Chlorthalidone

Class
Diuretics
Subclass
Thiazide-like diuretics
Substance name
Chlorthalidone, chlortalidone
Brand names
Thalitone®, Tenoretic®, Hygroton®
Common formulations
Tablet
Contained in
Atenolol / chlorthalidone (Tenoretic®)
Azilsartan / chlorthalidone (Edarbyclor®)
Dosage and administration
Adults patients
Treatment
Hypertension
•
Start at: 25 mg PO qAM
•
Maintenance: 25-100 mg PO qAM
•
Maximum: 100 mg per day
Taken with meals
Adjunctive treatment
Corticosteroid-induced edema
•
Start at: 50-100 mg PO daily
•
Maintenance: 50-200 mg PO qAM
•
Maximum: 200 mg per day
Taken with meals
Edema in patients with congestive HF
•
Start at: 50-100 mg PO daily
•
Maintenance: 50-200 mg PO qAM
•
Maximum: 200 mg per day
Taken with meals
Edema in patients with liver cirrhosis
•
Start at: 50-100 mg PO daily
•
Maintenance: 50-200 mg PO qAM
•
Maximum: 200 mg per day
Taken with meals
Estrogen-induced edema
•
Start at: 12.5-25 mg PO daily
•
Maintenance: 25-50 mg PO qAM
•
Maximum: 200 mg per day
Taken with meals
Other off-label uses
•
Treatment of Ménière's disease
•
Treatment of hypertension
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
•
Adjunctive treatment for corticosteroid-induced edema
•
Adjunctive treatment for edema in patients with congestive HF
•
Adjunctive treatment for edema in patients with liver cirrhosis
•
Adjunctive treatment for estrogen-induced edema
Off-label indications
Adults
•
Treatment of Ménière's disease
Children
•
Treatment of hypertension
Safety risks
Contraindications
Hypersensitivity to chlorthalidone or its components or thiazide diuretics or other sulfonamides
Anuria
Warnings and precautions
Electrolyte and metabolic abnormalities
•
Maintain a high level of suspicion, as chlorthalidone can cause hyperglycemia, hyperlipidemia, hyponatremia, hypomagnesemia, hypercalcemia, and hyperuricemia, potentially precipitating a gout attack in susceptible patients. Monitor serum electrolytes periodically.
Hyperglycemia
•
Use caution in patients with diabetes or prediabetes.
Hypotension
•
Use extreme caution in patients with impaired sympathetic response or volume or salt depletion.
Reactivation of SLE
•
Use caution in patients with SLE.
Renal failure
•
Use caution in patients with CKD, HF, or volume depletion. Monitor renal function periodically. Consider discontinuing treatment if a clinically significant decrease in renal function occurs.
Specific populations
Renal impairment
CrCl > 10 mL/min
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for electrolyte disturbances.
CrCl 10-30 mL/min
•
Use with caution.
CrCl < 10 mL/min
•
Do not use.
Renal replacement therapy
Any modality
•
Do not use.
Hepatic impairment
Acute or decompensated chronic liver disease
•
Use with caution.
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Do not use. Evidence of fetal harm in humans.
Breastfeeding
Halt breastfeeding temporarily.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
Acute pancreatitis, agranulocytosis, aplastic anemia, color vision impairment, ↓ WBC count, ↓ platelet count, ↓ blood neutrophil count, ↓ serum chloride, ↓ serum magnesium, ↓ serum potassium, ↑ serum uric acid, ↓ serum sodium, erythroderma, gout, hemolytic anemia, hypotension, hypovolemia, ↑ blood glucose, ↑ serum TBIL, ↑ serum calcium, ↑ serum cholesterol, ↑ serum triglycerides, ↑ serum urea nitrogen-to-creatinine ratio, ↑ serum uric acid, jaundice, metabolic alkalosis, orthostatic hypotension, pancytopenia, photosensitivity of skin, renal failure, constipation, ↓ libido, diarrhea, dizziness, erectile dysfunction, headache, loss of appetite, muscle spasms, nausea, palpitations, paresthesia, polyuria, restlessness, skin rash, syncope, vertigo, vomiting, Stevens-Johnson syndrome, vasculitis, ventricular arrhythmias, toxic epidermal necrolysis
Interactions
Drug(s)
Check Interactions
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