffective, do not use
• Creatinine clearance greater than 10 ml/min: no dose adjustment required.

Geriatric:

• Possibility of electrolyte imbalance in the elderly; monitor serum electrolytes

What side effects are associated with the use of chlorthalidone?

Side effects of chlorthalidone include:

• Cardiovascular: low blood pressure (hypotension), vasculitis, dizziness when standing up.
• Dermatological: sun sensitivity, skin irritation from the sun, rash or purple spots on the skin, rash, urticaria, inflammation of the blood vessels.
• Endocrine / metabolic disorders: electrolyte disturbances, high blood sugar (hyperglycemia), excess uric acid in the blood (hyperuricemia), excess sugar in the urine (glucosuria).
• From the gastrointestinal tract: stomach irritation, constipation, diarrhea, loss of appetite, nausea, vomiting, spasms, yellowing of the skin and eyes (jaundice).
• From the musculoskeletal system: involuntary muscle movement or stiffness (spasticity), weakness
• Neurological: dizziness, sensation of rotation (vertigo), headache, numbness / tingling.
• Ophthalmic: Blurred vision, impaired color vision.
• Psychiatric: anxiety
  

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• Reproductive: impotence

Rare side effects of chlorthalidone include:

• Cardiovascular system: abnormal heart rhythm (cardiac arrhythmia)
• Dermatological: scaly eczema, Stevens-Johnson syndrome, toxic epidermal necrolysis.
• Gastrointestinal tract: pancreatitis.
• Hematologic: hematopoietic disorder: low white blood cell count, deficiency of granulocytes in the blood (agranulocytosis), low platelet count, no production of red blood cells (aplastic anemia)
• Liver: liver damage
• Immunological: systemic lupus erythematosus (SLE).
• Respiratory: Fluid in the lungs (pulmonary edema).

This document does not contain all possible side effects that you may experience. For more information about side effects, please consult your doctor.

What other drugs interact with chlorthalidone?

If your doctor has advised you to use this medicine, your doctor or pharmacist may already be aware of any possible drug interactions and can monitor you for them. Do not start, stop, or change the dosage of any medicine without talking to your doctor, health care provider, or pharmacist.

Chlorthalidone has no serious drug interactions.

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Serious chlorthalidone interactions include:

• aminolevulinic acid
• amisulpride
• cisapride
• isocarboxazid
• methylaminolevulinate 9 0008
• squill
• tretinoin
• tretinoin topical

Chlorthalidone interacts moderately with at least 154 different drugs.

Chlorthalidone interacts insignificantly with at least 147 different drugs.

This information does not contain all possible interactions or side effects. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Consult your healthcare professional or physician for additional medical advice, or if you have any health questions, concerns, or additional information about this medicine.

What are the warnings and precautions for taking chlorthalidone?

Warnings

• This medicine contains chlorthalidone. Do not take hygroton, thaliton, or chlorthalide if you are allergic to chlorthalidone or any of the ingredients in this medicine.

Keep out of the reach of children. In case of overdose, seek medical attention or contact a Poison Control Center immediately.

Contraindications.

• Confirmed hypersensitivity to chlorthalidone or sulfonamides.
• Failure of the kidneys to produce urine (anuria)

Effects of drug abuse

• No information available

Short-term effects

• associated with the use of chlorthalidone?

Long-term effects

list of antibiotics for bladder infections

• See “What side effects are associated with the use of chlorthalidone?”

Warnings

• Use with caution in diabetes mellitus, fluid or electrolyte imbalances, excess cholesterol (hypercholesterolemia), excess uric acid in the blood (hyperuricemia) or gout, low blood pressure (hypotension), systemic lupus erythematosus, liver disease, severe kidney disease, advanced age, history of allergies or bronchial asthma.
• Avoid concomitant use with lithium (may require a 50% reduction in lithium dosage).
• May aggravate digitalis toxicity.
• Patients allergic to sulfa drugs may show cross-sensitivity.
• Risk of male sexual dysfunction.
• Photosensitization possible.
• Electrolyte disturbances (low blood potassium (hypokalemia), low blood sodium (hyponatremia), low blood chloride ions (hypochloremic alkalosis)) may occur.

