I. Indications

  1. Hypertension (first-line agent)
  2. Osteoporosis Prevention (investigational)
  3. Severe Congestive Heart Failure
    1. Adjunct to Loop Diuretics
  4. Meniere's Disease

II. 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

III. 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

IV. 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
      2. Two to three times as potent as Hydrochlorothiazide
      3. Conversion: Use 12.5 mg of Chlorthalidone in place of 25 mg Hydrochlorothiazide
    3. Monitor Serum Potassium at baseline, 2 weeks and every 6-12 months (increased Hypokalemia risk)
      1. Decrease sodium intake (high sodium intake is associated with increased potassium losses, as well as worse Blood Pressure control)
      2. Consider Potassium Supplementation (if not on potassium sparing agents or significant Chronic Kidney Disease)
        1. Potassium chloride 20 meq orally daily for Hypokalemia or prevention of Hypokalemia or
        2. Dietary Potassium for prevention of Hypokalemia
      3. Consider using Chlorthalidone in combination with agents balance potassium losses
        1. Additional Blood Pressure lowering required
          1. ACE Inhibitor or Angiotensin Receptor Blocker
          2. Spironolactone or Eplerenone
        2. No additional Blood Pressure lowering required
          1. Triamterene or Amiloride
    4. References
      1. (2012) Presc Lett 19(2): 8
      2. (2014) Presc Lett 21(9): 52
  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)

Images: Related links to external sites (from Google)

