- Hydrochlorothiazide is the most commonly prescribed Thiazide Diuretic for Hypertension
- Hypertension (Adults)
- Start: 12 to 25 mg orally daily
- Typical maintenance dose 25 mg orally daily
- Maximum 50 mg/day
- Higher doses worsen Hypokalemia without additional Antihypertensive benefit
- Available as generic scored tablets (25 and 50 mg) and capsules (25 mg)
- Combinations
- Many ACE and ARBs are combined with Hydrochlorothiazide
- Hydrochlorothiazide and Triamterene
- Hctz/Triamterene 25/50 (Dyazide) once daily
- Hctz/Triamterene 50/75 (Maxzide) once daily
- Renal excretion, unchanged in urine
- Onset of activity: 2 hours
- Shorter Half-Life (6-12 hours) than the 24 hour half life of Chlorthalidone and Indapamide
- Immediate release Hydrochlorothiazide may only reduce daytime systolic Blood Pressure
- Controlled release Hydrochlorothiazide (available outside the U.S.) has 24 hour activity
- Less potent than Chlorthalidone
- Chlorthalidone reduces systolic Blood Pressure 10 mmHg more than Hydrochlorothiazide
- However, Hydrochlorothiazide and Chlorthalidone are associated with similar cardiovascular outcomes
- Chlorthalidone also raises the risk of Hypokalemia
- Ishani (2022) N Engl J Med 387(26):2401-10 +PMID: 36516076 [PubMed]
- Considered Safe in Lactation
- Pregnancy Category B
- Pregnancy Category D for Pregnancy Induced Hypertension
- See Thiazide Diuretic
-
Cyclosporine
- Increased risk of Hypercalcemia, Gouty Arthritis
-
Corticosteroids
- Increased risk of Hypokalemia
- Cytotoxic medications (e.g. Cyclophosphamide, Methotrexate)
- Hydrochlorothiazide may decrease renal excretion of cytotoxic medications
- Hydrochlorothiazide (DailyMed)
- (2021) Presc Lett, Resource #370507, Commonly Used Diuretics
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 62-3
- Hamilton (2020) Tarascon Pocket Pharmacopoeia