Chlorothiazide sodium
Other products: Chlorothiazide
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From MedlinePlus, U.S. National Library of Medicine
Dosing in kidney impairment
CONTRAINDICATIONS Anuria. Hypersensitivity to any component of this product or to other sulfonamide-derived drugs. WARNINGS Intravenous use in infants and children has been limited and is not generally recommended. Use with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia.
Cumulative effects of the drug may develop in patients with impaired renal function. Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Thiazides may add to or potentiate the action of other antihypertensive drugs.
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Preparation and administration
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When medication can be taken orally, therapy with chlorothiazide tablets or oral suspension may be substituted for intravenous therapy, using the same dosage schedule as for the parenteral route. Chlorothiazide Sodium for Injection, USP may be given slowly by direct intravenous injection or by intravenous infusion. Extravasation must be rigidly avoided.
Directions for Reconstitution Use aseptic technique. Because Chlorothiazide Sodium for Injection, USP contains no preservative, a fresh solution should be prepared immediately prior to each administration, and the unused portion should be discarded. Add 18 mL of Sterile Water for Injection to the vial to form an isotonic solution for intravenous injection.
Never add less than 18 mL. When reconstituted with 18 mL of Sterile Water, the final concentration of Chlorothiazide Sodium for Injection, USP is 28 mg per mL. The reconstituted solution is clear and essentially free from visible particles. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use whenever solution and container permit.
The solution is compatible with dextrose or sodium chloride solutions for intravenous infusion. Avoid simultaneous administration of solutions of chlorothiazide with whole blood or its derivatives.
Drug interactions
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- Chlorothiazide sodium
Label text (3 paragraphs)
Drug Interactions When given concurrently the following drugs may interact with thiazide diuretics. Alcohol, barbiturates, or narcotics - potentiation of orthostatic hypotension may occur. Antidiabetic drugs - (oral agents and insulin) - dosage adjustment of the antidiabetic drug may be required. Other antihypertensive drugs - additive effect or potentiation. Corticosteroids, ACTH - intensified electrolyte depletion, particularly hypokalemia. Pressor amines (e.g., norepinephrine) - possible decreased response to pressor amines but not sufficient to preclude their use. Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine) - possible increased responsiveness to the muscle relaxant.
Lithium - generally should not be given with diuretics. Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity. Refer to the package insert for lithium preparations before use of such preparations with chlorothiazide sodium. Non-steroidal Anti-inflammatory Drugs - In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics.
Therefore, when chlorothiazide sodium and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.
Supplement interactions
Dietary supplement interactions
4 noted- Thiazide diuretics (e.g., Hygroton, Lozol, and Microzide) decrease urinary calcium excretion. The combination of these diuretics with vitamin D supplements (which increase intestinal calcium absorption) might lead to hypercalcemia, especially among older adults and individuals with compromised renal function or hyperparathyroidism.
- Chronic treatment with loop diuretics, such as furosemide (Lasix) and bumetanide (Bumex), and thiazide diuretics, such as hydrochlorothiazide (Aquazide H) and ethacrynic acid (Edecrin), can increase the loss of magnesium in urine and lead to magnesium depletion. In contrast, potassium-sparing diuretics, such as amiloride (Midamor) and spironolactone (Aldactone), reduce magnesium excretion.
- Thiazide diuretics, such as chlorthalidone (e.g., Hygroton, Thalitone) and hydrochlorothiazide (e.g., Esidrix, HydroDIURIL), increase zinc excretion in the urine. This increased excretion, in turn, decreases serum zinc concentrations.
- Treatment with loop diuretics, such as furosemide (Lasix) and bumetanide (Bumex), and thiazide diuretics, such as chlorothiazide (Diuril) and metolazone (Zaroxolyn), increases urinary potassium excretion and can lead to hypokalemia. Experts recommend monitoring potassium status in people taking these medications and initiating potassium supplementation if warranted.
Contraindications
Anuria. Hypersensitivity to any component of this product or to other sulfonamide-derived drugs.
Safety data
Reported adverse events (FAERS)
Liver injury (LiverTox)
LiverTox has no chapter for chlorothiazide sodium. Check the label's hepatic warnings.
Pregnancy and lactation
Pregnancy
Pregnancy Teratogenic Effects - Pregnancy Category C : Although reproduction studies performed with chlorothiazide doses of 50 mg/kg/day in rabbits, 60 mg/kg/day in rats and 500 mg/kg/day in mice revealed no external abnormalities of the fetus or impairment of growth and survival of the fetus due to chlorothiazide, such studies did not include complete examinations for visceral and skeletal abnormalities. It is not known whether chlorothiazide can cause fetal harm when administered to a pregnant woman; however, thiazides cross the placental barrier and appear in cord blood. Chlorothiazide should be used during pregnancy only if clearly needed (see INDICATIONS AND USAGE ).
Nonteratogenic Effects : Chlorothiazide may cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult.
Lactation
Nursing Mothers Because of the potential for serious adverse reactions in nursing infants from chlorothiazide sodium for injection, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Breastfeeding (LactMed)
Amounts of chlorothiazide in milk are low, but high doses might suppress lactation. Low-dose chlorothiazide appears to be acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production.
Supply and cost
Drug shortage status
Recalls (last 24 months)
Therapeutic equivalence (Orange Book)
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