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
Pharmacology
- Sulfonamide Diuretic (see Sulfonamides, [[Sulfonamides]])
- Site of Activity: distal tubule
Metabolism
- xxxx
Administration
- PO:
Dose Adjustment
- Hepatic
- Renal
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
- 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
References
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