Cost: Medications

HYDROCHLOROTHIAZIDE (on 2/10/2012 at Target.com)
HYDROCHLOROTHIAZIDE 12.5 MG* Capsule #30 for $4.00 ($0.13/unit)
HYDROCHLOROTHIAZIDE 25 MG Tablet #30 for $4.00 ($0.13/unit)
HYDROCHLOROTHIAZIDE 50 MG Tablet #30 for $4.00 ($0.13/unit)
INDAPAMIDE (on 2/10/2012 at Target.com)
INDAPAMIDE 1.25 MG Tablet #30 for $4.00 ($0.13/unit)
INDAPAMIDE 2.5 MG Tablet #30 for $4.00 ($0.13/unit)
Captopril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Captopril-Hydrochlorothiazide 50-15mg Tablets #60 for $53.99 ($0.90/unit)
Captopril-Hydrochlorothiazide 25-15mg Tablets #90 for $47.99 ($0.53/unit)
Captopril-Hydrochlorothiazide 25-25mg Tablets #90 for $44.99 ($0.50/unit)
Captopril-Hydrochlorothiazide 50-25mg Tablets #60 for $54.99 ($0.92/unit)
Nadolol-Bendroflumethiazide (on 2/9/2012 at DrugStore.com)
Nadolol-Bendroflumethiazide 40-5mg Tablets #100 for $219.99 ($2.20/unit)
Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Hydrochlorothiazide 50mg Tablets #100 for $15.99 ($0.16/unit)
Hydrochlorothiazide 12.5mg Tablets #100 for $27.99 ($0.28/unit)
Hydrochlorothiazide 12.5mg Capsules #30 for $14.99 ($0.50/unit)
Hydrochlorothiazide 25mg Tablets #100 for $12.99 ($0.13/unit)
Benazepril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Benazepril-Hydrochlorothiazide 5-6.25mg Tablets #30 for $25.91 ($0.86/unit)
Benazepril-Hydrochlorothiazide 10-12.5mg Tablets #30 for $22.99 ($0.77/unit)
Benazepril-Hydrochlorothiazide 20-12.5mg Tablets #30 for $26.99 ($0.90/unit)
Benazepril-Hydrochlorothiazide 20-25mg Tablets #30 for $26.99 ($0.90/unit)
Bisoprolol-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Bisoprolol-Hydrochlorothiazide 10-6.25mg Tablets #30 for $22.99 ($0.77/unit)
Bisoprolol-Hydrochlorothiazide 2.5-6.25mg Tablets #90 for $59.99 ($0.67/unit)
Bisoprolol-Hydrochlorothiazide 5-6.25mg Tablets #90 for $19.96 ($0.22/unit)
Chlorothiazide (on 2/9/2012 at DrugStore.com)
Chlorothiazide 250mg Tablets #30 for $14.99 ($0.50/unit)
Chlorothiazide 500mg Tablets #30 for $14.99 ($0.50/unit)
Methyclothiazide (on 2/9/2012 at DrugStore.com)
Methyclothiazide 5mg Tablets #30 for $54.99 ($1.83/unit)
Metoprolol-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Metoprolol-Hydrochlorothiazide 50-25mg Tablets #60 for $63.99 ($1.07/unit)
Metoprolol-Hydrochlorothiazide 100-25mg Tablets #30 for $50.99 ($1.70/unit)
Metoprolol-Hydrochlorothiazide 100-50mg Tablets #30 for $55.99 ($1.87/unit)
Quinapril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Quinapril-Hydrochlorothiazide 10-12.5mg Tablets #30 for $35.99 ($1.20/unit)
Quinapril-Hydrochlorothiazide 20-25mg Tablets #90 for $90.99 ($1.01/unit)
Quinapril-Hydrochlorothiazide 20-12.5mg Tablets #90 for $86.99 ($0.97/unit)
Amiloride-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Amiloride-Hydrochlorothiazide 5-50mg Tablets #90 for $31.99 ($0.36/unit)
Methyldopa-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Methyldopa-Hydrochlorothiazide 250-25mg Tablets #60 for $22.99 ($0.38/unit)
Moexipril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Moexipril-Hydrochlorothiazide 7.5-12.5mg Tablets #30 for $37.99 ($1.27/unit)
Moexipril-Hydrochlorothiazide 15-12.5mg Tablets #100 for $109.98 ($1.10/unit)
Moexipril-Hydrochlorothiazide 15-25mg Tablets #30 for $36.99 ($1.23/unit)
Enalapril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Enalapril-Hydrochlorothiazide 10-25mg Tablets #30 for $27.99 ($0.93/unit)
Enalapril-Hydrochlorothiazide 5-12.5mg Tablets #30 for $23.99 ($0.80/unit)
Lisinopril-Hydrochlorothiazide (on 2/9/2012 at DrugStore.com)
Lisinopril-Hydrochlorothiazide 10-12.5mg Tablets #30 for $23.99 ($0.80/unit)
Lisinopril-Hydrochlorothiazide 20-12.5mg Tablets #30 for $21.99 ($0.73/unit)
Lisinopril-Hydrochlorothiazide 20-25mg Tablets #30 for $21.99 ($0.73/unit)
Chlorthalidone (on 2/9/2012 at DrugStore.com)
Chlorthalidone 50mg Tablets #30 for $26.99 ($0.90/unit)
Chlorthalidone 25mg Tablets #90 for $45.99 ($0.51/unit)
Chlorthalidone 100mg Tablets #30 for $33.99 ($1.13/unit)
Atenolol-Chlorthalidone (on 2/9/2012 at DrugStore.com)
Atenolol-Chlorthalidone 50-25mg Tablets #30 for $13.99 ($0.47/unit)
Atenolol-Chlorthalidone 100-25mg Tablets #90 for $30.99 ($0.34/unit)
Indapamide (on 2/9/2012 at DrugStore.com)
Indapamide 1.25mg Tablets #90 for $15.99 ($0.18/unit)
Indapamide 2.5mg Tablets #30 for $13.99 ($0.47/unit)
Metolazone (on 2/9/2012 at DrugStore.com)
Metolazone 5mg Tablets #30 for $37.99 ($1.27/unit)
Metolazone 2.5mg Tablets #30 for $42.99 ($1.43/unit)
Zaroxolyn (on 2/9/2012 at DrugStore.com)
Zaroxolyn 10mg Tablets #30 for $79.99 ($2.67/unit)
Zaroxolyn 5mg Tablets #30 for $88.99 ($2.97/unit)
Zaroxolyn 2.5mg Tablets #30 for $94.99 ($3.17/unit)

