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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for RENESE (RENESE).
| Breastfeeding | Pexiganan (Renese) excretion into breast milk is unknown; M/P ratio not available. Avoid use in nursing mothers unless benefit outweighs potential risk. |
| 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 |
■ FDA Black Box Warning
None.
| Serious Effects |
["Anuria","Hypersensitivity to thiazides or sulfonamide-derived drugs"]
| 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"] |
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| 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. |