Cardiovascular Medicine Book

Congestive Heart Failure

Coronary Artery Disease

Electrocardiogram

Examination

Hyperlipidemia

Hypertension

Miscellaneous

Pericardial Disorders

Obstetrics Chapter related topics

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Thiazide DiureticAka: Hydrochlorothiazide, Chlorthiazide, Chlorthalidone, Indapamide, Metolazone, Zaroxolyn

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  1. Indications
    1. Hypertension (first-line agent)
    2. Osteoporosis Prevention (investigational)
    3. Severe Congestive Heart Failure
      1. Adjunct to Loop Diuretics
    4. Meniere's Disease
  2. Precautions: Renal Insufficiency (GFR <30 ml/min)
    1. Thiazide Diuretics are minimally effective when GFR falls below 30 ml/min
    2. Switch to Loop Diuretics at this level of renal insufficiency
  3. Adverse effects
    1. Hyperuricemia
      1. Occurs more often with doses over 25mg
      2. Less of an issue if avoid Hypokalemia
      3. Avoid thiazide Diuretics in gout!
    2. Hyperglycemia
    3. Hyperlipidemia
    4. Hypokalemia
      1. One banana a day is sufficient Potassium Replacement
        1. Each inch of banana supplies 1 meq of potassium
      2. Cost benefit is lost when potassium supplement used
    5. Hyponatremia
    6. Hypomagnesemia
  4. Preparations:
    1. Hydrochlorothiazide (Esidrex, HydroDIURIL)
      1. Hypertension: 12 to 25 mg orally daily
    2. Hydrochlorothiazide and Triamterene
      1. Hctz/Triamterene 25/50 (Dyazide) one daily
      2. Hctz/Triamterene 50/75 (Maxzide) one daily
    3. Chlorothiazide (Diuril)
      1. Hypertension: 125-250 orally daily or divided bid
    4. Chlorthalidone (Hygroton)
      1. Hypertension: 12.5 to 25 mg orally daily
      2. May be preferred over hydrochlorothiazide
        1. Longer half life than hydrochlorothiazide
    5. Indapamide (Lozol)
      1. Hypertension: 1.25 to 5 mg orally daily
    6. Metolazone (Zaroxolyn)
      1. Hypertension: 0.5 mg orally daily (max: 1 mg daily)
      2. CHF with edema: 2.5 mg daily (max: 20 mg/day)

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