Pregnancy and lactation

• The use of chlorthalidone during pregnancy may be acceptable. Either animal studies show no risk but no human studies are available, or animal studies show little risk and human studies are done and show no risk.
• Expert review suggests the use of chlorthalidone only in LIFE-THREAKING EMERGENCIES where no safer drug is available. There is positive evidence for the risk of fetal development in humans. Possible hazards include fetal or neonatal jaundice, thrombocytopenia, and other adverse reactions that have been observed in adults.
• Chlorthalidone passes into breast milk; not recommended for breastfeeding. The American Academy of Pediatrics states that chlorthalidone is compatible with breastfeeding.

used literature Medscape. Chlortalidone.
https://reference.medscape.com/drug/hygroton-thalitone-chlorthalidone-342410
RxList. Taliton Side Effects Center.
https://www.rxlist.com/thalitone-drug/side-effects-interactions.htm

How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease? | Grigoryeva N.Yu., Samolyuk M.O., Sheshina T.V., Koroleva N.B., Koroleva T.V.

Introduction

Endothelial dysfunction (ED) and oxidative stress are important mechanisms for the formation and progression of both cardiovascular and bronchopulmonary pathologies [1, 2]. In particular, this applies to the most common cardiovascular disease — arterial hypertension (AH), which in 34. 3% of cases is combined with chronic obstructive pulmonary disease (COPD) [3]. In this regard, it is relevant to study changes in the state of endothelial function and lipid peroxidation (LPO) under the influence of prescribed therapy, and therefore, the search for drugs that positively affect not only hemodynamic changes, but also the pathogenetic mechanisms of the progression of these diseases.

According to the latest European and Russian clinical guidelines for hypertension [4, 5], thiazide and thiazide-like diuretics are considered one of the main classes of antihypertensive drugs. Their use in concomitant COPD is due to the fact that they do not violate the ventilation-perfusion ratio in the lungs, do not affect the tone of the pulmonary vessels and bronchi. However, their use can cause a number of side effects, such as hypokalemia, hypomagnesemia, hyperuricemia, increased blood glucose levels, and changes in blood lipid composition [4, 5]. In this regard, the search for the most effective drugs from this group, which have a positive effect on both the state of the vascular wall and the course of concomitant COPD, while having minimal side effects, is relevant.

Purpose of the study: to conduct a comparative assessment of the hypotensive effect, as well as the effect on endothelial function, oxidative stress and pressure in the pulmonary artery of chlorthalidone and hydrochlorothiazide as part of combined antihypertensive therapy in patients with hypertension in combination with COPD after 6 months. treatment.

Material and methods

A prospective study was conducted, which included 66 patients with hypertension and COPD. The study was approved by the local ethics committee of the Nizhny State Medical Academy of the Ministry of Health of Russia (protocol No. 10 dated December 25, 2017).

Inclusion Criteria : Grade 1-3 essential hypertension; COPD stage I–III according to GOLD without exacerbation; voluntary informed consent to participate in the study. Exclusion criteria : under 18 years of age; secondary hypertension; coronary heart disease in history; chronic heart failure with reduced ejection fraction and above functional class III; valvular heart disease with hemodynamically significant disorders; COPD in the stage of moderate and severe exacerbation; severe comorbidity; oncological diseases; pregnancy, lactation; bronchial asthma; past acute inflammatory diseases within a month prior to the onset of
research.

