HYDRO-RIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HYDRO-RIDE (HYDRO-RIDE).
Thiazide diuretic that inhibits sodium-chloride symporter in the distal convoluted tubule, increasing excretion of sodium and water.
| Metabolism | Not extensively metabolized; small amount undergoes hepatic metabolism. |
| Excretion | Primarily renal (50% unchanged; remainder as glucuronide conjugate); biliary/fecal <10%. |
| Half-life | Terminal half-life 4-6 hours (prolonged in renal impairment). |
| Protein binding | 95% (mainly albumin). |
| Volume of Distribution | 0.15 L/kg (indicates high plasma binding; minimal extravascular distribution). |
| Bioavailability | Oral: 60-70% (due to first-pass metabolism); IV: 100%. |
| Onset of Action | Oral: 30-60 minutes; IV: 5-10 minutes; IM: 20-30 minutes. |
| Duration of Action | 6-12 hours (dose-dependent; increased with GFR<30 mL/min). |
Initiate at 12.5-25 mg orally once daily. Titrate to 50-100 mg once daily. Maximum 200 mg per day.
| Dosage form | TABLET |
| Renal impairment | GFR 30-60: Reduce dose by 50%. GFR 15-30: Reduce dose by 75%. GFR <15: Contraindicated. |
| Liver impairment | Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50%. Child-Pugh C: Contraindicated. |
| Pediatric use | 1 mg/kg orally once daily, not to exceed 25 mg/day. Titrate up to 2 mg/kg/day (max 50 mg) if needed. |
| Geriatric use | Initiate at 12.5 mg orally once daily. Titrate cautiously. Monitor renal function and electrolytes. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HYDRO-RIDE (HYDRO-RIDE).
| Breastfeeding | Excreted in breast milk in low concentrations; M/P ratio not established. Caution in preterm infants or those with jaundice due to potential bilirubin displacement. |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: potential for congenital anomalies (not well studied). Second and third trimesters: risk of fetal jaundice, thrombocytopenia, electrolyte disturbances. Avoid in preeclampsia due to reduced placental perfusion. |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
["Anuria","Hypersensitivity to hydrochlorothiazide or sulfonamides"]
| Precautions | ["Electrolyte disturbances (hypokalemia, hyponatremia, hypomagnesemia)","Hyperuricemia","Acute angle-closure glaucoma","Systemic lupus erythematosus exacerbation","Sulfonamide allergy cross-reactivity"] |
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| Monitor maternal serum electrolytes, uric acid, blood pressure, fetal growth ultrasound, and amniotic fluid index. |
| Fertility Effects | No documented adverse effects on fertility in humans. |