Chlorthalidone

DEA Class; Rx

Common Brand Names; Hygroton, Thalitone, Chlorthalid

Thiazide-like diuretic used for HTN and edema; longer acting than other thiazides; diminished efficacy in patients with renal insufficiency.

Indicated for use as adjunctive therapy in edema associated with heart failure, hepatic cirrhosis, nephrotic syndrome, acute glomerulonephritis, chronic renal failure, and corticosteroid and estrogen therapy.

Documented hypersensitivity to chlorthalidone or sulfonamides

Common

Cardiovascular: Hypotension, vasculitis

Dermatologic: Photosensitivity, phototoxicity

Endocrine/metabolic: Electrolyte abnormalities, hyperglycemia, hyperuricemia

Gastrointestinal: Constipation, diarrhea, loss of appetite, nausea, vomiting

Musculoskeletal: Spasticity

Neurologic: Dizziness, headache, paresthesia

Ophthalmologic: Blurred vision, xanthopsia

Psychiatric: Restlessness

Reproductive: Impotence

Serious

Cardiovascular: Cardiac dysrhythmia (rare)

Dermatologic: Scaling eczema (rare), Stevens-Johnson syndrome (rare), toxic epidermal necrolysis (rare)

Gastrointestinal: Pancreatitis (rare)

Hematologic: Disorder of hematopoietic structure (rare)

Hepatic: Hepatotoxicity (rare)

Immunologic: Systemic lupus erythematosus (rare)

Respiratory: Pulmonary edema (rare)

Therapy may alter glucose tolerance; raise serum levels of cholesterol and triglycerides, raise the serum uric acid level due to reduced clearance of uric acid and may cause or exacerbate hyperuricemia and precipitate gout in susceptible patients; drug decreases urinary calcium excretion and may cause elevations of serum calcium; monitor calcium levels in patients with hypercalcemia receiving therapy

Use with caution in diabetes mellitus, fluid or electrolyte imbalance, hypercholesterolemia, hypotension, systemic lupus erythematosus, liver disease, severe renal disease, advanced age, history of allergy or bronchial asthma

Use with caution in patients with hyperuricemia or gout; gout can be precipiated in patients with history of gout, familial predisposition to gout or chronic renal failure; risk can be increased with doses ≥25 mg (in hydrochlorothiazide equivalents)

Avoid concurrent use with lithium (reduction of lithium dosage by 50% may be necessary)

May aggravate digitalis toxicity

Patients allergic to sulfa drugs may show cross-sensitivity; however, recent reports have suggested that cross reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at very least, potential if extremely low

Risk of male sexual dysfunction

Photosensitization may occur

Available data over decades from observational studies and reports with chlorthalidone use in pregnant women have not identified a drug-associated risk of major birth defects or miscarriage

Drug is present in human milk; there is no information regarding effects of on breastfed infant or on milk production; because of potential for drug accumulation which may lead to serious adverse reactions in breastfed infant (such as jaundice, thrombocytopenia, hyperglycemia, electrolyte abnormalities), advise patients that breastfeeding is not recommended during therapy