RENESE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for RENESE (RENESE).
Thiazide diuretic that inhibits the sodium-chloride symporter in the distal convoluted tubule, reducing sodium and chloride reabsorption, leading to increased diuresis and vasodilation.
| Metabolism | Not extensively metabolized; primarily eliminated unchanged by renal excretion. |
| Excretion | Renal: ~85% unchanged; fecal: ~15% (via bile). |
| Half-life | 13–15 hours; prolonged in renal impairment (CrCl <30 mL/min: up to 30–40 hours). |
| Protein binding | 94% bound to albumin and α1-acid glycoprotein. |
| Volume of Distribution | 0.8–1.2 L/kg; indicates extensive extravascular distribution. |
| Bioavailability | Oral: 90–95%. |
| Onset of Action | Oral: 1–2 hours; IV: 15–30 minutes. |
| Duration of Action | Oral: 12–24 hours; IV: 6–12 hours. Antihypertensive effect persists for up to 24 hours. |
| Molecular Weight | 380.91 Da |
Initial 2.5-5 mg orally once daily; increase by 2.5-5 mg every 2-4 weeks up to 20 mg/day as needed.
| Dosage form | TABLET |
| Renal impairment | eGFR 30-59 mL/min: reduce dose by 50%; eGFR <30 mL/min: avoid use. |
| Liver impairment | Child-Pugh class B: reduce dose by 50%; Child-Pugh class C: avoid use. |
| Pediatric use | 0.1 mg/kg orally once daily (max 5 mg/day) for hypertension; not recommended for children <6 years. |
| Geriatric use | Start at 2.5 mg orally once daily; titrate slowly due to increased risk of hypotension and electrolyte disturbances. |
| 1st trimester | Avoid; thiazide diuretics may cause decreased placental perfusion and fetal electrolyte disturbances; animal studies show risk, human data limited. |
| 2nd trimester | Avoid; use only if clearly needed as thiazides may cause maternal hypovolemia and placental hypoperfusion. |
| 3rd trimester | Avoid; associated with fetal electrolyte abnormalities, jaundice, thrombocytopenia, and maternal volume depletion. |
Clinical note
Comprehensive clinical and safety monograph for RENESE (RENESE).
| Placental transfer | Crosses placenta; likely via passive diffusion; known to achieve fetal serum concentrations similar to maternal. |
| Breastfeeding | Excreted in breast milk in low concentrations; may suppress lactation; caution in high doses due to risk of neonatal electrolyte imbalance. |
■ FDA Black Box Warning
None.
| Serious Effects |
AnuriaHypersensitivity to thiazide diuretics or sulfonamidesHepatic coma or precoma
| Precautions | May cause volume depletion and electrolyte imbalances (hypokalemia, hyponatremia, hypomagnesemia), Increased risk of hyperuricemia and gout, May exacerbate hypercalcemia, Can precipitate or worsen metabolic alkalosis, Use caution in patients with hepatic impairment or renal disease, May increase lithium toxicity, Photosensitivity reactions reported |
| Food/Dietary | Avoid excessive intake of high-potassium foods (e.g., bananas, oranges, spinach) if on potassium-sparing diuretics, but with thiazide monotherapy, hypokalemia is risk so potassium-rich foods may be beneficial. Limit sodium intake to reduce edema. Alcohol and caffeine may enhance diuretic effect and electrolyte loss. Grapefruit juice may increase polythiazide absorption; avoid concurrent use. |
Loading safety data…
| Lactation Rating |
| L3 (Limited Safety) |
| Teratogenic Risk | First trimester: Based on limited human data, no clear association with major congenital malformations has been established. Second and third trimesters: no known fetal risks, but use may cause maternal hypotension and reduced placental perfusion. |
| Fetal Monitoring | Monitor maternal blood pressure, renal function (serum creatinine, BUN, electrolytes), and fetal growth and well-being (ultrasound, nonstress test) during use in pregnancy. |
| Fertility Effects | Animal studies show no adverse effects on fertility; human data insufficient to determine impact. |
| Clinical Pearls | Renese (polythiazide) is a thiazide diuretic used for hypertension and edema. Monitor serum potassium and magnesium; hypokalemia increases digoxin toxicity risk. Onset of diuresis within 2 hours, peak at 6 hours, duration 24-48 hours. Use cautiously in renal impairment (CrCl <30 mL/min) as thiazides lose efficacy. Can cause hypercalcemia due to reduced calcium excretion. May increase uric acid levels; contraindicated in gout unless managed. Synergistic with loop diuretics but potentiate hypokalemia. |
| Patient Advice | Take exactly as prescribed, usually once daily in the morning to prevent nighttime urination. · Avoid prolonged sun exposure; wear sunscreen as thiazides can cause photosensitivity. · Report symptoms of electrolyte imbalance: muscle cramps, weakness, irregular heartbeat, or excessive thirst. · Maintain adequate fluid intake unless fluid restricted; avoid excessive alcohol or caffeine. · May increase blood sugar; monitor glucose if diabetic. · Do not take other potassium-depleting drugs (e.g., corticosteroids) without consulting doctor. · If you have gout, be aware of increased uric acid; report joint pain promptly. · Store at room temperature, away from moisture and heat. |