AH was diagnosed based on the criteria according to the guidelines on hypertension (ESC/ECH 2018, RKO 2020) [4, 5]. The degree of hypertension was determined by the level of blood pressure (BP) registered in the patient before the appointment of antihypertensive therapy. The stratification of the risk of developing cardiovascular complications was carried out on the basis of the SCORE scale. The diagnosis of COPD was established on the basis of anamnestic data, the clinical picture of the disease, an objective examination, and the results of instrumental studies in accordance with the Global COPD Initiative (GOLD, 2017, 2020) [6, 7].

The patients were divided into two groups by the free conversion method. As the main antihypertensive therapy, patients of the 1st group were prescribed a fixed combination of azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg – Edarbi ^® Klo. Patients of the 2nd group received a free combination of azilsartan medoxomil 40 mg (Edarbi®) and hydrochlorothiazide 12. 5 mg. The groups were comparable in terms of sex, age, severity of the underlying pathology (Table 1).

Initially, patients received antihypertensive therapy with antihypertensive drugs of various classes, including angiotensin-converting enzyme inhibitors, β-blockers, but the target blood pressure level is less than 130/80 mm Hg. Art. according to the European recommendations of 2018 and the Russian recommendations of 2020, hypertension was not achieved, therefore, these drugs were discontinued in all patients. β ₂ agonists, m-anticholinergics, inhaled glucocorticosteroids, or a combination of these classes of bronchodilator drugs were used in COPD therapy according to the 2019 GOLD clinical guidelines. The therapy was effective, all patients were not exacerbated by COPD, so the doses of the drugs did not change during the study.

The examination included the collection of complaints, clarification of the anamnesis of the disease and life, a general somatic examination and a complex of laboratory and instrumental studies.

Laboratory examination consisted in determining the level of lipid peroxidation products (diene conjugates (DC), triene conjugates (TC), Schiff bases (OS)) according to the method of I.A. Volchegorsky (1989), the content of nitric oxide (NO) according to the method of P.P. Golikov (2004), the level of endothelin-1 (ET-1) by enzyme immunoassay using a commercial test system Quantikine ELISA Endotelin-1 (R&D Systems, USA) according to the attached instructions, the intensity of free radical oxidation by the method of induced biochemiluminescence of blood serum by method E. AND. Kuzmina, A.S. Nelyubina, M.K. Shchennikova (1983) (S, Imax).

Instrumental research methods included: 24-hour blood pressure monitoring (ABPM), Doppler echocardiography (EchoDCG), endothelium-dependent vasodilation test (EDVD), assessment of respiratory function (RF). BP was assessed using ABPM on the BPLab MnSDP-2 recorder (Russia) with the determination of the daily profile and BP parameters. The study of respiratory function was performed on the apparatus “Cestgraph HI-101” (CHEST, Japan). EchoDCG was performed on the GEVIVID 7 Pro ultrasound machine (USA) with the measurement of mean pressure in the pulmonary artery. To detect ED, an ultrasound examination was performed using a high-resolution ultrasound probe according to the method of D. Celermajer (1992).

Statistical processing was performed using the licensed program Statistica 10.0. Quantitative data are presented as a median and interquartile range (Me [Q25; Q75]), qualitative data are presented as absolute and relative indicators. The type of distribution was analyzed using the Kolmogorov-Smirnov test. Differences were considered statistically significant at p<0.05.

Study results

Initially, the groups were comparable in terms of systolic blood pressure (SBP) (p=0.73) and diastolic blood pressure (DBP) (p=0.13). Against the background of treatment in both groups after 1 month. a statistically significant decrease in SBP was detected (p<0.001; Table 2).

An intergroup comparison of median SBP values ​​revealed that SBP decreased more significantly in the 1st group of patients treated with azilsartan medoxomil in combination with chlorthalidone, since by the end of the 1st month. SBP treatment in this group decreased by 26 [22.5; 30.5] mmHg Art., and in the 2nd group – by 16 [11.5; 21.5] mmHg Art.

