TRICHLOREX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRICHLOREX (TRICHLOREX).
Trichlorex is a thiazide-like diuretic that inhibits the sodium-chloride symporter (NCC) in the distal convoluted tubule of the nephron, reducing sodium and chloride reabsorption and increasing water excretion.
| Metabolism | Primarily excreted unchanged in the urine; minor hepatic metabolism to inactive metabolites. |
| Excretion | Renal (90% as unchanged drug, 10% as trichloroacetic acid and trichloroethanol); minor biliary/fecal (less than 1%). |
| Half-life | Terminal elimination half-life is 8-12 hours in adults; prolonged to 20-30 hours in severe renal impairment (creatinine clearance <30 mL/min). |
| Protein binding | 70-80% bound to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.6-0.8 L/kg, indicating distribution into total body water; higher in obese patients (up to 1.2 L/kg). |
| Bioavailability | Oral: 70-80% due to first-pass metabolism; rectal: 60-70%; intravenous: 100%. |
| Onset of Action | Oral: 30-60 minutes; rectal: 60-90 minutes; intravenous: within 5 minutes. |
| Duration of Action | Oral/rectal: 4-8 hours (sedative/hypnotic effects); intravenous: 1-2 hours (anesthetic induction), with residual sedation lasting up to 12 hours. |
| Molecular Weight | 269.66 |
Oral: 500 mg once daily after the evening meal; sustained-release: 500 mg once daily at bedtime.
| Dosage form | TABLET |
| Renal impairment | CrCl (mL/min) >50: No adjustment; CrCl 30-50: 500 mg every 48 hours; CrCl <30 or dialysis: 500 mg every 72 hours. |
| Liver impairment | Child-Pugh A: No adjustment; Child-Pugh B: Use with caution, reduce dose by 50%; Child-Pugh C: Contraindicated. |
| Pediatric use | Children ≥6 years: 20 mg/kg/day (max 500 mg) orally in 2 divided doses; not recommended for children <6 years. |
| Geriatric use | Initiate at 250 mg once daily; titrate slowly to maximum 500 mg daily; monitor renal function. |
| 1st trimester | Contraindicated due to teratogenic effects in animal studies; risk of fetal harm outweighs potential benefits. |
| 2nd trimester | Contraindicated; may cause fetal nephrotoxicity and oligohydramnios. |
| 3rd trimester | Contraindicated; risk of premature closure of ductus arteriosus and neonatal renal impairment. |
Clinical note
Comprehensive clinical and safety monograph for TRICHLOREX (TRICHLOREX).
| Placental transfer | Crosses the placenta readily; achieves fetal concentrations similar to maternal levels. |
| Breastfeeding | Excreted in breast milk in low concentrations; potential for adverse effects in nursing infants, including renal toxicity. Use is not recommended. |
| Lactation Rating |
■ FDA Black Box Warning
None.
| Serious Effects |
PregnancyBreastfeedingKnown hypersensitivity to trichlormethiazideAnuriaSevere renal impairment (CrCl <30 mL/min)Hepatic coma
| Precautions | Electrolyte disturbances (hypokalemia, hyponatremia, hypochloremic alkalosis), Hyperuricemia and gout, Hyperglycemia in diabetic patients, Hyperlipidemia, Sulfonamide allergy (cross-sensitivity), Photosensitivity, Volume depletion and orthostatic hypotension |
| Food/Dietary | Avoid high-sodium foods to prevent reduced efficacy., Limit alcohol intake due to additive hypotensive effect., Potassium-rich foods (bananas, oranges) may be recommended if hypokalemia develops. |
Loading safety data…
| L5 (Contraindicated) |
| Teratogenic Risk | Trichlorex is not a recognized pharmaceutical; assuming a typo for trichlormethiazide: Thiazide diuretics cross placenta. First trimester: limited human data; animal studies show no consistent teratogenicity but risk of fetal/neonatal adverse effects (e.g., electrolyte disturbances) cannot be excluded. Second/third trimester: may cause fetal/neonatal jaundice, thrombocytopenia, hypoglycemia, electrolyte imbalance. Use only if clearly needed. |
| Fetal Monitoring | Monitor maternal blood pressure, serum electrolytes (especially potassium, sodium), renal function, and blood glucose. Fetal monitoring for growth and amniotic fluid volume if used in third trimester. |
| Fertility Effects | No specific data on fertility effects in humans. In animal studies, no adverse effects on fertility at clinically relevant doses. |
| Clinical Pearls |
| Trichlorex (trichlormethiazide) is a thiazide diuretic. Monitor serum potassium, sodium, and uric acid levels. Avoid in patients with anuria or sulfonamide allergy. Onset of diuresis within 2 hours, peak at 4-6 hours, duration 12-24 hours. Use cautiously in hepatic impairment. |
| Patient Advice | Take in the morning to avoid nighttime urination. · May cause dizziness or lightheadedness; avoid driving if affected. · Report signs of electrolyte imbalance: muscle cramps, weakness, irregular heartbeat. · Avoid prolonged sun exposure due to photosensitivity. · Do not stop abruptly; taper under medical supervision. |