Management of HTN either alone or in combination with other antihypertensives.
Initial: 12.5mg qd
Start at lower end of dosing range, utilizing 12.5mg increments for further titration
Anuria, sulfonamide hypersensitivity.
May cause idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma; d/c as rapidly as possible. May manifest latent diabetes mellitus (DM). May precipitate azotemia with renal impairment. Hypokalemia reported; monitor serum electrolytes and for sign/symptoms of fluid/electrolyte disturbances. Dilutional hyponatremia may occur in edematous patients in hot weather. Hyperuricemia or acute gout may be precipitated. Caution with hepatic impairment; hepatic coma may occur with severe liver disease. Decreased Ca2+ excretion and changes in parathyroid glands with hypercalcemia and hypophosphatemia reported during prolonged use. D/C prior to parathyroid test.
Weakness, hypotension, pancreatitis, jaundice, diarrhea, vomiting, hematologic abnormalities, anaphylactic reactions, electrolyte imbalance, muscle spasm, vertigo, renal failure, erythema multiforme, transient blurred vision, impotence.
Potentiation of orthostatic hypotension with alcohol, barbiturates, narcotics. Additive effect or potentiation with antihypertensive drugs. Dose adjustment of antidiabetic drugs (oral agents or insulin) may be required. Reduced absorption with cholestyramine or colestipol. Increased risk of electrolyte depletion (eg, hypokalemia) with corticosteroids and adrenocorticotropic hormone. May decrease response to pressor amines (eg, norepinephrine). May increase responsiveness to nondepolarizing skeletal muscle relaxants (eg, tubocurarine). Increased risk of lithium toxicity; avoid with lithium. NSAIDs may reduce diuretic, natriuretic, and antihypertensive effects. May cause hypokalemia, which can sensitize or exaggerate the response of the heart to the toxic effects of digitalis.
PREGNANCY AND LACTATION
Category B, not for use in nursing.
MECHANISM OF ACTION
Thiazide diuretic; blocks reabsorption of Na+ and Cl- ions, thereby increasing the quantity of Na+ traversing the distal tubule and the volume of water excreted. Also decreases the excretion of Ca2+ and uric acid, may increase the excretion of iodide, and may reduce GFR.
Absorption: Well-absorbed; Cmax=70-490ng/mL; Tmax=1-5 hrs. Distribution: Plasma protein binding (40-68%); crosses placenta; found in breast milk. Elimination: Urine (55-77%, >95% unchanged); T1/2=6-15 hrs.
Assess for anuria, known hypersensitivity to sulfonamide-derived drugs, history of penicillin allergy, DM, risk for developing hypokalemia, impaired renal/hepatic function, edema, pregnancy/nursing status, and for possible drug interactions. Obtain baseline serum electrolytes.
Monitor for signs/symptoms of decreased visual acuity, ocular pain, azotemia, hypokalemia, fluid/electrolyte disturbances, dilutional hyponatremia, hyperuricemia or acute gout, and hepatic coma. Periodically monitor serum electrolytes in patients with risk for developing hypokalemia.
Counsel about signs/symptoms of fluid and electrolyte imbalance and advise to seek prompt medical attention.
20-25°C (68-77°F). Protect from light, moisture, freezing, -20°C (-4°F). Keep container tightly closed.
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