In terms of DBP, each group showed a similar statistically significant positive trend (see Table 2). Intergroup comparison revealed no statistically significant difference (p=0.1). In the 1st group of patients by the end of the 1st month. treatment mean DBP decreased by 17.5 [14; 20] mm Hg. Art., and in the 2nd group – by 11 [9,5; 17] mm Hg. Art.

It should be noted that the target blood pressure (less than 130/80 mm Hg. Art.) after 1 month. study was achieved in 30 (91%) patients in group 1 and in 17 (51.5%) patients in group 2.

According to the results of ABPM when prescribing azilsartan medoxomil therapy in combination with chlorthalidone after 6 months. treatment showed a statistically significant decrease in daytime and night SBP and DBP (p<0.001), as well as a significant decrease in the variability of both SBP and DBP during the day and night (p<0.001) and mean pulse BP (p<0.001) (Table. 3).

At the time of inclusion in the study, ABPM revealed 60.6% of patients with a daily non-dipper BP profile, 36.4% with a night-peaker, and 3% with a dipper. After 6 months. treatment by reducing the number of patients with insufficient reduction in blood pressure at night (night-peaker and non-dipper), the number of patients with a normal daily type of blood pressure (dipper) was 78.8%. In the remaining 21.2% of patients, the daily BP profile corresponded to the non-dipper type.

After 6 months study, all patients managed to achieve target blood pressure without increasing the dose of the drug. In 12 patients with morning hypertension, after 6 months. treatment, there was a decrease in morning SBP by an average of 7.0±2.1% and DBP by 10±7.3%.

In all patients who received azilsartan medoxomil in combination with hydrochlorothiazide, after 6 months. treatment, the target values ​​of blood pressure were achieved (see Table 3), however, in 4 cases it was necessary to increase the dose of hydrochlorothiazide to 25 mg. At baseline, there were 63.6% of patients with an insufficient decrease in night BP (non-dipper), and 36.4% with an increased BP profile (night-peaker). After 6 months by reducing the number of patients with insufficient reduction in blood pressure at night (night-peaker and non-dipper), the number of patients with a normal daily type of blood pressure (dipper) was 36.4%. In 57.6% of cases, the daily BP profile corresponded to the non-dipper type, in 6% – to the night-peaker type. In 13 patients with morning hypertension, after 6 months. there was a decrease in morning SBP by an average of 6. 3±5.9% and DBP — by 4.8±4.6%.

Thus, in patients suffering from hypertension in combination with COPD, therapy with a fixed combination of azilsartan medoxomil with chlorthalidone Edarbi ^® Clo has a more pronounced antihypertensive effect, in contrast to the therapy of azilsartan medoxomil with hydrochlorothiazide. Adherence to therapy in patients of both groups was equally high, since they were under the supervision of a research physician, therefore, its influence on the results of therapy is excluded. Thus, the difference in the results of therapy can be entirely associated with the different antihypertensive effect of chlorthalidone and hydrochlorothiazide.

In the study of indicators of ED and oxidative stress, the following results were obtained (Table 4).

In the 1st group after 6 months. treatment, significant positive dynamics was observed in relation to DC, TC, NO ₂ , S, Imax, OR, EZVD, ET-1, and in the 2nd group – in relation to DC, TC, Imax, OR, EZVD, ET-1 . In general, a more pronounced improvement in laboratory parameters characterizing ED and oxidative stress was noted in the 1st group. Statistically significant results when comparing the 1st and 2nd groups were obtained for TC, NO ₂ , S, Imax, ET-1 (see Table 4).

When performing a test for EZVD, the initial dilatation reaction of the brachial artery was reduced in all patients of the 1st group and averaged 4.9 [4.5; 5.5]%. After 6 months EDVR increased and amounted to 6.6 [5.3; 7.5]% (p<0.001). In the 2nd group, the initial EZVD was also below the norm -
5 [4.7; 5.2]% and significantly increased by the end of treatment to 5.6 [5.1; 6.4] % (p<0.001). However, the differences in EVD between the groups were not statistically significant (p=0.14).

