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Thiazide Diuretic

Aka: Thiazide Diuretic, Hydrochlorothiazide, Chlorthiazide, Chlorthalidone, Indapamide, Metolazone, Zaroxolyn
  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.
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
Russian KHLORTALIDON, FTALAMUDIN, KHLORFTALIDOLON, ФТАЛАМУДИН, ХЛОРТАЛИДОН, ХЛОРФТАЛИДОЛОН
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
Croatian KLORTALIDON
Polish Chlortalidon
Spanish clortalidona (producto), clortalidona (sustancia), clortalidona, Clorftalidolona, Clortalidona, Ftalamudina
German Chlorphthalidolon, Chlortalidon, Chlorthalidon, Phthalamudin
Italian Clortalidone
Portuguese Clorftalidolona, Clortalidona, Ftalamudina
Sources
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.
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
Russian INDAPAMID, METINDAMID, ИНДАПАМИД, МЕТИНДАМИД
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
Sources
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 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
Russian NEFRIKS, GIPOTIAZID, EZIDREKS, GIDROKHLOROTIAZID, DIKHLOTIAZID, GIDROKHLORTIAZID, ГИДРОХЛОРОТИАЗИД, ГИДРОХЛОРТИАЗИД, ГИПОТИАЗИД, НЕФРИКС, ЭЗИДРЕКС, ДИХЛОТИАЗИД
Japanese ヒドロクロロチアジド
Italian HCTZ, Diidroclorotiazide, Idroclorotiazide
Croatian HIDROKLOROTIAZID
Polish Hydrochlorotiazyd
French Hydrochlorothiazide
German Hydrochlorothiazid
Portuguese Hidroclorotiazida
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Zaroxolyn (C0701383)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D008788
English zaroxolyn, Zaroxolyn
Sources
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.
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
Russian METOLAZON, МЕТОЛАЗОН
Japanese メトラゾン
Polish Metolazon
Spanish metolazona (producto), metolazona (sustancia), metolazona, Metolazona
French Métolazone
German Metolazon
Italian Metolazone
Portuguese Metolazona
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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