Ontology: 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.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D002752
SnomedCT 387324004, 57893000
English Chlorphthalidolone, Chlorthalidone, Oxodoline, Phthalamudine, chlorthalidone, Benzenesulfonamide, 2-chloro-5-(2,3-dihydro-1-hydroxy-3-oxo-1H-isoindol-1-yl)-, Chlortalidone, Benzenesulfonamide, 2-Chloro-5-(2,3-dihydro-1-hydroxy-3-oxo-1H-isoindol-1-yl)-, Benzenesulfonamide, 2-chloro-5-(1-hydroxy-3-oxo-1-isoindolinyl)-, chlorthalidone (medication), CHLORTHALIDONE, Chlorthalidone [Chemical/Ingredient], chlortalidone, Chlorthalidone (product), Chlorthalidone (substance)
Swedish Klortalidon
Czech chlorthalidon
Finnish Klooritalidoni
French Phthalamudine, Chlorphthalidolone, Chlortalidone
Japanese クロルサリドン, クロルフタリドロン, フタルアムジン, クロルタリドン
Polish Chlortalidon
Spanish clortalidona (producto), clortalidona (sustancia), clortalidona, Clorftalidolona, Clortalidona, Ftalamudina
German Chlorphthalidolon, Chlortalidon, Chlorthalidon, Phthalamudin
Italian Clortalidone
Portuguese Clorftalidolona, Clortalidona, Ftalamudina

Ontology: Thiazide Diuretics (C0012802)

Definition (MSH) Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D049993
SnomedCT 372747003, 45518007, 371342005, 350616005, 371343000
English THIAZIDE DIURETICS, Thiazide diuretic, NOS, THIAZIDES/RELATED DIURETICS, thiazides, thiazide diuretics, 722 THIAZIDE DIURETICS, thiazide diuretics (medication), THIAZIDE DIURETIC, [CV701] THIAZIDES/RELATED DIURETICS, Thiazide Diuretic, Thiazide Diuretic [EPC], Thiazide-class Diuretic, thiazide diuretic, diuretic thiazide, diuretics thiazide, diuretic thiazides, Thiazide diuretic, Thiazide diuretic (substance), Thiazide diuretic (product), Thiazide diuretic product, Thiazide Diuretics, Thiazide diuretic product (product), Thiazide-related diuretic (substance), Thiazide-related diuretic product (product), Thiazide-related diuretic product, Thiazide-related diuretic (product), Thiazide-related diuretic, Thizaide-related diuretic, Benzothiadiazine Diuretics, Diuretics, Benzothiadiazine, Diuretics, Thiazide
French Diurétiques thiazides, Diurétiques thiazidiques, Benzothiadiazides, Diurétiques thiaziques
Spanish diurético relacionado con las tiazidas (producto), diurético relacionado con las tiazidas, diurético tipo tiazida, diurético tiazídico (sustancia), diurético tiazídico, producto (producto), diurético tiazídico, producto, diurético tiazídico, diurético tipo tiazida (producto), diurético tipo tiazida (sustancia), producto con diurético tiazídico (producto), producto con diurético tiazídico, diurético tiazídico (producto), tiazida
Czech diuretika thiazidová
German Diuretika, Thiazid-, Benzothiadiazindiuretika, Thiaziddiuretika
Italian Diuretici tiazidici

