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Chlorothiazide

    Brands

    DEA Class; Rx

    Common Brand Names; Diuril

    • Diuretics, Thiazide
    Oral and parenteral thiazide diuretic; used for HTN and edema; and for hypercalciuria in children.

    Indicated for the treatment of hypertension.

    For use as an adjunctive agent to treat peripheral edema associated with congestive heart failure, hepatic cirrhosis (ascites), corticosteroid therapy, or estrogen therapy; or to treat edema associated with renal dysfunction including nephrotic syndrome, acute glomerulonephritis, and chronic renal failure.
    For the treatment of hypercalciuria in pediatric patients.
    For the management of chronic lung disease (CLD).
    For the treatment of secondary hypoglycemia due to congenital hyperinsulinemia.
    For the management of central diabetes insipidus.

    Hypersensitivity to chlorothiazide or sulfonamides

    Anuria

    • Scaling eczema
    • Stevens-Johnson syndrome
    • Toxic epidermal necrolysis
    • Disorder of hematopoietic structure
    • Hepatotoxicity
    • Systemic lupus erythematosus
    • Hypotension
    • Alopecia
    • Photosensitivity
    • Phototoxicity
    • Rash
    • Urticaria
    • Hyperglycemia
    • Hyperuricemia
    • Constipation
    • Diarrhea
    • Loss of appetite
    • Nausea and vomiting
    • Electrolytes abnormal
    • Spasticity
    • Dizziness
    • Headache
    • Blurred vision
    • Xanthopsia
    • Impotence

    May aggravate digitalis toxicity

    Sensitivity reactions may occur with or without history of allergy or asthma

    Patients allergic to sulfa may show cross-sensitivity

    May deleteriously alter lipid/glucose metabolism

    Risk of male sexual dysfunction

    Use with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia; cumulative effects of drug may develop in patients with impaired renal function.

    Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma

    Thiazides may add to or potentiate the action of other antihypertensive drugs

    Sensitivity reactions may occur in patients with or without a history of allergy or bronchial asthma; the possibility of exacerbation or activation of systemic lupus erythematosus has been reported

    Lithium generally should not be given with diuretics

    Although any chloride deficit is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease), chloride replacement may be required in the treatment of metabolic alkalosis

    Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction, rather than administration of salt, except in rare instances when the hyponatremia is life-threatening; in actual salt depletion, appropriate replacement is therapy of choice

    Hyperuricemia may occur or acute gout may be precipitated in certain patients receiving thiazides

    In diabetic patients dosage adjustments of insulin or oral hypoglycemic agents may be required; hyperglycemia may occur with thiazide diuretics; latent diabetes mellitus may become manifest during thiazide therapy

    The antihypertensive effects of drug may be enhanced in the post-sympathectomy patient

    Pregnancy Category: C; D (expert analysis). Chlorothiazide may cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult. Use of diuretics for pregnancy-induced hypertension should be avoided due to risk of decreased placental perfusion.

    Lactation: enters breast milk/not recommended (AAP states “compatible with nursing”)

    Adults

    2,000 mg/day PO for hypertension; 1,000 mg/day PO or 2,000 mg/day IV for edema.

    Geriatric

    2,000 mg/day PO for hypertension; 1,000 mg/day PO or 2,000 mg/day IV for edema.

    Adolescents

    2,000 mg/day PO for hypertension or 1,000 mg/day PO for edema. Safety and efficacy of IV chlorothiazide have not been established; doses up to 20 mg/kg/day IV (Max: 2,000 mg/day IV) have been used off-label.

    Children

    2 to 12 years: 20 mg/kg/day PO (Max: 1,000 mg/day) is recommended by FDA-approved labeling; however, up to 40 mg/kg/day has been used off-label. Safety and efficacy of IV chlorothiazide have not been established; doses up to 20 mg/kg/day IV have been used off-label.
    1 year: 20 mg/kg/day PO (Max: 375 mg/day) is recommended by FDA-approved labeling; however, up to 40 mg/kg/day has been used off-label. Safety and efficacy of IV chlorothiazide have not been established; doses up to 20 mg/kg/day IV have been used off-label.

    Infants

    6 to 11 months: 20 mg/kg/day PO is recommended by FDA-approved labeling; however, up to 40 mg/kg/day PO has been used off-label. Safety and efficacy of IV formulation have not been established; doses up to 20 mg/kg/day IV have been used off-label.
    1 to 5 months: 30 mg/kg/day PO is recommended by FDA-approved labeling; however, up to 40 mg/kg/day PO has been used off-label. Safety and efficacy of IV formulation have not been established; doses up to 20 mg/kg/day IV have been used off-label.

    Neonates

    30 mg/kg/day PO is recommended by FDA-approved labeling; up to 40 mg/kg/day PO has been used off-label for chronic lung disease. Safety and efficacy have not been established for IV formulation.

    Chlorothiazide

    oral suspension

    • 250mg/5mL

    powder for injection

    • 500mg

    tablet

    • 250mg
    • 500mg