Nurses Compass
Drug Guide
Hydrochlorothiazide
Classification
Therapeutic: Diuretic, Antihypertensive
Pharmacological: Thiazide diuretic
FDA Approved Indications
- Edema associated with congestive heart failure, liver cirrhosis, corticosteroid or estrogen therapy
- Hypertension
Mechanism of Action
Inhibits sodium reabsorption in the distal tubules of the kidney, leading to increased excretion of sodium, chloride, and water, which helps reduce blood volume and blood pressure.
Dosage and Administration
Adult: Typically 25-100 mg daily in one or two divided doses, adjusted based on response.
Pediatric: Dosing varies; generally, 1-2 mg/kg/day divided into one or two doses, up to a maximum of 3 mg/kg/day.
Geriatric: Start at lower doses due to increased sensitivity; monitor renal function and electrolytes closely.
Renal Impairment: Dose adjustment may be necessary; monitor renal function regularly.
Hepatic Impairment: Use with caution; no specific dosage adjustment established.
Pharmacokinetics
Absorption: Well absorbed from the gastrointestinal tract.
Distribution: Widely distributed; crosses the placenta; minimal in breast milk.
Metabolism: Minimal hepatic metabolism; primarily excreted unchanged.
Excretion: Excreted mainly unchanged in the urine.
Half Life: about 6-15 hours.
Contraindications
- Anuria
- Hypersensitivity to hydrochlorothiazide or sulfonamides
Precautions
- Electrolyte imbalances (hypokalemia, hyponatremia), gout, diabetes mellitus, renal impairment, sulfa allergy.
Adverse Reactions - Common
- Electrolyte disturbances (hypokalemia, hyponatremia) (Common)
- Hypotension (Common)
- Dizziness or lightheadedness (Common)
Adverse Reactions - Serious
- Electrolyte imbalance leading to arrhythmias (Uncommon)
- Jaundice or hepatotoxicity (Rare)
- Allergic reactions, including rash or Stevens-Johnson syndrome (Rare)
Drug-Drug Interactions
- Other antihypertensives, Lithium, corticosteroids, digitalis
Drug-Food Interactions
- Limit alcohol intake as it may enhance hypotensive effects.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, electrolytes, renal function, and hydration status.
Diagnoses:
- Risk for electrolyte imbalance
- Risk for hypotension
Implementation: Administer with food or milk to reduce gastrointestinal irritation; monitor vital signs and labs as ordered.
Evaluation: Assess blood pressure, electrolyte levels, and signs of adverse reactions regularly.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Eat potassium-rich foods if advised by healthcare provider.
- Report any dizziness, weakness, or irregular heartbeat.
- Avoid alcohol and excessive sunlight exposure.
Special Considerations
Black Box Warnings:
- Sulfonamide hypersensitivity reactions.
Genetic Factors: None specific.
Lab Test Interference: May cause falsely elevated blood glucose and uric acid levels.
Overdose Management
Signs/Symptoms: Electrolyte disturbances, dehydration, hypotension, dizziness.
Treatment: Replace fluids and electrolytes as needed, monitor vital signs, and provide supportive care.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable under recommended conditions.