Chlorothiazide

FDA label

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Renal Use with caution in severe renal disease — may precipitate azotemia; cumulative effects in impairment; consider withholding/discontinuing if progressive renal impairment

Hepatic Use with caution in impaired hepatic function or progressive liver disease — may precipitate hepatic coma

Instructions

• Reserve IV for patients unable to take oral medication or emergencies
• Reconstitute with >=18 mL Sterile Water for Injection (final 28 mg/mL); give slow IV push or infusion
• Avoid extravasation; do NOT give subcutaneously or intramuscularly
• IV use in infants/children not generally recommended
• Switch to oral tablets/suspension at same dosage when tolerated

Contraindications

• Anuria
• Hypersensitivity to sulfonamide-derived drugs

Cautions

• Fluid/electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia) — periodic serum electrolytes; hypokalemia may cause arrhythmias and sensitize to digitalis toxicity.
• Use with caution in severe renal disease — may precipitate azotemia; cumulative effects in renal impairment.
• Use with caution in impaired hepatic function/progressive liver disease — minor fluid/electrolyte shifts may precipitate hepatic coma.
• May add to or potentiate other antihypertensives; lithium generally should not be given with diuretics.
• Sensitivity reactions with or without allergy/asthma history; possible exacerbation or activation of systemic lupus erythematosus.
• Hyperuricemia/acute gout; hyperglycemia — latent diabetes may become manifest (antidiabetic dose adjustment may be needed).
• Hypomagnesemia; decreased calcium excretion (marked hypercalcemia may indicate hidden hyperparathyroidism — stop before parathyroid tests).
• IV use in infants and children not generally recommended.

Adverse reactions

• Electrolyte imbalance
• Orthostatic hypotension
• Pancreatitis; cholestatic jaundice
• Blood dyscrasias
• Anaphylaxis/necrotizing angiitis
• Photosensitivity
• Hyperglycemia/glycosuria
• Hyperuricemia
• Renal failure/interstitial nephritis
• Erythema multiforme (SJS)/TEN

Pregnancy Category C; thiazides cross placenta; may cause fetal/neonatal jaundice and thrombocytopenia; use only if clearly needed

Lactation Potential for serious adverse reactions in nursing infants — decide whether to discontinue nursing or drug, weighing importance of drug to mother.