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Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.
Hydrochlorothiazide is used to treat high blood pressure (hypertension).
Hydrochlorothiazide is also used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen.
You should not use hydrochlorothiazide if you are unable to urinate.
Before using hydrochlorothiazide, tell your doctor if you have liver disease, kidney disease, glaucoma, asthma or allergies, gout, diabetes, or if you are allergic to sulfa drugs or penicillin.
Avoid drinking alcohol, which can increase some of the side effects of this medicine.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
There are many other drugs that can interact with hydrochlorothiazide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.
If you are being treated for high blood pressure, keep using hydrochlorothiazide even if you feel fine. High blood pressure often has no symptoms.
You should not use hydrochlorothiazide if you are allergic to it, or if you are unable to urinate.
To make sure hydrochlorothiazide is safe for you, tell your doctor if you have:
kidney disease;
liver disease;
gout;
glaucoma;
low levels of potassium or sodium in your blood;
high levels of calcium in your blood;
a parathyroid gland disorder;
diabetes; or
an allergy to sulfa drugs or penicillin.
Hydrochlorothiazide is not expected to be harmful to an unborn baby. However, if you take this medicine during pregnancy, your newborn baby may develop jaundice or other problems. Tell your doctor if you are pregnant or plan to become pregnant while taking hydrochlorothiazide.
Hydrochlorothiazide can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.
This medicine is not approved for use by anyone younger than 18 years old.
Take hydrochlorothiazide exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.
Hydrochlorothiazide is usually taken once per day. Follow your doctor's dosing instructions very carefully.
Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine, which can lead to severely low blood pressure or a serious electrolyte imbalance.
While using hydrochlorothiazide, you may need frequent medical tests and blood pressure checks. Your blood and urine may both be tested if you have been vomiting or are dehydrated.
If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide. You may need to stop using the medicine for a short time.
Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.
Store hydrochlorothiazide at room temperature away from moisture, heat, and freezing. Keep the bottle tightly closed when not in use.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include nausea, weakness, dizziness, dry mouth, thirst, and muscle pain or weakness.
Drinking alcohol with this medicine can cause side effects.
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
Get emergency medical help if you have signs of an allergic reaction to hydrochlorothiazide: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
a light-headed feeling, like you might pass out;
eye pain, vision problems;
jaundice (yellowing of the skin or eyes);
pale skin, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum);
shortness of breath, wheezing, cough with foamy mucus, chest pain;
signs of electrolyte imbalance--dry mouth, thirst, drowsiness, lack of energy, restlessness, muscle pain or weakness, fast heart rate, nausea and vomiting, little or no urine; or
severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common hydrochlorothiazide side effects may include:
nausea, vomiting, loss of appetite;
diarrhea, constipation;
muscle spasm; or
dizziness, headache.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Taking this medicine with other drugs that make you light-headed can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Tell your doctor about all your current medicines and any you start or stop using, especially:
cholestyramine, colestipol;
insulin or oral diabetes medicine;
lithium;
other blood pressure medications;
steroid medicine; or
NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete. Other drugs may interact with hydrochlorothiazide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use hydrochlorothiazide only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Hydrochlorothiazide (www.drugs.com/hydrochlorothiazide.html).
Applies to hydrochlorothiazide: oral capsule, oral tablet
Along with its needed effects, hydrochlorothiazide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking hydrochlorothiazide:
Incidence not known
Some side effects of hydrochlorothiazide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Applies to hydrochlorothiazide: compounding powder, oral capsule, oral solution, oral tablet
Frequency not reported: Electrolyte imbalance, hyperglycemia, glycosuria, hyperuricemia, mild hypokalemia (decrease of 0.5 mEq/L) occurs in up to 50% of patients (and may predispose patients to cardiac arrhythmias), metabolic alkalosis, hyponatremia, hypomagnesemia, hypercalcemia, hyperglycemia, elevated serum uric acid levels, glucose intolerance and a potentially deleterious effect on the lipid profile (i.e., increased serum cholesterol)
Since hydrochlorothiazide may increase total serum cholesterol by 11%, LDL lipoprotein cholesterol by 12%, and VLDL lipoprotein cholesterol levels by 50%, and may reduce insulin secretion, it should be used with caution in diabetic patients and in those with hypercholesterolemia. True glucose intolerance may develop in approximately 3% of patients. It is typically reversible within six months after discontinuation of therapy.
Hyperuricamia may be an important consideration in patients with a history of gout. Hypophosphatasemia and low serum magnesium concentrations may occur, but are usually clinically insignificant except in malnourished patients.
