Hydrochlorothiazide – What are the indications and contraindications?

October 1, 2020 4:25 am Published by

Hydrochlorothiazide is a thiazide diuretic antihypertensive drug. Out of the 5 classes of diuretics, loop diuretics (ex: Furosemide) are preferred for edema treatment in CHF, liver disease, and kidney disease.

MAO:

  • Inhibits Na/Cl transporter in distal tubule, increasing excretion of Na+, K+, hydrogen ions, and water.

Indications:

  • Hypertension
  • Edema in CHF, liver cirrhosis (ascites), kidney disease including nephrotic syndrome, and corticosteroid or estrogen therapy (loop diuretics (ex: Furosemide) are preferred but thiazides can be used as adjunctive therapy for refractory edema)
  • Calcium kidney stones (prevention)
  • Diabetes insipidus (via a paradoxical antidiuretic effect)
  • Osteoporosis in patients with hypercalciuria
  • Meniere’s disease

Contraindications:

  • Hypersensitivity
  • Sulfonamides hypersensitivity
  • Anuria
  • Severe renal impairment
  • Addison’s disease
  • Pre-existing hypercalcemia
  • Electrolyte imbalance (especially hypokalemia)
  • Diabetes
  • Lactation

Adverse Effects:

  • Hypokalemic metabolic alkalosis
  • Hyponatremia, hypochloremia, hypomagnesemia, hypercalcemia
  • Hyperuricemia and gout
  • Hyperglycemia
  • Hypotension
  • Photosensitivity

Interactions:

  • Combination of potassium-wasting diuretics such as loop diuretics and thiazides may increase risk of hypokalemia
  • Licorice may increase risk of hypokalemia in combination with Hydrochlorothiazide
  • Enhances effect of other antihypertensive drugs
  • Antihypertensive effect antagonized by corticosteroids
  • Concurrent use with alcohol, Barbiturates, and opioids may enhance diuretic-enhanced orthostatic hypotension

From a pharmacognosy perspective, Taraxcum officinalis leaf and Urtica dioica leaf are aquaretics (electrolyte sparing diuretics) similar to aldosterone antagonists, while Convallaria majalis and Digitalis purpurea are electrolyte wasting diuretics similar to thiazides and loop diuretics (they also have cardiac glycosides, making them useful in CHF,, angina and arrhythmia).

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This post was written by Omar Rifai