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Hydrochlorothiazide, HCTZ (Microzide) Contraindications and Precautions

  • anuria
  • sulfonamide hypersensitivity
  • thiazide diuretic hypersensitivity
  • breast-feeding
  • carbonic anhydrase inhibitor hypersensitivity
  • diabetes mellitus
  • elderly
  • electrolyte imbalance
  • gout
  • hepatic disease
  • hypercalcemia
  • hyperglycemia
  • hyperuricemia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypovolemia
  • neonates
  • pancreatitis
  • preeclampsia
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • sunlight (UV) exposure
  • sympathectomy
  • systemic lupus erythematosus (SLE)

    Hydrochlorothiazide, HCTZ (Microzide) Contraindications and Precautions

    According to the prescribing information, hydrochlorothiazide is contraindicated in patients with sulfonamide hypersensitivity. Thiazide diuretics, including hydrochlorothiazide, should be used with caution in patients with sulfonamide hypersensitivity or carbonic anhydrase inhibitor hypersensitivity because of the risk of cross-sensitivity. Thiazide diuretics should always be avoided in patients with known thiazide diuretic hypersensitivity. Although furosemide and, to a lesser extent, bumetanide are chemically related to the sulfonamides and theoretically should also be used cautiously, in fact, cross-sensitivity with furosemide is an extremely rare occurrence.

    Hydrochlorothiazide-induced fluctuations in serum electrolyte concentration can occur rapidly and precipitate hepatic coma in susceptible patients. Therefore, the drug should be used with caution in patients with hepatic disease.

    Hyperglycemia, impaired glucose tolerance, and glycosuria can occur during hydrochlorothiazide therapy, and blood and/or urine glucose levels should be assessed more carefully in patients with diabetes mellitus who are receiving hydrochlorothiazide. Although hyperglycemia did occur, chlorthalidone, a related thiazide diuretic, has been shown to reduce cardiovascular disease events in elderly diabetic patients with isolated systolic hypertension. Greater sensitivity to the hypotensive and diuretic effects of hydrochlorothiazide is possible in elderly patients.

    Hydrochlorothiazide should be used cautiously in patients with renal disease such as severe renal impairment or renal failure. Drug-induced hypovolemia can precipitate azotemia in these patients. Therapy should be interrupted or discontinued if renal impairment worsens, as evidenced by an increase in concentrations of BUN or serum creatinine. With the exception of metolazone, thiazide diuretics are considered ineffective when the creatinine clearance is less than 30 ml/minute. Hydrochlorothiazide is contraindicated in patients with anuria.

    Thiazide diuretics have been reported to cause pancreatitis. They should be used with caution in patients with a history of pancreatitis.

    Caution should be used when hydrochlorothiazide is administered to patients with gout or hyperuricemia since thiazide diuretics have been reported to reduce the clearance of uric acid.

    Hydrochlorothiazide has been reported to activate or exacerbate systemic lupus erythematosus (SLE).

    Patients with pre-existing significant hyponatremia, hypokalemia, hypomagnesemia, or hypercalcemia should have their electrolyte imbalances corrected before hydrochlorothiazide is initiated. Initiation of thiazide diuretics in patients with electrolyte imbalances such as hypokalemia or hyponatremia can produce life-threatening situations such as cardiac arrhythmias, hypotension, and seizures. Elderly patients are more susceptible to dilutional hyponatremia induced by thiazide diuretics. Hydrochlorothiazide has been shown to increase the urinary excretion of magnesium and potassium. Hydrochlorothiazide can increase serum calcium concentrations by decreasing excretion of urinary calcium. Patients receiving diuretics should be monitored closely for clinical signs of fluid or electrolyte imbalance.

    Thiazide diuretics have been associated with a slight increase in serum cholesterol and triglyceride concentrations. Data from long-term studies, however, suggest diuretic-induced cholesterol changes are not clinically significant and do not contribute to coronary heart disease risk.

    Antihypertensive effects of thiazide diuretics may be enhanced in patients with a sympathectomy.

    Photosensitivity has been reported with thiazide diuretics. Patients should avoid excessive sunlight (UV) exposure and therapy should be discontinued if phototoxicity occurs.

    Hydrochlorothiazide products are classified in FDA pregnancy risk category B. Many experts reserve the use of diuretics for pregnant patients with cardiac disease or essential hypertension, due to the fact that diuretic use may decrease placental perfusion and the data do not indicate a positive benefit of diuretic use on the outcome of preeclampsia during pregnancy. The pregnancy risk factor for thiazide diuretics increases to category D for those pregnant patients with reduced uteroplacental perfusion (e.g., preeclampsia or intrauterine growth retardation (IUGR). In general, the bulk of the evidence does not indicate that thiazide diuretics are teratogenic in the 1st trimester, although, many experts limit their use to the 2nd and 3rd trimesters. Neonatal thrombocytopenia has been reported following maternal use of thiazide diuretics near term; at term, thiazide diuretics have been reported to cross the placenta. Potential risks from thiazide use include electrolyte imbalances in the newborn, pancreatitis, jaundice, or neonatal complications resulting from such maternal complications such as hyperglycemia, electrolyte imbalance, or hypotension.

    Thiazide diuretics distribute into breast milk, and it has been recommended by some manufacturers that women not nurse while receiving selected thiazide diuretics. Some thiazide diuretics have been used off-label to suppress lactation, and thus should be used with caution during the establishment of breast-feeding.In general, the use of bendroflumethiazide, chlorthalidone, chlorothiazide, and hydrochlorothiazide is considered compatible with breast-feeding by the American Academy of Pediatrics, due to lack of noted adverse effects on the nursing infant.

    Thiazides should be avoided in neonates with jaundice. Thiazide-induced hyperbilirubinemia is greater in this patient population.

    [ Last revised: 2/9/2005 3:38:00 PM ]

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