There have been approximately 34 known cases of thiazide-induced pulmonary edema, encompassing 52 episodes of pulmonary edema, as of 1991 (per a 1996 review). In some cases, doses as small as 12.5 mg were associated with the development of pulmonary edema. The average time to onset of this adverse reaction is 44 minutes, women carry a relative risk of 9:1, and the average age is 56 years. The mortality rate is 6%. Some experts consider this side effect grossly underreported.
Frequency not reported: Anaphylactic reactions, necrotizing angiitis (vasculitis and cutaneous vasculitis), respiratory distress (including pneumonitis and pulmonary edema), photosensitivity, fever, urticaria, rash, purpura, toxic epidermal necrolysis
A 67-year-old woman with hypothyroidism, hypercalcemia, depression, and hypertension developed facial erythema, headaches, tremors, confusion and personality changes associated with a new positive ANA and anti-nRNP, and a skin biopsy consistent with lupus erythematosus while taking hydrochlorothiazide (HCTZ), levothyroxine, and amitriptyline. The eruption resolved upon discontinuation of HCTZ, but she later developed a higher ANA titer associated with symptomatic diffuse interstitial pulmonary infiltrates. She was successfully treated with corticosteroids.
Frequency not reported: Erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis (including toxic epidermal necrolysis), alopecia, erythema annular centrifugum, acute eczematous dermatitis, morbilliform and leukocytoclastic vasculitis, phototoxic dermatitis
Although hydrochlorothiazide has been used to treat nephrogenic diabetes insipidus, a case report in which the drug was believed to have caused this condition has been reported.
Frequency not reported: Renal insufficiency (manifest as an increase in serum creatinine and BUN may occur due to hydrochlorothiazide-induced intravascular volume depletion), interstitial nephritis, renal failure
Frequency not reported: Hypotension including orthostatic hypotension (may be aggravated by alcohol, barbiturates, narcotics or antihypertensive drugs), cardiac arrhythmias (including ventricular ectopy and complete AV heart block)
The incidence of premature ventricular contractions as measured by 48-hour ambulatory ECG monitoring is the same in both patients with and without left ventricular hypertrophy despite a similar fall in serum potassium concentrations.
Thiazide diuretics may increase serum cholesterol and triglycerides, resulting in increased risk of cholesterol gallstone formation. Reports of bowel strictures associated with thiazide ingestion were reported in the 1960s although these patients were on a combination hydrochlorothiazide-potassium product.
Frequency not reported: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), diarrhea, vomiting, sialadenitis, cramping, constipation, gastric irritation, nausea, anorexia, acute cholecystitis
Although rare, nearly 40 cases of hydrochlorothiazide-induced noncardiogenic pulmonary edema have been reported including at least two fatalities. Onset of symptoms can occur within minutes (range 10 to 150 minutes) of first exposure to the drug. Associated symptoms include dyspnea, hypoxia, respiratory distress, wheezing, cough, tachypnea, dizziness, nausea, vomiting, diarrhea, and hypotension. Ninety percent of cases have occurred in women at a mean dose of 38.7 mg. Treatment varies, but following discontinuation of hydrochlorothiazide most patients respond, with symptoms resolving in a mean 3.5 days. Rechallenge can result in a more severe reaction, even months to years after the initial exposure. Rechallenge with any thiazide diuretic is not recommended.
Rare (less than 0.1%): Acute noncardiogenic pulmonary edema
There are rare case reports of hydrochlorothiazide-induced immune hemolytic anemia. The following illustrates a fatal case:
A 53-year-old man with hypertension developed nausea, vomiting, diarrhea, and progressive anorexia and weakness associated with scleral icterus, anemia with spherocytosis, dark red urine with proteinuria, bilirubinuria, hemoglobinuria, and elevated lactic dehydrogenase levels 18 months after beginning hydrochlorothiazide and methyldopa. Haptoglobin was less than 50 mg per dl. Direct and indirect Coombs tests were positive. The patient died suddenly; autopsy revealed no obvious cause of death, left ventricular hypertrophy, and mild coronary atherosclerosis.
Rare (less than 0.1%): Allergic vasculitis, hemolytic anemia, development of a rash histologically identical to subacute cutaneous lupus
Frequency not reported: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia
Frequency not reported: Muscle spasm, myalgias
Frequency not reported: Weakness, vertigo, paresthesias, dizziness, headache, restlessness, chills
Frequency not reported: Transient blurred vision, idiosyncratic reactions to hydrochlorothiazide resulting in acute transient myopia and acute angle-closure glaucoma, xanthopsia
Frequency not reported: Impotence
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Hydrochlorothiazide (www.drugs.com/hydrochlorothiazide.html).
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