Ontology: 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 is used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism.
Definition (CHV) drug that increases voiding
Definition (CHV) drug that increases voiding
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.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D006852
SnomedCT 387525002, 91667005
English Dichlothiazide, Dihydrochlorothiazide, HCTZ, Hydrochlorothiazide, 2H-1,2,4-Benzothiadiazine-7-sulfonamide, 6-chloro-3,4-dihydro-, 1,1-dioxide, 6-Chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide, hydrochlorothiazide, hydrochlorothiazide (medication), HYDROCHLOROTHIAZIDE, Hydrochlorothiazide [Chemical/Ingredient], hctz, Hydrochlorothiazide (product), Hydrochlorothiazide (substance)
Spanish Hidroclorotiazida, hidroclorotiazida (producto), hidroclorotiazida (sustancia), hidroclorotiazida
Swedish Hydroklortiazid
Czech hydrochlorthiazid
Finnish Hydroklooritiatsidi
Japanese ヒドロクロロチアジド
Italian HCTZ, Diidroclorotiazide, Idroclorotiazide
Polish Hydrochlorotiazyd
French Hydrochlorothiazide
German Hydrochlorothiazid
Portuguese Hidroclorotiazida

Ontology: 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.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D007190
SnomedCT 387419003, 74213004
English Indapamide, Metindamide, Benzamide, 3-(aminosulfonyl)-4-chloro-N-(2,3-dihydro-2-methyl-1H-indol-1-yl)-, indapamide, indapamide (medication), INDAPAMIDE, Indapamide [Chemical/Ingredient], Indapamide (product), Indapamide (substance)
Swedish Indapamid
Czech indapamid
Finnish Indapamidi
Japanese インダパミド, メチンダミド
Polish Indapamid
Spanish indapamida (producto), indapamida (sustancia), indapamida, Indapamida, Metindamida
French Indapamide
German Indapamid, Metindamid
Italian Indapamide
Portuguese Indapamida, Metindamida

Ontology: 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.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D008788
SnomedCT 22198003, 387123003
English Metolazone, 6-Quinazolinesulfonamide, 7-chloro-1,2,3,4-tetrahydro-2-methyl-3-(2-methylphenyl)-4-oxo-, 2-Methyl-3-o-tolyl-6-sulfamyl-7-chloro-1,2,3,4-tetrahydro-4-quinazolinone, 7-Chloro-1,2,3,4-tetrahydro-2-methyl-3-(2-methylphenyl)-4-oxo-6-quinazolinesulfonamide, 7-Chloro-1,2,3,4-tetrahydro-2-methyl-4-oxo-3-o-tolyl-6-quinazolinesulfonamide, metolazone, Metolazene, metolazone (medication), METOLAZONE, Metolazone [Chemical/Ingredient], Metolazone (product), Metolazone (substance)
Swedish Metolazon
Czech metolazon
Finnish Metolatsoni
Japanese メトラゾン
Polish Metolazon
Spanish metolazona (producto), metolazona (sustancia), metolazona, Metolazona
French Métolazone
German Metolazon
Italian Metolazone
Portuguese Metolazona

Ontology: Thiazides (C0541746)

Definition (CSP) family of bicyclic compounds in which one ring has a sulfony l and 2 nitrogen heteroatoms; they inhibit renal sodium resorption, and so are used as diuretics and antihypertensives.
Definition (MSH) Heterocyclic compounds with SULFUR and NITROGEN in the ring. This term commonly refers to the BENZOTHIADIAZINES that inhibit SODIUM-POTASSIUM-CHLORIDE SYMPORTERS and are used as DIURETICS.
Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D049971
Italian Tiazidi
Swedish Tiazider
English thiazide, Thiazides, Thiazides [Chemical/Ingredient], thiazides
Czech thiazidy
Finnish Tiatsididiureetit
Croatian Not Translated[Thiazides]
Polish Tiazydu pochodne
Portuguese Tiazidas
German Thiazide
French Thiazides
Spanish Tiacidas, Tiazidas

Ontology: Zaroxolyn (C0701383)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
MSH D008788
English zaroxolyn, Zaroxolyn