It is worth noting the positive effect of the prescribed therapy in the form of a decrease in pressure in the pulmonary artery after 6 months. treatment in both groups, however, in the 1st group, the achieved positive dynamics was statistically significantly different from that in the 2nd group (Fig. 1). The results obtained are apparently associated with an improvement in the function of the endothelium in the vessels of the pulmonary circulation during treatment.

When evaluating the parameters of bronchial patency according to respiratory function, there was a statistically significant improvement in the FEV ₁ in both groups, however, the increase was less than 100 ml, which is clinically insignificant.

It should also be noted that the combination of azilsartan medoxomil with chlorthalidone was metabolically neutral in terms of blood electrolytes, uric acid levels and serum glucose, which indicates the safety of the use of this combination, while when using the combination of azilsartan medoxomil with hydrochlorothiazide, a decrease in potassium levels was noted from 4, 2 [3.9; 4.6] to 3.8 [3.5; 4.3] mmol/l (p=0.003) and an increase in the level of uric acid c 236 [211; 327] to 304 [267; 367] µmol/l (p=0.008).

Talk

In the treatment of AH patients with COPD, it is justified to prescribe drugs that not only effectively reduce blood pressure, but also meet a number of requirements, such as: adequate control of blood pressure at night and early morning hours; compatibility of drugs with the basic means of treating COPD; lack of effects that impair lung ventilation; positive effect on the hemodynamics of the pulmonary circulation; pronounced cardio- and vasoprotective effects [3, 8]. It is also necessary that the selected drug affect the pathogenetic mechanisms of the formation of hypertension in COPD.

The development of hypertension in COPD is based on the early formation of ED in the pulmonary and systemic circulation, an increase in sympathetic activity with an imbalance in the synthesis of catecholamines, oxidative stress, chronic systemic inflammation, and an imbalance in the renin-angiotensin-aldosterone system (RAAS) [9, 10]. RAAS blockers, primarily angiotensin II receptor blockers, are the drugs of choice in the treatment of hypertension in patients with COPD [3–5]. Their positive impact not only on the level of blood pressure, but also on the course of COPD in this category of patients is well known [3, 8]. The same can be said about calcium antagonists, primarily amlodipine [4, 5]. Thus, the combination of a RAAS blocker with a calcium antagonist in this situation seems to be the most rational. However, often the hypervolemic type of circulation, hypersympathicotonia, manifested by tachycardia and rhythm disturbances, the presence of side effects in calcium antagonists (especially when using high doses) do not allow them to be prescribed as part of combination therapy in patients with hypertension with concomitant COPD. There is a question about combination therapy with a RAAS blocker and a diuretic. The most popular among Russian doctors is the thiazide diuretic hydrochlorothiazide, despite its well-known side effects, which become more pronounced with increasing doses and are present in almost all patients receiving the drug at a dose above 12.5 mg/day [4, 5].

Not so long ago, the diuretic chlorthalidone, which is fundamentally different from hydrochlorothiazide in terms of pharmacokinetic characteristics, appeared on the Russian market. Unfortunately, in Russia it is not available in its pure form and is presented only as part of a fixed combination with azilsartan medoxomil – Edarbi ^® Klo. Various randomized clinical trials have studied the clinical and pharmacological effects of hydrochlorothiazide and chlorthalidone [11, 12]. There are also comparative studies of combination therapy of azilsartan medoxomil with hydrochlorothiazide or chlorthalidone, which demonstrate the advantage of the latter in terms of the effect on blood pressure and safety of use [13, 14]. However, there are not even single studies that would reveal the positive effect of combination therapy of hypertension with the diuretic chlorthalidone on LPO and ED, especially in patients with concomitant COPD, when this is especially important, since disease progression occurs through oxidative stress and endothelial dysfunction.

