DIUCARDIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DIUCARDIN (DIUCARDIN).
Thiazide diuretic that inhibits the Na+/Cl- symporter in the distal convoluted tubule, reducing sodium and chloride reabsorption, leading to increased diuresis and vasodilation.
| Metabolism | Primarily metabolized via cytochrome P450 (CYP3A4) and other minor pathways; undergoes hepatic metabolism to inactive metabolites. |
| Excretion | Primarily renal excretion: approximately 60-70% of the dose is excreted unchanged in urine within 24 hours. Biliary/fecal elimination accounts for about 20-30%, with some enterohepatic circulation. |
| Half-life | Terminal elimination half-life is approximately 18-24 hours in normal renal function. This prolongs significantly in renal impairment, requiring dose adjustment. |
| Protein binding | Approximately 95-98% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Volume of distribution is about 3-4 L/kg, indicating extensive tissue distribution. Clinical meaning: large Vd suggests drug penetrates well into interstitial and intracellular spaces. |
| Bioavailability | Oral bioavailability is 60-80% due to first-pass metabolism. Intravenous bioavailability is 100%. |
| Onset of Action | Oral: Onset of diuresis occurs within 1 hour, with peak effect at 2-4 hours. Intravenous: Onset within 15 minutes, peak at 30 minutes. |
| Duration of Action | Duration is 6-12 hours after oral administration. The antihypertensive effect lasts 24 hours with once-daily dosing. |
Hydrochlorothiazide 25-50 mg orally once daily, titrated based on response. Maximum dose 100 mg/day.
| Dosage form | TABLET |
| Renal impairment | GFR 30-50 mL/min: reduce dose by 50%; GFR <30 mL/min: avoid use (ineffective). |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: reduce dose by 50%; Class C: avoid use due to risk of electrolyte disturbances. |
| Pediatric use | Children >6 months: 1-2 mg/kg/day orally in 2 divided doses; maximum 50 mg/day. |
| Geriatric use | Start with 12.5-25 mg orally once daily; monitor electrolytes and renal function closely; avoid doses >50 mg/day. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DIUCARDIN (DIUCARDIN).
| Breastfeeding | Excreted in breast milk in low concentrations (M/P ratio ~0.5). No adverse effects reported in infants; use with caution, especially in neonates with immature renal function. |
| Teratogenic Risk | First trimester: Limited human data; animal studies show no teratogenicity. Avoid use unless benefit outweighs risk. Second/third trimester: Possible fetal hypotension, electrolyte disturbances (e.g., hypokalemia), hyponatremia, and decreased amniotic fluid volume. Avoid use for pregnancy-induced hypertension. |
■ FDA Black Box Warning
None
| Serious Effects |
["Anuria","Severe renal impairment (creatinine clearance <30 mL/min)","Sulfonamide hypersensitivity","Hepatic coma or precoma"]
| Precautions | ["Electrolyte imbalances (hypokalemia, hyponatremia, hypomagnesemia)","Hyperuricemia and potential gout attacks","Sulfonamide allergy cross-sensitivity","Photosensitivity reactions","Systemic lupus erythematosus exacerbation"] |
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| Fetal Monitoring |
| Maternal: Blood pressure, serum electrolytes (especially potassium, sodium), renal function, fluid balance. Fetal: Ultrasonography to assess amniotic fluid volume and fetal growth; non-stress test or biophysical profile as indicated. |
| Fertility Effects | No known adverse effects on human fertility. Animal studies showed no impairment. |