Dosing and uses of Diuril (chlorothiazide)
Adult dosage forms and strengths
oral suspension
- 250mg/5mL
powder for injection
- 500mg
tablet
- 250mg
- 500mg
Edema
0.5-1 g (10 to 20 mL) PO/IV qDay or q12hr; many patients with edema respond to intermittent therapy (ie, administration on alternate days or 3-5 days each week; reduces risk of undesirable electrolyte imbalance)
Hypertension
0.5 -1 g (10-20 mL)/day PO/IV as single or divided dose; increase or decrease dosage based on blood pressure response
Renal Impairment
CrCl <10 mL/minute: Do not use
CrCl<30 mL/minute: Ineffective
Overdose Management
May use normal saline for volume replacement
May use dopamine or norepinephrine to treat hypotension
If dysrhythmia due to decreased K+ or Mg+ suspected replace aggressively
Discontinue treatment if no symptoms after 6hr
Other Indications & Uses
Edema associated with: CHF, cirrhosis, steroids, estrogen therapy, renal dysfunction
Off-label: Calcium nephrolithiasis, osteoporosis, diabetes insipidus
Pediatric dosage forms and strengths
oral suspension
- 250mg/5mL
powder for injection
- 500mg
tablet
- 250mg
- 500mg
Edema
10 to 20 mg/kg (5-10 mg/lb) qDay or divided q12hr, not to exceed 375 mg/day
Hypertension
10 to 20 mg/kg (5-10 mg/lb) qDay or divided q12hr, not to exceed 375 mg/day
Geriatric dosage forms and strengths
Edema
0.5-1 g (10 to 20 mL) PO/IV qDay or q12hr; many patients with edema respond to intermittent therapy (ie, administration on alternate days or 3-5 days each week; reduces risk of undesirable electrolyte imbalance)
Hypertension
0.5 -1 g (10-20 mL)/day PO/IV as single or divided dose; increase or decrease dosage based on blood pressure response
Diuril (chlorothiazide) adverse (side) effects
<1%
Scaling eczema
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Disorder of hematopoietic structure
Hepatotoxicity
Systemic lupus erythematosus
Frequency not defined
Hypotension
Alopecia
Photosensitivity
Phototoxicity
Rash
Urticaria
Hyperglycemia
Hyperuricemia
Constipation
Diarrhea
Loss of appetite
Nausea and vomiting
Electrolytes abnormaL
Spasticity
Dizziness
Headache
Blurred vision
Xanthopsia
Impotence
Warnings
Contraindications
Hypersensitivity to chlorothiazide or sulfonamides
Anuria
Cautions
DM, fluid or e'lyte imbalance, hyperuricemia/gout, hypotension, SLE, post-sympathectomy, liver disease, renal disease
Avoid concurrent use with lithium
May aggravate digitalis toxicity
Sensitivity reactions may occur with or without history of allergy or asthma
Patients allergic to sulfa may show cross sensitivity
May deleteriously alter lipid/glucose metabolism
Risk of male sexual dysfunction
Pregnancy and lactation
Pregnancy category: C; D (expert analysis). Chlorothiazide may cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult. Use of diuretics for pregnancy-induced hypertension should be avoided due to risk of decreased placental perfusion.
Lactation: enters breast milk/not recommended (AAP states "compatible with nursing")
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Diuril (chlorothiazide)
Mechanism of action
Thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excrertion of Na+ and water, also K+ and H+ ions
Pharmacokinetics
Half-Life: 145-120 min
Onset: initial effect: 2 hr, max effect: 4 hr
Duration: 6-12 hr
Peak Plasma Time: IV: 30 min; PO: 4 hr
Bioavailability: Very limited
Metabolism: Does not appear to be metabolized
Excretion: Urine (96%)
Dialyzable: No
Administration
IV Incompatibilities
Additive: amikacin, chlorpromazine, hydralazine, insulin regular, levorphanol, morphine sulfate, norepinephrine bitartrate, polymyxin B sulfate, procaine, prochlorperazine, promazine, promethazine, streptomycin, triflupromazine, vancomycin
Other: multivitamins
IV Compatibilities
Solution: D5W, D10W, dextrose/saline, dextrose/LR, dextrose/Ringers, Ringers, LR, NS, ½NS, Na-lactate 1/6m
Additive: Cimetidine, lidocaine, nafcillin, ranitidine
IV Administration
Administer IV by direct injection or infusion
Do not administer IM or SC
Storage
Intact vials at 2-25°C