Conclusion

Therapy of hypertension in patients with concomitant COPD with a fixed combination of azilsartan medoxomil and chlorthalidone – Edarbi ^® Klo compared with therapy with a free combination of azilsartan medoxomil with hydrochlorothiazide after 6 months. treatment has a more pronounced antihypertensive effect, while positively affecting the daily blood pressure profile, pulmonary artery pressure, endothelial function and lipid peroxidation processes.

When prescribing diuretics to patients with hypertension in combination with COPD as part of combination therapy, preference should be given to chlorthalidone due to its greater antihypertensive efficacy and positive effect on oxidative stress, endothelial function, and pulmonary artery pressure instead of hydrochlorothiazide traditionally used in Russian clinical practice.

Thanks

The editors would like to thank Nizhpharm JSC for their assistance in the technical editing of this publication.

Acknowledgment

Editorial Board is grateful to JSC Nizhfarm for the assistance in technical edition of this publication.

Credits:

Grigorieva Natalya Yuryevna — Doctor of Medical Sciences, Associate Professor, Professor of the Department, Acting Head of the Department of Clinical Medicine, National Research Nizhny Novgorod State University. N.I. Lobachevsky, 603950, Russia, Nizhny Novgorod, prosp. Gagarina, d. 23; ORCID iD 0000-0001-6795-7884.

Samolyuk Marina Olegovna — Assistant, Department of Clinical Medicine, National Research Nizhny Novgorod State University named after I.I. N.I. Lobachevsky, 603950, Russia, Nizhny Novgorod, prosp. Gagarina, d. 23; ORCID iD 0000-0001-9118-5327.

Sheshina Tatyana Vladimirovna — Assistant, Department of Clinical Medicine, National Research Nizhny Novgorod State University named after I. I. N.I. Lobachevsky, 603950, Russia, Nizhny Novgorod, prosp. Gagarina, d. 23; ORCID iD 0000-0003-1417-2340.

Koroleva Natalya Borisovna — 5th year student of the Faculty of Medicine, National Research Nizhny Novgorod State University named after I.I. N.I. Lobachevsky, 603950, Russia, Nizhny Novgorod, prosp. Gagarina, d. 23; ORCID iD 0000-0001-9993-4812.

Koroleva Tatyana Viktorovna — Head of the 2nd Cardiology Department, GBUZ NO “City Clinical Hospital No. 5”, 603005, Russia, Nizhny Novgorod, st. Nesterova, 34.

Contact information: Grigoreva Natalya Yuryevna, e-mail: [email protected]. Transparency of financial activities: none of the authors has a financial interest in the presented materials or methods. There is no conflict of interest. Article received on 07/06/2020, received after review on 07/20/2020, accepted for publication on 08/03/2020.

About the authors:

Natalia Yu. Grigorieva – Dr. of Sci. (Med.), Associate Professor, Professor and Acting Head of the Department of Clinical Medicine, Lobachevsky State University of Nizhny Novgorod: 23, Gagarina str., Nizhny Novgorod, 603950, Russian Federation; ORCID iD 0000-0001-6795-7884.

Marina O. Samolyuk – Assistant Professor of the Department of Clinical Medicine, Lobachevsky State University of Nizhny Novgorod: 23, Gagarina str., Nizhny Novgorod, 603950, Russian Federation; ORCID iD 0000-0001-9118-5327.

Tatiana V. Sheshina — Assistant Professor of the Department of Clinical Medicine, Lobachevsky State University of Nizhny Novgorod: 23, Gagarina str., Nizhny Novgorod, 603950, Russian Federation; ORCID iD 0000-0003-1417-2340.

Natalia B. Koroleva — 5th year student of the Faculty of General Medicine, Lobachevsky State University of Nizhny Novgorod: 23, Gagarina str., Nizhny Novgorod, 603950, Russian Federation; ORCID iD 0000-0001-9993-4812.

Tatyana V.