HYDRODIURIL
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HYDRODIURIL (HYDRODIURIL).
Inhibits sodium-chloride symporter in the distal convoluted tubule of the kidney, increasing excretion of sodium and water, reducing plasma volume and cardiac output.
| Metabolism | Primarily eliminated unchanged by renal excretion; minor hepatic metabolism |
| Excretion | Renal: approximately 95% eliminated unchanged in urine via glomerular filtration and tubular secretion; biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life is approximately 5.6–14.8 hours (mean ~10 hours); clinically, duration of diuresis correlates with half-life, allowing once or twice daily dosing. |
| Protein binding | Approximately 68% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Vd is about 3–4 L/kg; indicates extensive extravascular distribution, with accumulation in erythrocytes and kidneys. |
| Bioavailability | Oral: approximately 50–80% (mean ~65%); variable due to first-pass metabolism and food effects. |
| Onset of Action | Oral: diuresis begins within 2 hours, peak effect at 4–6 hours. |
| Duration of Action | Oral: diuretic effect lasts 6–12 hours; clinical note: antihypertensive effect may persist up to 24 hours with chronic therapy. |
25-100 mg orally once daily. For hypertension: 12.5-25 mg once daily.
| Dosage form | TABLET |
| Renal impairment | eGFR 30-50 mL/min: use with caution; eGFR <30 mL/min: not recommended (thiazides ineffective). Dose reduction may be needed. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: use with caution, consider reduced initial dose; Child-Pugh C: avoid use due to risk of electrolyte imbalances and hepatic encephalopathy. |
| Pediatric use | 1-2 mg/kg orally once daily; maximum 50 mg/day for children <12 years. For hypertension: 0.5-1 mg/kg once daily. |
| Geriatric use | Initiate at 12.5 mg orally once daily, increase slowly. Monitor electrolytes and renal function. Avoid in patients with severe renal impairment. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HYDRODIURIL (HYDRODIURIL).
| Breastfeeding | Hydrochlorothiazide is excreted into human breast milk in small amounts (M/P ratio approximately 0.5-1.0). Theoretical risk of neonatal electrolyte disturbances and thrombocytopenia. Use with caution in breastfeeding; alternative agents are preferred. |
| Teratogenic Risk | First trimester: Thiazides cross the placenta. Potential association with congenital anomalies (e.g., cleft lip/palate) based on some studies; however, data are conflicting. Second and third trimesters: Risk of fetal or neonatal jaundice, thrombocytopenia, electrolyte disturbances. May cause decreased placental perfusion. Avoid in pregnancy-induced hypertension due to reduced maternal blood volume. |
■ FDA Black Box Warning
None
| Serious Effects |
["Anuria","Hypersensitivity to hydrochlorothiazide or sulfonamide-derived drugs","Severe renal impairment (CrCl <30 mL/min)"]
| Precautions | ["Electrolyte disturbances (hypokalemia, hyponatremia, hypomagnesemia)","Hypersensitivity reactions (including anaphylaxis)","Acute angle-closure glaucoma","Systemic lupus erythematosus exacerbation","Photosensitivity","Sulfonamide cross-reactivity"] |
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| Fetal Monitoring | Monitor maternal blood pressure, serum electrolytes (especially potassium, sodium), renal function, and hydration status. Monitor fetal growth and amniotic fluid volume via ultrasound. Assess for signs of placental insufficiency. |
| Fertility Effects | No direct evidence of impaired fertility in humans. In animal studies, no adverse reproductive effects at therapeutic doses. Thiazides may reduce renal function and electrolyte balance but do not typically affect ovulation or spermatogenesis. |