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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)

Chlorthalidone (C0008294)

Definition (MSH)A benzenesulfonamide-phthalimidine that tautomerizes to a BENZOPHENONES form. It is considered a thiazide-like diuretic.
Definition (NCI)A thiazide diuretic of the sulfamoylbenzamide class. Chlorthalidone directly inhibits sodium and chloride reabsorption on the luminal membrane of the early segment in the distal convoluted tubule in the kidney. This leads to an increase in water, sodium, chloride, bicarbonate, and potassium secretion and a decrease in calcium and uric acid secretion. Chlorthalidone is used in the treatment of high blood pressure, edema and congestive heart failure.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD002752
EnglishChlorphthalidolone, Chlortalidone, Chlorthalidone, CHLORTHALIDONE PREPARATION, Oxodoline, Phthalamudine
Spanishclortalidona
Parent ConceptsBenzophenones (C0005077), Phthalimides (C0031785), Sulfonamides (C0038760), Thiazide Diuretics (C0012802), Sulfonamide diuretic (C0304485), Saluretic drug (C0304487)
SourcesCSP, LCH, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Hydrochlorothiazide (C0020261)

Definition (MSH)A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism.
Definition (NCI)The hydrogenated derivative of chlorothiazide, a thiazide diuretic with antihypertensive and anti-urolithic effects. This agent binds to the electroneutral Na-K-Cl cotransporter (NKCC) and thereby impairs Na+, K+ and Cl- reabsorption on the luminal membrane of the early segment in the distal convoluted tubule in the kidney. This leads to an increase in urinary excretion of sodium, chloride, potassium, bicarbonate and water subsequently reducing plasma and extracellular fluid volume leading to a reduction in blood pressure. Hydrochlorothiazide also decreases urinary calcium and uric acid excretion by direct action on the distal tubule.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD006852
EnglishDichlothiazide, Dihydrochlorothiazide, HCTZ, Hydrochlorothiazide, HYDROCHLOROTHIAZIDE PREPARATION
Spanishhidroclorotiazida
Parent ConceptsChlorothiazide (C0008273), Thiazide Diuretics (C0012802), Saluretic drug (C0304487)
SourcesLNC, MSH, MTHFDA, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Indapamide (C0021186)

Definition (MSH)A benzamide-sulfonamide-indole. It is called a thiazide-like diuretic but structure is different enough (lacking the thiazo-ring) so it is not clear that the mechanism is comparable.
Definition (NCI)An indole derivative of chlorosulphonamide and a sulfamyl diuretic with antihypertensive activity. Indapamide may interact directly with the subunits of delayed rectifier potassium channels, thereby blocking both slow and rapid K+ (IKs and IKr) currents through the channels. Through the homeostasis mechanism in balancing total ion concentration (Ca++, Na+), it reduces vascular hyperreactivity and peripheral and arterial vascular resistance, possibly by inhibiting transmembrane ionic influx, probably calcium ions, and stimulating prostaglandin E2 synthesis, thereby causing vasodilatation. Indapamide exerts its diuretic effect by inhibiting reabsorption of sodium and chloride, primarily as a result of action on the cortical diluting segment of the renal distal tubule, thereby promoting urinary excretion of water and electrolytes.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD007190
EnglishIndapamide, INDAPAMIDE PREPARATION, Metindamide
Spanishindapamida
Parent ConceptsIndoles (C0021242), Sulfonamides (C0038760), Thiazide Diuretics (C0012802), Sulfonamide diuretic (C0304485)
SourcesMSH, MTHFDA, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Metolazone (C0025854)

Definition (MSH)A quinazoline-sulfonamide that is considered a thiazide-like diuretic which is long-acting so useful in chronic RENAL FAILURE. It also tends to lower BLOOD PRESSURE and increase POTASSIUM loss.
Definition (NCI)A sulfonamide derivative and a member of the quinazoline family, chemically related to thiazides, with diuretic, antihypertensive and antiurolithic properties. By blocking Na/Cl transporter, metolazone inhibits electrolyte reabsorption in the distal convoluted tubule and proximal tubule in the kidney. This prevents salt and fluid retention, leading to decreased plasma volume and reduce peripheral resistance of blood vessels, thereby reversal of hypertension.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD008788
EnglishMetolazone, METOLAZONE PREPARATION
Spanishmetolazona
Parent ConceptsSulfonamides (C0038760), Quinazolinones (C1720912), Thiazide Diuretics (C0012802), Quinazolines (C0034407), Sulfonamide diuretic (C0304485), Quinazoline diuretic product (C0304486), Saluretic drug (C0304487)
SourcesCSP, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Zaroxolyn (C0701383)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD008788
EnglishZaroxolyn
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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