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All about: Chlorthalidone

Big Image Pronouncation: (klor-THAL-ih-dohn)
Class: Thiazide diuretic

Trade Names:
Chlorthalidone
- Tablets 25 mg
- Tablets 50 mg
- Tablets 100 mg

Trade Names:
Thalitone
- Tablets 15 mg

Apo-Chlorthalidone (Canada)

Mechanism of Action

Pharmacology

Inhibits reabsorption of sodium and chloride in proximal portion of distal convoluted tubules.

Pharmacokinetics

Absorption

64% absorbed.

Distribution

Excreted in breast milk.

Elimination

The t ½ is 40 h.

Onset

2 to 3 h.

Peak

2 to 6 h.

Duration

24 to 72 h.

Indications and Usage

Reduction of edema associated with CHF, hepatic cirrhosis, renal function impairment, corticosteroid and estrogen therapy; management of hypertension.

Unlabeled Uses

Treatment of calcium nephrolithiasis, osteoporosis, diabetes insipidus.

Contraindications

Hypersensitivity to thiazides, related diuretics, or sulfonamide-derived drugs; anuria; renal decompensation.

Dosage and Administration

Edema
Adults

PO 50 to 200 mg daily or on alternate days.

Hypertension
Adults

PO 25 to 100 mg daily. Doses above 25 mg/day potentiate potassium excretion but do not benefit sodium excretion or BP reduction.

Drug Interactions

Allopurinol

Concurrent use may increase incidence of hypersensitivity reactions to allopurinol.

Amphotericin B, corticosteroids

May intensify potassium depletion.

Anticholinergics

May increase chlorthalidone absorption.

Anticoagulants

May diminish anticoagulant effects.

Bile acid sequestrants

May reduce chlorthalidone absorption. Give chlorthalidone at least 2 h before bile acid sequestrant.

Calcium salts

Hypercalcemia may develop.

Diazoxide

May cause hyperglycemia.

Digitalis glycosides

Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.

Lithium

May decrease renal excretion of lithium.

Loop diuretics

Synergistic effects may result in profound diuresis and serious electrolyte abnormalities.

Methenamines, NSAIDs

May decrease effectiveness of chlorthalidone.

Sulfonylureas, insulin

May decrease hypoglycemic effect of sulfonylureas.

Laboratory Test Interactions

Increased serum bilirubin levels. Serum magnesium levels in uremic patients may be increased.

Adverse Reactions

CNS

Dizziness; lightheadedness; vertigo; headache; paresthesias; weakness; restlessness; insomnia.

Dermatologic

Purpura; photosensitivity; rash; urticaria; necrotizing angiitis; vasculitis; cutaneous vasculitis; exfoliative dermatitis; toxic epidermal necrolysis.

EENT

Xanthopsia (yellow vision).

GI

Anorexia; gastric irritation; nausea; vomiting; abdominal pain or cramping; bloating; diarrhea; constipation; pancreatitis.

Genitourinary

Impotence; reduced libido.

Hematologic

Leukopenia; thrombocytopenia; agranulocytosis; aplastic or hypoplastic anemia.

Hepatic

Jaundice.

Metabolic

Hyperglycemia; glycosuria; hyperuricemia; fluid and electrolyte imbalances.

Miscellaneous

Muscle cramps or spasms.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Hypersensitivity

May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides also may occur.

Renal Function

May precipitate azotemia; use with caution.

Hepatic Function

Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use with caution.

Lipids

May cause increased concentrations of total serum cholesterol, total triglycerides, and LDL in some patients.

Postsympathectomy patients

Antihypertensive effects may be enhanced.

Overdosage

Symptoms

Orthostatic hypotension, dizziness, drowsiness, syncope, potassium depletion, nausea, vomiting, lethargy, coma, GI irritation, GI hypermotility, seizures.

Patient Information

  • Teach patient signs and symptoms of hypokalemia (eg, weakness, cramps, nausea, dizziness), especially if patient is taking digitalis.
  • Explain diuretic effects of drug so patient is aware of expected and potential outcomes.
  • Instruct patient to follow low-sodium diet to enhance action of medication.
  • If high-potassium diet is recommended by health care provider, help patient identify appropriate meal plans or potassium supplements.
  • Teach patient to record weight daily at a consistent time and to notify health care provider if weight fluctuates 5 or more pounds.
  • Tell patient to notify health care provider of salt or water retention occurs (eg, swelling of feet, ankles, calves).
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise patient to avoid sudden position changes to prevent orthostatic hypotension. Have patient get up slowly and dangle feet before getting out of bed.

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