Indications

• Hypertension (see Hypertension, [[Hypertension]])
• Peripheral Edema (see Peripheral Edema, [[Peripheral Edema]])
  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Cirrhosis (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
  • Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
  • Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]]): nephrotic syndrome, etc

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Pharmacology

• Sulfonamide Diuretic (see Sulfonamides, [[Sulfonamides]])
  • Site of Activity: distal tubule

Metabolism

• xxxx

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Administration

• PO:

Dose Adjustment

• Hepatic
• Renal

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Adverse Effects

Gastrointestinal Adverse Effects

Acute Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]])

• Epidemiology: definite association with acute pancreatitis

Pulmonary Adverse Effects

Diffuse Alveolar-Interstitial Infiltrates/Acute Lung Injury-ARDS (see Pneumonia, [[Pneumonia]], Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]], Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])

• Epidemiology
  • Over 40 reported cases of diffuse infiltrates associated with hydrochlorothiazide
  • May begin with first dose of hydrochlorothiazide or may occur days later
  • 90% of cases occur in women who take hydrochlorothiazide intermttently (presumably for fluid retention), rather than daily
• Diagnosis
  • Swan: normal PCWP
  • Absence of ANA and eosinophilia
  • CXR/Chest CT: diffuse alveolar-interstitial infiltrates
• Clinical
  • Dyspnea (see Dyspnea, [[Dyspnea]]): fairly rapid onset
  • Fever (see Fever, [[Fever]]): may occur
• Treatment: withdraw hydrochlorothiazide -> usually clears within 48-72 hrs

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])

• Epidemiology:

Renal Adverse Effects

Acute Interstitial Nephritis (see Acute Interstitial Nephritis, [[Acute Interstitial Nephritis]])

• Physiology: class effect common to all thiazides

Hyponatremia (see Hyponatremia, [[Hyponatremia]])

• Thiazide diuretics act at the distal tubule
• Mechanisms postulated for thiazide diuretic-induced hyponatremia include hypovolemia-stimulated ADH and interference with urinary dilution in the cortical diluting segment
• Some studies have identified specific risk factors for the development of hyponatremia and these include: institutionalized elderly patients, low serum potassium concentration, low total body weight and indapamide use

Other Adverse Effects

• xxx

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References

• xxx