Drug Guide
Trichlormethiazide
Classification
Therapeutic: antihypertensive, diuretic
Pharmacological: thiazide diuretic
FDA Approved Indications
- edema associated with congestive heart failure, liver cirrhosis, or renal disease
- hypertension
Mechanism of Action
Trichlormethiazide inhibits sodium reabsorption in the distal tubules of the nephron, leading to increased excretion of sodium, chloride, and water, thereby reducing blood volume and blood pressure.
Dosage and Administration
Adult: Typically 2.5 to 5 mg once daily, titrated based on response.
Pediatric: Use is not well established; consult specific pediatric guidelines.
Geriatric: Start at lower doses due to increased sensitivity and risk of electrolyte disturbances.
Renal Impairment: Adjust dose accordingly; monitor closely.
Hepatic Impairment: Use with caution; no specific dose adjustments established.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, minimal protein binding.
Metabolism: Minimal hepatic metabolism.
Excretion: Primarily renal; unchanged drug in urine.
Half Life: Approximately 3-6 hours.
Contraindications
- Hypersensitivity to sulfonamides or thiazides
- Anuria
Precautions
- Electrolyte imbalances (hypokalemia, hyponatremia), gout, diabetic patients, kidney impairment, pregnancy and lactation; monitor blood pressure, electrolytes, renal function regularly.
Adverse Reactions - Common
- Electrolyte disturbances (hypokalemia, hyponatremia, hypomagnesemia) (Common)
- Hyperuricemia (Common)
- Hypersensitivity reactions (Uncommon)
Adverse Reactions - Serious
- Electrolyte imbalance leading to arrhythmias (Serious, requires monitoring)
- Pancreatitis (Rare)
- Blood dyscrasias (agranulocytosis, aplastic anemia) (Rare)
Drug-Drug Interactions
- Other antihypertensives, corticosteroids, lithium, digitalis
Drug-Food Interactions
- None significant
Drug-Herb Interactions
- Potential interactions with diuretic herbs; consult specific herb-drug interaction resources
Nursing Implications
Assessment: Monitor blood pressure, electrolytes (potassium, sodium), renal function.
Diagnoses:
- Risk for electrolyte imbalance, risk for dehydration, ineffective tissue perfusion.
Implementation: Administer with food to reduce gastrointestinal upset. Monitor intake and output.
Evaluation: Assess blood pressure and electrolytes periodically; ensure therapeutic goals are met.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of electrolyte imbalance (muscle weakness, irregular heartbeat).
- Maintain adequate hydration.
- Follow up for blood tests and monitoring.
Special Considerations
Black Box Warnings:
- Electrolyte and volume depletion; may cause hypotension, dehydration, and electrolyte disturbances.
Genetic Factors: No specific known genetic factors significantly alter response.
Lab Test Interference: May affect serum glucose, electrolytes, uric acid levels.
Overdose Management
Signs/Symptoms: Severe electrolyte depletion, dehydration, hypotension.
Treatment: Administer IV fluids, correct electrolyte imbalances, monitor cardiac status. No specific antidote.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable under recommended storage conditions.