Names and pronunciation
(hye-droe-klor-oh-thye′a-zide) Urozide
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Drug reference
(hye-droe-klor-oh-thye′a-zide) Urozide
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Func. class.: Thiazide diuretic, antihypertensive
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Chem. class.: Sulfonamide derivative
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ACTION: Acts on distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, potassium
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USES: Edema, hypertension, diuresis, HF; idiopathic lower extremity edema therapy
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Unlabeled uses: Diabetes insipidus, hypercalciuria, nephrolithiasis, premen- strual syndrome, renal calculus
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CONTRAINDICATIONS: Hyper- sensitivity to thiazides or sulfonamides, pre- eclampsia, anuria, renal decompensation Precautions: Pregnancy, breastfeed- ing, hypokalemia, renal/hepatic disease, gout, COPD, LE, diabetes mellitus, hyperlipidemia, CCr <30 mL/min, hypo- magnesemia
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SIDE EFFECTS CNS: Drowsiness, paresthesia, depression, headache, dizziness, fatigue, weakness, fever CV: Irregular pulse, orthostatic hypo- tension, palpitations, volume depletion, allergic myocarditis EENT: Blurred vision ELECT: Hypokalemia, hypercalcemia, hyponatremia, hypochloremia, hypomag- nesemia GI: Nausea, vomiting, anorexia, consti- pation, diarrhea, cramps, pancreati- tis, GI irritation, hepatitis, jaundice GU: Urinary frequency, polyuria, ure- mia, glucosuria, hyperuricemia, renal failure, erectile dysfunction HEMA: Aplastic anemia, hemolytic ane- mia, leukopenia, agranulocytosis, throm- bocytopenia, neutropenia INTEG: Rash, urticaria, purpura, photo- sensitivity, alopecia, erythema multiforme META: Hyperglycemia, hyperuricemia, increased creatinine, BUN SYST: Stevens-Johnson syndrome
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INTERACTIONS Increase: hyperglycemia, hyperuricemia, hypotension risk—diazoxide Increase: hypokalemia risk—corticoste- roids, amphotericin B, topiramate Increase: toxicity—lithium, non-depo- larizing skeletal muscle relaxants, car- diac glycosides Increase: hypersensitivity reaction risk with allopurinol, monitor level Decrease: thiazide effect—NSAIDs, mon- itor renal function Increase: effects—loop diuretics Decrease: effects—antidiabetics, moni- tor glucose Decrease: thiazides absorption—chole- styramine, colestipol Drug/Herb Increase: severe hypokalemia—licorice Drug/Lab Test Increase: parathyroid test, uric acid, cal- cium, glucose, cholesterol, triglycerides Decrease: potassium, sodium, HB, WBC, platelets
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TREATMENT OF OVERDOSE: Lavage if recently ingested orally; moni- tor electrolytes; administer dextrose in saline; monitor hydration, CV, renal sta- tus; provide supportive care HIGH ALERT
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DOSAGE AND ROUTES Hypertension Adult/adolescent: PO 12.5-25 mg/day, may increase to 50 mg/day in 1-2 divided doses, max 100 mg/day Edema Adult: PO 25-100 mg in 1-2 divided doses Child 6 mo-12 yr: PO 1-2 mg/kg/day in 1 or 2 divided doses, may increase to max 37.5 mg/day (child 6 mo-2 yr) 100 mg/ day (child 2-12 yr) Child <6 mo: PO 1-3 mg/kg/day in 1 or 2 divided doses, max 37.5 mg/day Renal dose: • Adult: PO CCr <30 mL/min, do not use; not effective
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Available forms: Tabs 12.5, 25, 50, 100 mg; caps 12.5 mg
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Administer: PO route • In AM to avoid interference with sleep if using product as a diuretic; tab may be crushed, mixed with food • Potassium replacement if potassium <3 mg/dL, replace magnesium if needed • With food; if nausea occurs, absorp- tion may be decreased slightly
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Assess: • B/P, pulse; weight, I&O, electrolytes baseline and periodically to determine fluid loss; effect of product may be de- creased if used daily • Hypersensitivity to sulfonamides: if skin rash occurs, discontinue product; fatal Stevens-Johnson syndrome may occur • Hypertension: B/P lying, standing; postural hypotension may occur • Blood studies: BUN, blood glucose, CBC, serum creatinine, uric acid • Signs of hypokalemia: postural hypo- tension, malaise, fatigue, tachycardia, leg cramps, weakness, dehydration; monitor potassium • Signs of metabolic alkalosis, restless- ness, drowsiness • Confusion, especially in geriatric pa- tients; take safety precautions if needed • Beers: use with caution in older adults; may exacerbate or cause syn- drome of inappropriate antidiuretic hor- mone secretion or hyponatremia • Pregnancy, breastfeeding: may af- fect fetus, crosses placental barrier, if using for hypertension before pregnancy continue; do not breastfeed
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Evaluate: • Therapeutic response: improvement in edema of feet, legs, sacral area daily; decreased B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To rise slowly from lying or sitting position to prevent postural hypo tension • To notify prescriber of muscle weak- ness, cramps, nausea, dizziness; hypoka- lemia is common; rash • That product may be taken with food or milk • To use sunscreen for photosensitivity • That blood glucose may be increased in diabetics • To take early in day at same time of day to avoid nocturia • To avoid alcohol, OTC meds unless approved by prescriber • To monitor weight and notify pre- scriber of changes • To discuss dietary potassium require- ments • That follow-ups and routine lab tests will be required • How to take B/P, to continue with other medical regimens (weight loss, exercise), that effect in hypertension may take several weeks
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PHARMACOKINETICS PO: Onset 2-6 hr, peak 1-5 hr, duration 6-12 hr, half-life 6-15 hr, excreted H unchanged by kidneys, crosses placenta, enters breast milk
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• Adult: PO CCr <30 mL/min, do not use; not effective
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